- 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.
- 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.