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Clinical Approaches to Osseous Metastases in Prostate Cancer

Genitourinary Oncology Service, Division of Solid Tumor Oncology, Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York, USA; Department of Medicine, Weill Medical College of Cornell University, New York, New York, USA

Michael J. Morris, M.D., Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, Box 444, New York, New York 10021, USA. Telephone: 646-422-4469; Fax: 212-988-0701; e-mail: morrism{at}mskcc.org

Background. Prostate cancer is unique among solid tumors in its proclivity to metastasize primarily to bone. Osseous metastases pose a formidable health threat to patients with metastatic disease, putting them at risk for pain, marrow crowding, fracture, and other sequelae. Treatments directed against bone disease have the potential both to palliate pain and to increase survival.

Conclusions. A number of agents exist that have the potential to palliate the effects of osseous metastases and should be routinely applied in the clinical care of the patient with advanced prostate cancer. These include hormones, bone-seeking radiopharmaceuticals, chemotherapy, and bisphosphonates. Strategies under investigation aim to eradicate bone disease, and not merely palliate symptoms. These approaches combine those listed above with tumor-directed targeting of osseous disease and manipulation of the biology that underlies the cancer’s relationship to bone.

Key Words. Prostate cancer • Osseous metastases • Bisphosphonates • Radiopharmaceuticals • Bone disease