Complication Of Prostate Cancer Research Articles

SpaceOAR hydrogel complications in prostate cancer.

SpaceOAR hydrogel, a novel biodegradable spacer, is increasingly used in managing prostate cancer patients undergoing radiation therapy to minimize rectal radiation dose and associated complications. However, its use has raised new concerns regarding its potential complications and impact on subsequent imaging interpretation. This article provides a pictorial review of the imaging complications of using SpaceOAR hydrogel in prostate cancer patients. We present multiple examples demonstrating the types of complications that can occur, potential underlying mechanisms, and their impact on patient outcomes and imaging interpretation. This review aims to provide radiologists and oncologists with an updated understanding of these complications, guiding better patient management and interpretation of imaging studies.

Assessment of Male Medical Students' Knowledge and Attitudes About Prostate Cancer and Screening at the University of Khartoum

Background: Prostate cancer (PC) is the most common cancer among men in Sudan. It was ranked fourth among all cancer treatment centers in Khartoum. This study aimed to assess knowledge and attitude toward PC among male medical students in their final and semifinal years at the University of Khartoum. Methods and Results: A descriptive cross-sectional online survey was conducted at the University of Khartoum (Faculty of Medicine) on semifinal and final-year male medical students from March 2022 until May 2022. Data were collected from medical students, using a standardized, pretested, coded questionnaire that contained close-ended questions. The questionnaire was distributed online to the medical students using Google Forms. Knowledge levels were determined using 10 questions on risk factors, signs and symptoms, prevention, treatment, and complications of PC. A total of 131 participants received questionnaires, and the response rate was 100%. The results are presented in chronological order in the way they were analyzed, starting with sociodemographic characteristics of the participants, sources of information on PC, knowledge levels (low, medium, and high) of PC, and attitude levels (positive, negative) relating to the year of study. All medical students in the last 2 years have heard about PC, and medical students overwhelmingly (88.5%) believe that early detection of PC through screening improves survival. Almost all the respondents in our study indicated their willingness to go for PC screening (87.8%), and the rest of the respondents’ attitudes about the importance of PC and treatment were positive. Conclusion: Most students have sufficient knowledge about prostate cancer, its risk factors, complications, and treatment. Medical students are an important population in studying the determinants of screening for prostate cancer.

Osteoblasts Generate Testosterone From DHEA and Activate Androgen Signaling in Prostate Cancer Cells.

Bone metastasis is a complication of prostate cancer in up to 90% of men afflicted with advanced disease. Therapies that reduce androgen exposure remain at the forefront of treatment. However, most prostate cancers transition to a state whereby reducing testicular androgen action becomes ineffective. A common mechanism of this transition is intratumoral production of testosterone (T) using the adrenal androgen precursor dehydroepiandrosterone (DHEA) through enzymatic conversion by 3β- and 17β-hydroxysteroid dehydrogenases (3βHSD and 17βHSD). Given the ability of prostate cancer to form blastic metastases in bone, we hypothesized that osteoblasts might be a source of androgen synthesis. RNA expression analyses of murine osteoblasts and human bone confirmed that at least one 3βHSD and 17βHSD enzyme isoform was expressed, suggesting that osteoblasts are capable of generating androgens from adrenal DHEA. Murine osteoblasts were treated with 100 nM and 1 μM DHEA or vehicle control. Conditioned media from these osteoblasts were assayed for intermediate and active androgens by liquid chromatography-tandem mass spectrometry. As DHEA was consumed, the androgen intermediates androstenediol and androstenedione were generated and subsequently converted to T. Conditioned media of DHEA-treated osteoblasts increased androgen receptor (AR) signaling, prostate-specific antigen (PSA) production, and cell numbers of the androgen-sensitive prostate cancer cell lines C4-2B and LNCaP. DHEA did not induce AR signaling in osteoblasts despite AR expression in this cell type. We describe an unreported function of osteoblasts as a source of T that is especially relevant during androgen-responsive metastatic prostate cancer invasion into bone. © 2021 American Society for Bone and Mineral Research (ASBMR). This article has been contributed to by US Government employees and their work is in the public domain in the USA.

