Use of potential therapeutic agents to protect bone health in prostate cancer
Mahdokht Forouzan moheb,
1,* Mohammad hasan karimi,
2 Faranak jamshidian,
3 Seyed yusef seydena,
4 Nafise taromi,
5
1. department of biology, faculty of basic sciences, north tehran branch, islamic azad university, tehran, iran
2. department of biology, faculty of basic sciences, tonekabon branch, islamic azad university, mazandaran, iran
3. department of biology, faculty of basic sciences, east tehran branch (ghiamdasht), islamic azad university, tehran, iran
4. department of biology, faculty of basic sciences, north tehran branch, islamic azad university, tehran, iran
5. iran university of medical sience
Abstract
Introduction
Patients with prostate cancer are at risk of impaired bone health. prostate cancer has a propensity to metastasize to bone, after which patients are at risk of skeletal-related events. these complications are associated with increased mortality, substantial pain, and reduced quality of life. patients are also at risk of bone loss due to androgen deprivation therapy, which can be compounded in elderly patients with reduced bone density. it is essential, therefore, that aspects of bone health and therapies able to prevent the occurrence of skeletal-related events are considered throughout the clinical course of prostate cancer.
Methods
We reviewed the literature regarding the molecular mechanisms underpinning bone lesion formation, the modes of action of therapies that prevent skeletal-related events, and the efficacy and safety of these therapies in patients with hormone-sensitive or castration-resistant prostate cancer.
Results
Therapies such as denosumab (a rankl inhibitor) and zoledronic acid (a bisphosphonate) were indicated for prevention of skeletal-related events. radium-223 dichloride also has proven efficacy in delaying symptomatic skeletal-related events, as well as in improving overall survival through effects on bone metastases. before development of bone metastases, low-dose denosumab may also be used for treatment of androgen deprivation therapy-associated bone loss. denosumab may also have the potential to delay bone metastases development in patients with castration-resistant prostate cancer, although this is not currently an approved indication. the safety profile of therapies to prevent skeletal-related events should be considered. this review consolidates the available evidence on use of denosumab and bisphosphonates in prostate cancer, differentiated by hormone-sensitive and castration-resistant disease.
Conclusion
There is convincing evidence to support the use of denosumab and bisphosphonates to maintain bone health in patients with prostate cancer. clinicians should be mindful of the adverse event risk profile of these therapies.
Keywords
prostate cancer, bone, denosumab
