Bisphosphonates in prostate cancer

• patients with metastatic prostate cancer are at risk of complications including pain, hypercalcaemia, bone fracture and spinal cord compression
  • hormonal treatment is the mainstay of treatment for these patients but most of them will then become hormone refractory
  • bisphosphonates act by inhibiting osteoclast activities and are a potential therapeutic option for metastatic prostate cancer
    • a systematic review has been undertaken (1):
      • 1,950 patients from ten studies were included in this review
        • pain response rates were 27.9% and 21.1% for the treatment group and the control group, respectively, with an absolute risk difference of 6.8%.The OR for pain response was 1.54 (95% CI 0.97 to 2.44, P = 0.07), showing a trend of improved pain relief in the bisphosphonate group, although this was not statistically significant
        • rates for skeletal events were 37.8% and 43.0% for the treatment group and the control group, respectively, with an absolute risk difference of 5.2%. The OR for skeletal events was 0.79 (95% CI 0.62 to 1.00, P = 0.05)
        • a significant increase in nausea was observed in patients who received bisphosphonates compared to placebo
        • no increase in other adverse events was observed
        • no statistically significant difference between the bisphosphonate group and the control group in terms of prostate cancer death, disease progression, radiological response and PSA response
      • study authors concluded that bisphosphonates should be considered for patients with metastatic prostate cancer for the treatment of refractory bone pain and prevention of skeletal events

Reference:

1. Yuen KK et al. Bisphosphonates for advanced prostate cancer.Cochrane Database Syst Rev. 2006 Oct 18;(4):CD006250.