Comprehensive Evaluation of Focal Therapy Complications in Prostate Cancer: A Standardized Methodology.

Purpose: Today, up to one-third of newly diagnosed prostate cancer (PCa) cases may be suitable for focal treatment. The lack of data about the toxicity profiles of lesion-targeting therapies, however, has made it difficult to compare treatment modalities. The aim of the present study was to evaluate comprehensively the incidence, severity, and timing of onset of complications for PCa patients undergoing focal high-intensity focused ultrasound (HIFU) and focal cryosurgical ablation of the prostate (CSAP). Materials and Methods: A total of 336 patients were included who underwent focal HIFU or focal CSAP as a primary treatment for PCa between January 2009 and December 2017. Mean follow-up was 11 months (standard deviation: 3.0). All complications were captured and graded according to severity, and classified by timing of onset. Univariate and multivariate analysis was performed to identify predictors of the most common side effects. Results: There were 98 complications in 79/210 patients (38%) undergoing focal HIFU and 34 complications in 27/126 patients (21%) undergoing focal CSAP. In terms of severity, 95% of the complications of focal HIFU and 91% of the complications of focal CSAP were minor. Most complications presented in the early postoperative period. On multivariate analysis, subtotal HIFU was associated with acute urinary retention (AUR), while a smaller prostate size and longer catheterization time with dysuria. In CSAP patients, longer catheterization time was associated with AUR and urethral sloughing. The main limitation is the nonrandomized and retrospective nature. Conclusions: Focal HIFU and focal CSAP provide a tolerable toxicity, with primarily minor complications presenting in the early postoperative period.

Timing of Androgen Deprivation Therapy for Prostate Cancer Patients after Radiation: Planned Combined Analysis of Two Randomized Phase 3 Trials

The TOAD (TROG 03.06; NCT00110162) phase 3 randomized trial showed that immediate androgen deprivation therapy (IADT) improved overall survival (OS) and time to clinical progression compared with delayed ADT (DADT) in progressive or relapsed prostate cancer patients after radical radiation therapy (RT) or prostatectomy + RT. ELAAT (NCT00439751) was a similarly designed trial but failed to reach its accrual goal. The two investigative teams planned a combined analysis before ELAAT was activated. This combined analysis seeks to determine if IADT improves a number of clinical outcomes including overall survival. The PSA failures from TOAD and 78/79 patients accrued to ELAAT were combined (1 patient was excluded due to castrate resistant prostate cancer (CRPC)). Participants for both trials were randomized 1:1 to IADT or DADT. The primary endpoint was all-cause mortality by intention-to-treat. Secondary endpoints were cancer-specific mortality (CSM), local progression, distant progression, CRPC, and prostate cancer complications (PCC). A total of 261 patients from TOAD and 78 patients from ELAAT were followed a median of 5.0y. TOAD patients were younger (mean age 70.5 vs 73.8y) and more had a relapse-free interval <2y from RT (30% vs 10%). In the DADT arms, 63% received ADT a median of 1.58y for TOAD; 38% received ADT a median 1.65y for ELAAT. For patients receiving ADT, the mean pre-ADT PSAs were 3.52 and 30.2 ng/ml in the IADT and DADT arms of TOAD and 3.98 and 18.1 ng/ml in ELAAT. There were 60 deaths, 40 and 20 respectively. Overall, for IADT and DADT arms the proportions of deaths in each trial were 15%, 11%, 19% and 26%, 27% and 24%. All-cause mortality (HR 0.75, 95% CI 0.40, 1.41; p = 0.37) and CSM (HR 0.57, 95% CI 0.22, 1.49) were not statistically different between IADT and DADT. Time to local progression (survival time ratio 1.97, 95% CI 1.28, 3.04; p=0.002) and distant progression (survival time ratio 1.28, 95% CI 1.04, 1.58; p=0.02) was higher while PCC (3.7 v 7.5%, p=0.06) was lower with IADT. CRPC outcomes will be presented at conference. No difference in OS was detected between IADT and DADT in the combined analysis. A possible explanation is that ELAAT accrued older patients with lower risk of CSM and had a smaller difference in PSA between the IADT and DADT arms. Not all relapsed men need IADT; many will die without ever needing ADT and never have a complication or develop CRPC. Further work is needed to identify patients who will benefit from IADT and those suitable for DADT.

