Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada.
Urol Oncol. 2012 Jul-Aug;30(4):369-78. doi: 10.1016/j.urolonc.2010.08.007. Epub 2010 Dec 16.
Disrupted skeletal homeostasis is common in patients with prostate cancer. Low bone density is common at diagnosis, and fracture risk is further elevated by the effects of androgen-deprivation therapy. Later in the disease course, bone metastases can result in skeletal morbidity. Although prostate-specific antigen (PSA) levels can provide important insights into overall disease progression, convenient, noninvasive tools for monitoring skeletal health are lacking. Biochemical markers released into serum and urine as a result of bone turnover might fulfill this unmet need. The objectives of this article are to assess current evidence examining the potential utility of bone turnover markers for monitoring skeletal health, bone disease progression, and response to antiresorptive therapies in the prostate cancer setting.
Published articles and abstracts from major oncology or urology congresses pertaining to the use of bone turnover markers to monitor skeletal health and disease progression were identified and assessed for relevance and methodologic stringency.
Several randomized trials and correlative studies support the utility of bone marker level changes to assess disease progression in the metastatic setting, bone health during hormonal therapy, and response to bisphosphonate therapy. The available data support potential associations between levels of the collagen type I telopeptides (NTX and CTX) and the severity of metastatic bone disease as well as outcomes during antiresorptive therapy. Evidence linking bone marker level changes with early diagnosis of skeletal metastases is emerging. Although several markers have shown promising results in correlative studies, results from ongoing prospective trials are needed to establish the role of bone markers in this setting.
Bone marker levels reflect ongoing skeletal metabolism and can provide important insights into bone health and response to bisphosphonate therapy in patients with prostate cancer. The data supporting a role for bone markers to monitor skeletal disease progression and response to zoledronic acid therapy are especially strong. Bone marker assessments may complement established diagnostic and monitoring paradigms in prostate cancer.
骨骼平衡紊乱在前列腺癌患者中较为常见。在诊断时常见骨密度降低，雄激素剥夺治疗的影响进一步增加了骨折风险。在疾病后期，骨转移可导致骨骼发病率升高。虽然前列腺特异性抗原（PSA）水平可以为整体疾病进展提供重要信息，但缺乏用于监测骨骼健康的便捷、非侵入性工具。由于骨转换而释放到血清和尿液中的生化标志物可能满足这一未满足的需求。本文的目的是评估目前评估骨转换标志物用于监测骨骼健康、骨疾病进展以及在前列腺癌治疗中对抗吸收治疗反应的潜在效用的证据。
确定并评估了与使用骨转换标志物监测骨骼健康和疾病进展相关的已发表的文章和主要肿瘤学或泌尿科大会的摘要，以评估其相关性和方法学严谨性。
几项随机试验和相关性研究支持骨标志物水平变化用于评估转移性疾病中的疾病进展、激素治疗期间的骨骼健康以及双膦酸盐治疗反应的效用。现有数据支持骨标志物水平与转移性骨疾病严重程度以及抗吸收治疗期间结局之间的潜在关联。与骨转移早期诊断相关的骨标志物水平变化的证据正在出现。尽管几种标志物在相关性研究中显示出有前景的结果，但仍需要正在进行的前瞻性试验来确定骨标志物在该环境中的作用。
骨标志物水平反映了持续的骨骼代谢，可提供有关前列腺癌患者骨骼健康和对双膦酸盐治疗反应的重要信息。支持骨标志物用于监测骨骼疾病进展和唑来膦酸治疗反应的作用的证据尤其有力。骨标志物评估可能补充前列腺癌的既定诊断和监测模式。
