Abstract
Nine out of ten metastatic prostate cancer (PCa) patients will develop osseous metastases. Of these, every second will suffer from skeletal-related events (SRE). SRE are associated with an increased risk for death, which is markedly increased in the presence of pathological fracture. Moreover, health insurance costs nearly double in the presence of SRE. Zoledronic acid and denosumab are both approved drugs for the prevention or delay of SRE in castration-resistant prostate cancer (CRPC) patients with osseous metastases. However, long-term treatment with one of these two drugs is associated with the development of medication-related osteonecrosis of the jaw (MRONJ). Routine inspections of the oral cavity before and during treatment are mandatory in these patients. Regarding imaging techniques, bone scintigraphy seems to be a promising tool to detect early stage MRONJ. Zoledronic acid does not reduce the incidence of SRE in hormone-sensitive PCa. First data shows 3-monthly application of zoledronic acid to be equi-effective to monthly application.
Highlights
Prostate cancer (PCa) is the most frequently diagnosed cancer in men and the second leading cause of cancer death in Western countries
While medication-related osteonecrosis of the jaw (MRONJ) incidence was 1.0% in metastatic castration-resistant prostate cancer (mCRPC) patients receiving zoledronic acid for a median of 11.2 months, we previously reported an incidence of 18.6% in patients receiving zoledronic acid at least 14 times [15,17]
In another study with the primary objective of delaying the development of osseous metastases in prostate cancer (PCa)-patients, MRONJ-incidence increased to 5% when receiving denosumab for at least
Summary
Prostate cancer (PCa) is the most frequently diagnosed cancer in men and the second leading cause of cancer death in Western countries. We report about the incidence of SRE in prostate cancer (PCa) patients with osseous metastases, and its economic burden. We critically discuss the indication and application form of zoledronic acid and denosumab in PCa patients and search the current literature for further treatment approaches in the presence of medication-related osteonecrosis of the jaw (MRONJ). 2. Skeletal-Related Events in Metastatic Prostate Cancer: A Frequent Phenomenon and Economic Burden. Up to 90% of patients will develop osseous metastases [7,8,9,10]. While in the US, costs increase by $12,780/person-year in the case of bone metastases, this amount nearly doubles in the presence of SRE [11]
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