Risk of diabetes complications among those with diabetes receiving androgen deprivation therapy for localized prostate cancer.

Androgen deprivation therapy (ADT), used increasingly in the treatment of localized prostate cancer, is associated with substantial long-term adverse consequences, including incident diabetes. While previous studies have suggested that ADT negatively influences glycemic control in existing diabetes, its association with diabetes complications has not been investigated. In this study, we examined the association between ADT use and diabetes complications in prostate cancer patients. A retrospective cohort study was conducted among men with newly diagnosed localized prostate cancer between 1995 and 2008, enrolled in three integrated health care systems. Men had radical prostatectomy or radiotherapy (curative intent therapy), existing type II diabetes mellitus (T2DM), and were followed through December 2010 (n = 5,336). Cox proportional hazards models were used to examine associations between ADT use and diabetes complications (any complication), and individual complications (diabetic neuropathy, diabetic retinopathy, diabetic amputation or diabetic cataract) after prostate cancer diagnosis. ADT use was associated with an increased risk of any diabetes complication after prostate cancer diagnosis (adjusted hazard ratio, AHR, 1.12, 95% CI 1.03-1.23) as well as an increased risk of each individual complication compared to non-use. ADT use in men with T2DM, who received curative intent therapy for prostate cancer, was associated with an increased risk of diabetes complications. These findings support those of previous studies, which showed that ADT worsened diabetes control. Additional, larger studies are required to confirm these findings and to potentially inform the development of a risk-benefit assessment for men with existing T2DM, before initiating ADT.

Disseminated intravascular coagulation secondary to advanced prostate cancer: Clinical characteristics, management, and prognosis.

355 Background: Although disseminated intravascular coagulation (DIC) is a recognized complication of prostate cancer, little is known about the clinical features and optimal management of these patients. Although anecdotal case studies indicating that the prognosis of prostate cancer associated with DIC might improve with chemotherapy, the clinical data from single case report are far from sufficient for establishment of a standardized treatment strategy. The main objective of this study was to determine the clinical features, treatment and prognosis clinical outcome of patients with prostate cancer complicated by DIC. Methods: We conducted a pooled analysis of 85 prostate cancer patients diagnosed with DIC, two treated in our institution and 83 patients from published literature between January 1976 and June 2017. Results: Eighty-five patients were included in final analysis. The median age was 68 years (range, 44 to 92 years). The majority of patients (98%) has adenocarcinoma. Two (2%) patients with small cell carcinoma. The median of PSA was 614 ng/ml (range: 0.8 – 8138). A Gleason score of 8 or higher was found in 67% of patients. Distant metastasis was reported in 98% of patients. At diagnosis of DIC, the median platelet count was 75 *109 /L (range: 3-205). Regarding the presenting symptoms of DIC, subcutaneous bleeding was reported in 64% of cases; hematuria in 27%. Invasive procedure including prostate biopsy might have been the provoking events of DIC in 25% of the cases. Seventy-one patients received cancer directed therapy including various androgen deprivation, chemotherapy, and novel androgen signaling inhibitor, whereas 13 patients received only best supportive care (BSC). The median overall survival (OS) of the entire cohort of patients was 10 months (95% confidence interval [CI], 5.3-14.7). Significantly prolonged OS was observed in the cancer therapy group, with a median survival of 12 months compared to 2 weeks in the BSC group (p &lt; 0.001, log-rank test). Conclusions: Our analysis showed that patients with prostate cancer complicated by DIC had very poor prognosis, and active cancer therapy might improve OS of these patients.

