Prostate cancer: ASCO endorses guideline on bone health and bone-targeted therapies

  • Saylor PJ & al.
  • J Clin Oncol
  • 28 Jan 2020

  • curated by Deepa Koli
  • Univadis Clinical Summaries
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Takeaway

  • The American Society of Clinical Oncology (ASCO) has endorsed the 2017 Cancer Care Ontario Guidelines on Bone Health and Bone-Targeted Therapies for patients with prostate cancer.
  • ASCO endorsed all 4 original recommendations.

Key recommendations

  • Patients with nonmetastatic prostate cancer at high risk for fracture and receiving androgen-deprivation therapy: consider denosumab at the osteoporosis-indicated dosage to reduce fracture risk. 
    • When denosumab is contraindicated or not available, a bisphosphonate may be used.
  • In high-risk patients with localized disease, bisphosphonates are not recommended to reduce risk for first bone metastasis.
    • In men with nonmetastatic castration-resistant prostate cancer (CRPC), denosumab is not recommended.
  • Patients with metastatic CRPC: either zoledronic acid or denosumab is recommended for preventing or delaying skeletal-related events.
  • Consider radium-223 in men with symptomatic disease and bone pain for reducing symptomatic skeletal events and improving health-related QoL.
    • Radiopharmaceuticals or intravenous bisphosphonates may be considered for pain palliation in men with bone pain.
    • Evidence is insufficient for a recommendation in metastatic castration-sensitive disease.
  • Patients with symptomatic metastatic CRPC: consider radium-223 to extend OS.