Lattouf Jean-Baptiste, Saad Fred
Urologic-Oncology Division, Centre Hospitalier de l'Université de Montréal, Canada.
Curr Opin Support Palliat Care. 2007 Oct;1(3):192-7. doi: 10.1097/SPC.0b013e3282f0c74f.
Bone is the most common site of metastasis in prostate cancer. The burden of disease from bone metastasis has repercussions in terms of cost to society, decreased quality of life, and decreased survival. Given the magnitude of bone-related morbidity in advanced prostate cancer, physicians need to be aware of preventive and therapeutic measures, and to be proactive in implementing them.
Patients with prostate cancer are often osteopenic at baseline. Implementing androgen-deprivation therapy further increases bone mineral density loss. Lifestyle changes, vitamin D and calcium supplementation may slow the rate of bone mineral density loss. Bisphosphonates reduce androgen-deprivation therapy-related bone loss in prostate cancer patients. Zoledronic acid is the only bisphosphonate proven to decrease skeletal-related events in a randomized controlled trial in patients with metastatic prostate cancer. Newer agents such as selective oestrogen receptor modifiers and antibodies targeting receptor activator of nuclear factor-kappaB ligand are under investigation.
Bone mineral density loss and skeletal complications are directly related to androgen-deprivation therapy and metastases in prostate cancer patients. Preventive and therapeutic modalities are available to physicians, who should be proactive in implementing them. Novel agents are under investigation and data pertaining to their efficacy should become available in the near future.
骨骼是前列腺癌最常见的转移部位。骨转移导致的疾病负担在社会成本、生活质量下降和生存期缩短方面都有体现。鉴于晚期前列腺癌中与骨相关的发病率之高，医生需要了解预防和治疗措施，并积极加以实施。
前列腺癌患者基线时往往存在骨质减少。实施雄激素剥夺治疗会进一步增加骨密度丢失。生活方式改变、补充维生素D和钙可能会减缓骨密度丢失速度。双膦酸盐可减少前列腺癌患者雄激素剥夺治疗相关的骨质流失。唑来膦酸是唯一在转移性前列腺癌患者的随机对照试验中被证明可减少骨相关事件的双膦酸盐。新型药物如选择性雌激素受体调节剂和靶向核因子-κB受体活化因子配体的抗体正在研究中。
骨密度丢失和骨骼并发症与前列腺癌患者的雄激素剥夺治疗及转移直接相关。医生可采用预防和治疗方法，应积极实施。新型药物正在研究中，有关其疗效的数据在不久的将来应该会公布。