Comparison of Surgery and Radiation as Local Treatments in the Risk of Locoregional Complications in Men Subsequently Dying From Prostate Cancer.

Late locoregional complications in prostate cancer (PCa) affect quality of life and require medical interventions. Our objective was to compare late locoregional complications in men dying of castration-resistant PCa (CRPC) who previously received external-beam radiotherapy (EBRT) to radical prostatectomy (RP). No group without previous primary local treatment was included. The cohort consists of CRPC patients who died between 2001 and 2013 and who underwent previous EBRT or RP. The Régie de l'assurance maladie du Québec administrative databases were used to identify late locoregional complications (urologic procedures, minor rectal procedures, and other major surgical procedures) and PCa-related hospitalizations occurring in the last 2 years of life. Multivariable logistic regression and negative binomial regression analyses were performed. The cohort comprised 1189 patients; 535 (45%) and 654 (55%) received EBRT and RP, respectively. Overall, 46.4% of patients experienced at least 1 late locoregional complication. Primary local treatment type was not associated with the odds of late locoregional complications (odds ratio [OR], 0.91; 95% confidence interval [CI], 0.72, 1.16). RP was associated with greater odds of PCa-related hospitalization (OR, 1.63; 95% CI, 1.23, 2.17) relative to EBRT, as were the usage of a CRPC treatment (OR, 3.96; 95% CI, 2.83, 5.53) and the occurrence of a late locoregional complication (OR, 2.76; 95% CI, 2.05, 3.69). For the number of PCa-related hospitalization days, RP was not found to be significant (rate ratio, 1.09; 95% CI, 0.90, 1.32). In this population-based cohort, the risk of late locoregional complications in CRPC was not associated with the type of primary local treatment (RP or EBRT).

Abstract 694: Axon guidance neuropilin and plexin A2 genes are involved in ERG-associated prostate cancer

Abstract Background: Bone metastases are frequent and severe complications of prostate cancer (PCa), the most common malignancy that affects men in Western countries. Recurrent gene fusions, involving the ERG gene and the androgen-regulated promoter of the TMPRSS2 gene, occur in over 50% of PCa. The abnormal over-expression of the ERG transcription factor disturbs prostate cell transcriptome. We previously identified a series of genes directly and positively regulated by the ERG-fusion in vitro and in vivo. Among them can be found Plexin A2 (PLXNA2), which is a semaphorin receptor family member involved in axon guidance and in many pathophysiological processes, including cancer and bone disorders. We showed that PLXNA2 is involved in TMPRSS2:ERG-mediated enhancements of PC3c cell migration and invasion. These results prompted us to look for genes functionally related to PLXNA2 and involved in ERG-associated PCa. Methods: Using a PCa cell line (PC3c) stably over-expressing the TMPRSS2:ERG fusion, we first used Ingenuity Pathway Analysis® in silico studies to analyze transcriptomic results and identify axon guidance genes associated with ERG-fusion expression in PCa. Their expression was validated in stable clones by RT-PCR and Immunofluorescence. Secondly, using RNAs of a human PCa sample cohort, we performed qRT-PCR to detect and correlate candidate genes to fusion expression. Finally, to validate the relevance of the identified genes, using immunohistochemistry experiments, we studied the expression of these genes in tissue samples, including primary tumors and lymph nodes or bone metastases. Results: Using transcriptomic analyzes and expression validation, we identified neuropilin (NRP1 and NRP2) genes, plexin and semaphorin genes deregulated by the ERG fusion expression in stable clones. In human samples, PLXNA2, NRP1 and NRP2 expression were strongly associated to PCa, and particularly to metastastic PCa. We established a significant correlation between both PLXNA2 and NRP1 gene expression and the presence of TMPRSS2-ERG fusion. At protein level, NRP1 and NRP2 were highly detected in human lymph nodes and bone metastasis samples. Since neuropilin proteins are known to interact with plexin to act as coreceptors for semaphorin ligands, protein colocalization in stable clones suggested a functional association of PLXNA2 and NRPs in tumor cells. Conclusion: Taken together, our results reveal that TMPRSS2-ERG fusion gene expression is able to deregulate axon guidance genes such as NRP1 and PLXNA2 in PCa. Therefore, since the interaction between plexins and their NRP1 and 2 coreceptors often determines the functional specificity of their semaphorin ligand effects, we hypothesize that the ERG fusion expression imbalances the plexin/neuropilin/semaphorin signaling to contribute to PCa progression. These results reinforce the recent interest in targeting neuropilins for cancer therapy. Citation Format: Anthony Turpin, Carine Delliaux, Tian Tian, Nathalie Vanpouille, Anne Flourens, Rachel Deplus, Xavier Leroy, Yvan de Launoit, Martine Duterque-Coquillaud. Axon guidance neuropilin and plexin A2 genes are involved in ERG-associated prostate cancer. [abstract]. In: Proceedings of the 107th Annual Meeting of the American Association for Cancer Research; 2016 Apr 16-20; New Orleans, LA. Philadelphia (PA): AACR; Cancer Res 2016;76(14 Suppl):Abstract nr 694.

