SY7-3 - Treatment strategy for prostate cancer patients with bone metastases

Abstract

Bone metastasis leads to bone-related events (SRE) such as pain as well as functional impairment due to fractures, and thus loss of autonomy, leading to a decrease in QOL and ADL. Among urological cancers, prostate cancer has a high frequency of bone metastasis and, coupled with a decrease in bone mineral density by androgen ablation therapy (ADT), is also an important cancer of management against <bone health>. In the current situation that several novel drugs for castration-resistant prostate cancer (CRPC) have appeared, the necessity and importance of bone management (for osteoporosis and SRE) of prostate cancer is increasing. Prostate cancer develops bone metastases in many cases as its progression. There are also many cases that exhibit only bone metastasis, and such a condition is called “bone-dominant disease” and it is indicated by Radium-223. Bone metastasis of prostate cancer is characterized by osteoblastic bone metastasis (sometimes mixed or osteolytic). There is also a very excellent blood marker called PSA in monitoring the progression of cancer. For monitoring of patients with bone metastasis, monitoring with ALP, NTx, LDH together with the PSA is important. With the advent of novel life-prolonging drugs (abiraterone/enzalutamide/Cabazitaxel), improvement of the treatment outcome of CRPC has been recognized and long-term survival is becoming possible. Bone treatment strategies such as bone modifying agents (BMA: i.e., bisphosphonate and denosumab) and Radium-223 have been developed and remarkably advanced for the treatment of bone metastasis in addition to conventional analgesics, palliative radiotherapy. In particular, BMA has been shown to be able to suppress the occurrence of SRE and it is widely used in daily practice. Early intervention to bone microenvironment may prevent visceral metastasis, which is the terminal image of prostate cancer.