Ther Adv Urol. 2012 Apr;4(2):85-101. doi: 10.1177/1756287212441234.
Many patients with advanced genitourinary malignancies develop bone metastases, which can lead to potentially debilitating skeletal complications. Moreover, age-related bone loss and cancer treatments such as hormonal therapy for prostate cancer can weaken bone, placing patients at risk for osteoporotic fractures in addition to skeletal-related events (SREs) from bone metastases. Zoledronic acid, a bisphosphonate, is approved worldwide to reduce the risk of SREs in patients with bone metastases from solid tumors or bone lesions from multiple myeloma. Zoledronic acid, although underutilized in genitourinary malignancies, has long been the mainstay of treatment in patients with bone metastases, and can also help preserve bone during anticancer therapy. Recently, denosumab, a monoclonal antibody directed against the receptor activator of nuclear factor kappa-B ligand, was approved in the United States and the European Union for reducing the risk of SREs in patients with bone metastases from solid tumors. Denosumab (at a lower dose) is also approved in the European Union and the United States to treat androgen deprivation-induced bone loss in men with prostate cancer. In addition, preclinical rationale and emerging clinical data suggest that bone-modifying agents may be able to delay disease progression in genitourinary cancers, just as newly developed anticancer treatments have produced reductions in SREs, possibly by indirect effects on the disease course. This review article summarizes current data and ongoing studies to preserve bone health in patients with advanced genitourinary cancers.
许多患有晚期泌尿生殖系统恶性肿瘤的患者会发生骨转移，这可能导致潜在的骨骼并发症。此外，与年龄相关的骨质流失和癌症治疗，如前列腺癌的激素治疗，会削弱骨骼，使患者面临骨质疏松性骨折的风险，以及来自骨转移的骨骼相关事件（SREs）。唑来膦酸是一种双膦酸盐，已在全球范围内获得批准，可降低有骨转移的实体瘤或多发性骨髓瘤骨病变患者的 SRE 风险。唑来膦酸虽然在泌尿生殖系统恶性肿瘤中的应用不足，但长期以来一直是骨转移患者的主要治疗方法，并且在癌症治疗期间也有助于保持骨骼健康。最近，一种针对核因子-κB 配体受体激活剂的单克隆抗体地舒单抗在美国和欧盟获得批准，用于降低有骨转移的实体瘤患者的 SRE 风险。地舒单抗（剂量较低）也在欧盟和美国获得批准，用于治疗前列腺癌男性的去势诱导性骨丢失。此外，临床前的理论依据和新兴的临床数据表明，骨修饰剂可能能够延缓泌尿生殖系统癌症的疾病进展，就像新开发的抗癌治疗方法通过对疾病过程的间接影响，降低了 SREs 风险一样。这篇综述文章总结了目前的数据和正在进行的研究，以维持晚期泌尿生殖系统癌症患者的骨骼健康。