Bicalutamide causes heart failure in an elderly patient with prostate cancer

ABSTRACTObjective: To examine the molecular mechanisms by which bicalutamide may cause heart failure in an elderly patient.Methods: Retrospective analysis of bicalutamide as a cause of heart failure in Mr FD, an 82 years old with prostate cancer.Results: Following months of therapy, Mr FD was diagnosed with heart failure. Bicalutamide has been ceased, but 21 months later, Mr FD was still on heart failure medications, and passed away months later probably due to complications of prostate cancer. The Naranjo ADR probability scale gave this case a score of seven.Conclusion: The Naranjo scale strongly suggests that bicalutamide was the cause of heart failure. Apoptosis seems to be one of the mechanisms mediating heart failure, with the involvement of many molecular actors, such as ET-1, Bcl-2 and cyclin-A. The author believes this to be the first analysis describing bicalutamide as a probable cause of heart failure.

Pelvic lymph node dissection in prostate cancer: indications, extent and tailored approaches.

The purpose of this study is to review the current literature concerning the indication of pelvic lymph node dissection (PLND), its extent and complications in prostate cancer (PCa) staging, the available tools, and the future perspectives to assess the risk of lymph node invasion (LNI). A literature review was performed using the Medline, Embase, and Web of Science databases. The search strategy included the terms pelvic lymph nodes, PLND, radical prostatectomy, prostate cancer, lymph node invasion, biochemical recurrence, staging, sentinel lymph node dissection, imaging, and molecular markers. PLND currently represents the gold standard for nodal staging in PCa patients. Available imaging techniques are characterized by poor accuracy in the prediction of LNI before surgery. On the contrary, an extended PLND (ePLND) would result into proper staging in the majority of the cases. Several models based on preoperative disease characteristics are available to assess the risk of LNI. Although ePLND is not associated with a substantial risk of severe complications, up to 10% of the men undergoing this procedure experience lymphoceles. Concerns over potential morbidity of ePLND led many authors to investigate the role of sentinel lymph node dissection in order to prevent unnecessary ePLND. Finally, the incorporation of novel biomarkers in currently available tools would improve our ability to identify men who should receive an ePLND. Nowadays, the most informative tools predicting LNI in PCa patients consist in preoperative clinical nomograms. Sentinel lymph node dissection still remains experimental and novel biomarkers are needed to identify patients at a higher risk of LNI.

Preventive Effects of Aspirin on Cardiovascular Complications in Prostate Cancer Cases after Endocrinotherapy.

