Bone and calcium metabolism associated with malignancy. Bone metastasis of prostate cancer:overview of clinical features and treatments.

Abstract

Bones are the most frequent sites in patients with progressive prostate cancer. Spinal column and pelvic bone are vulnerable for metastasis, and osteoblastic lesions are frequently observed. Imaging evaluation is performed using bone scintigrapy with 99mTc, CT or MRI. Extent of disease is categorized as EOD score, and it is still used for evaluation of bone metastasis in clinical trials. Clinical guidelines recommend the uses of bone modifying agents including zoledronic acid and denosumab for bone metastasis in patients with castration-resistant prostate cancer. New androgen targeted agents, enzalutamide and abiraterone, or taxans, docetaxel and cabazitaxel, show clinical efficacy for bone metastasis of prostate cancer. Recently, metastasis free survival(MFS)has been approved as a primary endpoint for nonmetastatic castration-resistant prostate cancer. For this category, enzalutamide and apalutamide have been approved for patients with nonmetastatic castration-resistant prostate cancer. Treatment and follow-up strategy is now dramatically changed in the area of bone metastasis of prostate cancer.