The palliative management of skeletal metastases in prostate cancer: Use of bone-seeking radionuclides and bisphosphonates

In prostate cancer, the development of skeletal metastases is associated wi th a significant increase in morbidity, mainly because of severe bone pain, which eventually becomes refractory to conventional analgesia. Androgen ab lation is the treatment of choice, but the majority of patients relapse wit hin 2 to 3 years from initiation of treatment. After failure of hormone the rapy, external-beam irradiation therapy is effective in the palliation of p ain, but radionuclides represent an attractive and cost-effective alternati ve. Strontium 89 is currently the most commonly used radionuclide in the pa lliative management of prostate cancer metastatic to the skeleton. The rati onale for the use of bisphosphonates in metastatic prostate cancer is not i mmediately obvious, given the predominantly osteoblastic nature of the meta static process. The clinical use of these agents rests on a number of basic and clinical observations that provide ample evidence that in prostate can cer, the metastatic process is associated with increased hone resorption. E vidence regarding the beneficial effects of hisphosphonates in reducing mor bidity from metastatic prostate cancer is reasonably solid, although the ch oice of optimal bisphosphonate, mode of administration, dose, and duration of treatment must be determined in large, controlled studies before their w idespread clinical use can be advocated. Available therapeutic modalities t hat use either radionuclides or bisphosphonates can effectively and safely be used in the palliative management of metastatic prostate cancer. Neither radionuclides nor bisphosphonates have been shown to prolong survival, but the potential of both agents to beneficially alter the metastatic process in prostate cancer is intriguing. Copyright (C) 2001 by W.B. Saunders Company.