To explore the preventive effect of aspirin on the cardiovascular complications in prostate cancer after endocrinotherapy. A total of 92 patients with prostate cancer were divided into observation group (n=44) and control group (n=48). The control group was treated with medical castration plus anti-androgenic drugs. Based on the above treatment, the observation group was added aspirin. The follow-up duration was 2 years. The changes of partial prothrombin time (PT), activated partial thromboplastin time (APTT), platelet aggregation rate (PAG), prostate-specific antigen (PSA) and serum testosterone (T) before and after treatment as well as incidence of cardiovascular disease were observed. The 2-year survival rates of patients without cardiovascular disease in observation group and control group were 95.45% (42/44) and 72.92% (35/48), respectively, and significant difference was presented between two groups by comparison to the survival rates (χ2=8.5453, p=0.0035). There was no statistical significance between two groups as well as before and after treatment regarding PT (p>0.05). After treatment, APTT went down and PAG was gradually on the rise in control group, while PAG down and APTT on the rise increasingly in observation group. Significant differences were presented between two groups as well as before and after treatment (p<0.01). Both PSA and T levels were decreased significantly in two groups after treatment (p<0.01), but there was no statistical significant between two groups (p>0.05). Application of endocrinotherapy in prostate cancer can easily lead to occurrence of cardiovascular disease, but cardiovascular complications can be prevented by aspirin, without affecting the effect of endocrinotherapy.

Metastatic compressive lower motor neurone hypoglossal nerve palsy: A rare complication of prostate cancer

Metastatic compressive lower motor neurone hypoglossal nerve palsy: A rare complication of prostate cancer

Preventing bone complications in prostate cancer

Bone metastases alone or in combination with androgen deprivation therapy-related bone loss places prostate cancer patients at greater risk for skeletal morbidities, including pain, pathologic fracture and spinal cord compression. These events significantly impair the patient's quality of life and place a significant burden on health-care resources. This review focuses on the management options for reducing skeletal morbidity in patients with prostate cancer, including life-style modifications, food supplementation, osteoclast-targeted therapy and selective estrogen-receptor modulators. The use of osteoclast-targeted therapy (denosumab and zoledronic acid) is supported by the strongest evidence and has been US Food and Drug Administration-approved for the treatment of patients with PCa at high risk of osteoporotic fractures and for the reduction of the risk of skeletal-related events in patients with castration-resistant prostate cancer. Ongoing trials are studying the potential role of osteoclast-targeted therapy in other settings throughout the course of the disease.

Abstract 2690: Evaluation of the hemostatic status in patients with prostate cancer using thromboelastography and tissue factor- microparticles

Abstract Coagulopathy is reported as the second most common cause of death from cancers, particularly prostate cancer. DVT and pulmonary embolism are two major thrombotic complications in prostate cancer and the risk is even higher with chemotherapy and hormonal therapy. Thromboelastography (TEG) is a global hemeostatic test that detects and specifies the type of coagulopathy encountered through a vesicoelastic trace that reflects the kinetics of the clot from the initial fibrin thread till and fibrinolysis. We performed a hemostatic study in 27 patients (age range 59-88 years) diagnosed with prostate cancer at various stages (metastatic and non-metastatic) as compared to a control group (n=9) matching the same age range and with -ve pathology for prostate cancer. The study included whole blood TEG and flow cytometry analysis of microprticles (MPs) in plasma using Annexin V- FITC and anti-tissue factor - PE. Analysis of the data revealed hypercoagulable state in all patients except two who were maintained on coumadin as prophylaxis for previous DVT. Hypercoagulability was indicated by shorter R time, increased alpha angle, MA and clot index. The mean values for TEG parameters in the patients were: R: 6.01 vs 9.8 minutes in the control group, alpha angle: 68.3 vs 53.1 degrees in controls, MA: 69.3 vs 57.9 mm in controls, and CI: 3.32 vs 0.7 in controls. Paired student t test showed significant differences as regards R time (P=0.009), MA (p=0.053) and CI (P=0.051). Microparticle assay revealed significant elevation in the number of microparticles carrying tissue factor in the patient group compared to the control group (p=0.05). The mean plasma TF-MPs in patient group was 5,142 MPs/uL compared to 2,914 MPs/ uL in the control group suggesting a link between elevated tissue factor and hypercoagulability observed in these patients. To our knowledge, this is the first report for the use of TEG in patients with prostate cancer. TEG is a relatively simple test that uses a small volume of blood and can be a useful tool for evaluation of patients’ thrombotic potential and may help identification of those who may require anticoagulant prophylaxis. Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 103rd Annual Meeting of the American Association for Cancer Research; 2012 Mar 31-Apr 4; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2012;72(8 Suppl):Abstract nr 2690. doi:1538-7445.AM2012-2690

