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Managing Metastatic Prostate Cancer In Your Urological Oncology Practice pp 231–257Cite as

Bone Preservation Strategies for Men on Androgen Deprivation Therapy

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Abstract

Bone metastases are common in many men with advanced prostate cancer. Maintaining bone health related to the management of prostate cancer is important. Skeletal related events (SRE) are a major source of morbidity for prostate cancer patients. Furthermore, men receiving androgen deprivation therapy (ADT) are at considerably higher risk for debilitating skeletal events. Abnormal bone remodeling secondary to irregular osteoclast activity is a favorable therapeutic target. Bisphosphonates, such as zoledronic acid, can increase bone mineral density of men on ADT and significantly decrease the risk of skeletal complications at risk patients. Denosumab is a human monoclonal antibody that specifically binds and inactivates the RANK ligand, a molecular activation switch for osteoclasts. This osteoclast specific therapy can increase bone mineral density and decrease the risk of fracture. Both therapies have proven benefit in preventing SREs for men with metastatic castration resistant prostate cancer (mCRPC). No agents are currently approved for prevention of bone metastasis, although recent phase III studies are promising. Radium-223, abiraterone and enzalutamide are several mechanistically distinct agents that diminished tumor growth and also decrease the rate of SRE in men with mCRPC. Incorporation and optimization of these bone targeted agents into primary therapy for metastatic prostate cancer investigation is currently on going.

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Authors and Affiliations

  1. Department of Urology, Wake Forest University School of Medicine, Medical Center Blvd, Winston Salem, NC, USA

    Charles C. Peyton

  2. Department of Urology, Cancer Biology, Institute of Regenerative Medicine, Wake Forest University School of Medicine, W.G. (Bill) Hefner VA Medical Center, Medical Center Blvd, Winston Salem, NC, 27157-1094, USA

    K. C. Balaji

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  1. Charles C. Peyton
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  2. K. C. Balaji
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Correspondence to Charles C. Peyton .

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  1. School of Medicine, Wake Forest University, Winston Salem, North Carolina, USA

    K.C Balaji

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Peyton, C.C., Balaji, K.C. (2016). Bone Preservation Strategies for Men on Androgen Deprivation Therapy. In: Balaji, K. (eds) Managing Metastatic Prostate Cancer In Your Urological Oncology Practice. Springer, Cham. https://doi.org/10.1007/978-3-319-31341-2_14

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  • DOI: https://doi.org/10.1007/978-3-319-31341-2_14

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