Skeletal Complications in Men with Prostate Cancer: Effects on Quality-of-Life Outcomes throughout the Continuum of Care

Abstract

Objective: Men with prostate cancer survive for many years after diagnosis and are at risk for clinically important skeletal complications throughout the course of their disease. This review discusses the effect of skeletal complications on quality of life and treatment options available to maintain bone health throughout the continuum of care for prostate cancer. Methods: Published studies were identified through MEDLINE searches, reviewing bibliographies of relevant articles, and reviewing abstracts from scientific meetings. Results: At the time of diagnosis, many men with prostate cancer are osteopenic or osteoporotic. Subsequent androgen ablation therapy increases bone loss and the risk of fracture. The development of bone metastases further increases the risk of skeletal complications, including pathologic fractures and bone pain requiring radiation therapy. Skeletal complications result in significant morbidity and reductions in the quality of life and survival of these patients. Pathologic fractures and radiation to bone (for palliation of pain) are associated with significant declines in physical functioning and emotional well-being. Fractures can also significantly reduce overall survival. Conclusions: Skeletal complications arising from bone metastases and bone loss can adversely affect quality of life. Therefore, bisphosphonates, which maintain bone health and reduce skeletal complications in men with prostate cancer, should improve the quality of life in these patients. Zoledronic acid is effective in preventing skeletal-related events in men with advanced prostate cancer.