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