Management of Anaemia in Prostate Cancer

ABSTRACTAnaemia is a frequent complication of prostate cancer and of its treatments. In Europe prostate cancer accounts for the 10.8% of all malignant neoplasms. Iatrogenic hypogonadism and age-related physiologic changes along with nutritional deficits contribute to increase prevalence of prostate cancer related anaemia. The reason of the present review is to provide clinicians with all aspects of a frequent and multifactorial co-morbidity, whose effects are often underestimated. Erythropoiesis pathology and causes of anaemia in prostate cancer are reviewed. Critical issues of clinical management of anaemia in prostate cancer are discussed.

Bone metabolism and new targets for intervention

Bone metastasis is a common complication of prostate cancer and is associated with significant morbidity for patients. Bone metabolism and prostate cancer metastasis to bone are complex processes. The interactions between host cells and metastatic prostate cancer cells are important components of organ-specific cancer progression. In addition to traditional treatment approaches, targeted therapy is currently becoming more popular. Bone metabolism, metastatic processes of prostate cancer, and the targeting of treatment for advanced disease are discussed here.

Multidisciplinary management of bone complications in prostate cancer and optimizing outcomes of bisphosphonate therapy

Prostate cancer is the second most common cancer diagnosed in men worldwide and, although advances in treatment options have extended the overall survival of these patients, bone health issues remain a challenge throughout the continuum of care. Patients with prostate cancer are at high risk of skeletal complications from bone metastases and bone loss induced by cancer treatments, such as androgen-deprivation therapy. The preservation of skeletal health might require the cooperation of urologists, oncologists, pain specialists, and other physicians specializing in the treatment of prostate cancer. Complications resulting from bone loss and bone metastases can result in increased risk of fracture and death. Implementation of a multidisciplinary approach for the management of bone health can, therefore, provide clinically meaningful benefits to patients with skeletal complications. The early diagnosis and treatment of bone loss and bone metastases with bisphosphonates are critical for the maintenance of skeletal wellness and prevention of bone complications in patients with prostate cancer.

Bone Complications in Prostate Cancer: Current and Future Role of Bisphosphonates

During all disease stages, patients with prostate cancer may suffer from generalised bone loss or localised decreases in bone integrity (for example, at sites of metastatic bone lesions) [...]

Skeletal complications of prostate cancer: Pathophysiology and therapeutic potential of bisphosphonates

Patients with prostate cancer are at risk for skeletal complications resulting from treatment-induced bone loss and for bone metastases. The therapeutic potential of zoledronic acid for the treatment of prostate cancer has been demonstrated in both preclinical and clinical studies. In patients receiving androgen-deprivation therapy, zoledronic acid increases bone mineral density, and, in patients with bone metastases, it reduces the incidence of skeletal complications. Preclinical studies have also demonstrated the antitumor potential of bisphosphonates. Specifically, zoledronic acid inhibits proliferation and induces apoptosis of human prostate cancer cell lines in vitro and has enhanced antitumor activity when combined with taxanes. Animal models have further shown that bisphosphonates decrease tumor-induced osteolysis and reduce skeletal tumor burden. In a model of prostate cancer, zoledronic acid significantly inhibited growth of both osteolytic and osteoblastic tumors and reduced circulating levels of prostate-specific antigen. These studies suggest that zoledronic acid has the potential to inhibit bone metastasis and bone lesion progression in patients with prostate cancer.