Last updated December 18, 2021

Bone Health and Bone-Targeted Therapies for Prostate Cancer

Recommendations

For men with nonmetastatic prostate cancer at high risk of fracture receiving androgen deprivation therapy (ADT), denosumab at the osteoporosis-indicated dosage should be considered to reduce the risk of fracture. In situations or jurisdictions where denosumab is contraindicated or not available, a bisphosphonate is a reasonable option.
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In men with high-risk localized prostate cancer, bisphosphonates are not recommended to reduce the risk of first bone metastasis.
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In men with nonmetastatic (castration-resistant prostate cancer; CRPC), denosumab at the bone metastasis-indicated dosage is not recommended to reduce the risk of first bone metastasis.
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In men with metastatic CRPC (mCRPC), either zoledronic acid (minimally symptomatic or asymptomatic disease) or denosumab (disease independent of symptoms) (both at bone metastasis-indicated dosages) is recommended for preventing or delaying skeletal-related events (SREs). Insufficient evidence exists to make a recommendation with respect to men with CSPC and bone metastasis.
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In men with symptomatic mCRPC and bone pain, radium-223 (Ra-223) should be considered for reducing symptomatic skeletal events and improving health-related QoL.
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In men with mCRPC and bone pain, radiopharmaceuticals or intravenous bisphosphonates may be considered for pain palliation.
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In men with symptomatic mCRPC, Ra-223 is recommended to extend overall survival.
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Recommendation Grading

Overview

Title

Bone Health and Bone-Targeted Therapies for Prostate Cancer

Authoring Organization

Publication Month/Year

February 19, 2020

Document Type

Guideline

External Publication Status

Published

Country of Publication

US

Target Patient Population

Men with prostate cancer

Inclusion Criteria

Male, Adult

Health Care Settings

Hospital, Outpatient

Scope

Management, Treatment

Diseases/Conditions (MeSH)

D017430 - Prostate-Specific Antigen, D001859 - Bone Neoplasms

Keywords

prostate cancer, osteoporosis, Bone Health, Bone-Targeted Therapies

Supplemental Methodology Resources

Data Supplement

Methodology

Number of Source Documents
38
Literature Search Start Date
December 1, 2016
Literature Search End Date
June 30, 2019
Description of External Review Process
Note: ASCO used 2 reviewers to endorse the CCO Guideline.
Specialties Involved
Endocrinology, Family Medicine, Geriatric Medicine, Hematology, Internal Medicine General, Oncology, Urology, Medical Oncology, Radiation Oncology, Oncology, Radiology