Abstract
Approximately 85% of patients who die from prostate cancer have bone metastases. Even though the radiological aspect of such metastases is osteoblastic, we currently know that these lesions are mixed, with coexisting blastic and lytic lesions, always beginning with bone lysis by osteoclast proliferation. Treatment options are palliative and have poor response, and when there is an improvement it is usually short-lived. This work intends to study the effect of clodronate in the treatment of skeletal complications of prostate cancer. In an open prospective study 32 patients with hormone refractory prostate cancer with metastases to bones were assessed, in the period between November 2000 and September 2002. Mean age was 69 years (51 to 83 years). Patients were previously assessed by a pain scale and Karnofsky index. They underwent bone scintigraphy, X-ray, dosage of prostate specific antigen (PSA) and biochemical tests before and following treatment (administration of intravenous clodronate every 28 days). The Student's t-test was used for statistical analysis. Twenty-nine patients (90.6%) showed improvement after the first and the 2nd cycles, which persisted for at least 4 months. Average on the pain scale improved from 7.7 to 2.1 and Karnofsky index raised from 42 to 71. Radiological aspect of the metastases improved in 15 patients (46.8%) and side effects were low (only 2 patients - 6.2%). Bisphosphonate was effective in the treatment of skeletal complications of prostate cancer, presenting an objective response in 90.6% of treated patients, with a marked improvement in the pain scale, Karnofsky index and consequently in the quality of life of patients, and with low side effects.
Highlights
85% of patients who die from prostate cancer have bone metastases
Radiological aspect of the metastases improved in 15 patients (46.8%) and side effects were low
Bisphosphonate was effective in the treatment of skeletal complications of prostate cancer, presenting an objective response in 90.6% of treated patients, with a marked improvement in the pain scale, Karnofsky index and in the quality of life of patients, and with low side effects
Summary
85% of patients who die from prostate cancer have bone metastases. Even though the radiological aspect of such metastases is osteoblastic, we currently know that these lesions are mixed, with coexisting blastic and lytic lesions, always beginning with bone lysis by osteoclast proliferation. Considering that about 30% of patients who receive treatment for localized prostate cancer presented a relapse, the number of patients with advanced disease is high. Most of such patients who are under hormone treatment become resistant to the hormone between 18 and 36 months after the therapy initiation and 85% to 95% of these patients will present bone metastases and their complications (such as pain, fractures and plegias) [1,2,3]. The patient who presents already bone metastases has an average survival of 2 years, which is a very long time, considering that he will suffer with skeletal complications [2,3,4]
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