Saad Fred, McKiernan James, Eastham James
Centre Hospitalier de l'Université de Montréal, Hôpital Notre-Dame, Montréal, Quebec, Canada.
Urol Oncol. 2006 Jan-Feb;24(1):4-12. doi: 10.1016/j.urolonc.2005.06.020.
Men with prostate cancer are at risk for bone loss and skeletal complications throughout the course of their disease. Bone loss is prevalent in many men with prostate cancer at initial diagnosis, and initiating androgen deprivation therapy results in accelerated bone resorption, leading to bone loss and an increased risk of fracture. These men are also at high risk for disease progression and bone metastases that can result in significant skeletal morbidity, including pathologic fracture, spinal cord compression, and debilitating bone pain requiring additional therapy. Excessive osteoclast activity plays a central role in the pathophysiology of bone disease at each stage of prostate cancer disease progression. Zoledronic acid, a highly potent inhibitor of osteoclast-mediated bone resorption, has increased bone mineral density in men receiving androgen deprivation therapy and is the only bisphosphonate that has shown statistically significant reductions in skeletal morbidity in patients with bone metastases from prostate cancer. Furthermore, preclinical evidence suggests that zoledronic acid has antitumor activity in prostate cancer models. Recently, a treatment algorithm was developed by the 3rd International Consultation on Prostate Cancer recommending the use of zoledronic acid for the prevention of skeletal complications in patients with bone metastases from prostate cancer, regardless of their hormone status, and for the prevention of treatment-induced bone loss in patients without evidence of bone metastases. According to this algorithm, zoledronic acid should be considered for the prevention of skeletal morbidity in patients with prostate cancer throughout their treatment continuum.
前列腺癌男性患者在其疾病过程中存在骨质流失和骨骼并发症的风险。在许多前列腺癌男性患者初诊时，骨质流失就很普遍，而开始雄激素剥夺治疗会导致骨吸收加速，进而导致骨质流失和骨折风险增加。这些男性患者还面临疾病进展和骨转移的高风险，这可能导致严重的骨骼疾病，包括病理性骨折、脊髓压迫以及需要额外治疗的使人衰弱的骨痛。在前列腺癌疾病进展的每个阶段，破骨细胞过度活跃在骨病的病理生理学中都起着核心作用。唑来膦酸是一种强效的破骨细胞介导的骨吸收抑制剂，已提高了接受雄激素剥夺治疗男性的骨矿物质密度，并且是唯一在前列腺癌骨转移患者中显示出骨骼疾病发生率有统计学显著降低的双膦酸盐。此外，临床前证据表明唑来膦酸在前列腺癌模型中具有抗肿瘤活性。最近，第三届前列腺癌国际咨询会议制定了一种治疗方案，建议对前列腺癌骨转移患者，无论其激素状态如何，使用唑来膦酸预防骨骼并发症；对无骨转移证据的患者，使用唑来膦酸预防治疗引起的骨质流失。根据该方案，在前列腺癌患者的整个治疗过程中，都应考虑使用唑来膦酸预防骨骼疾病。
