Use of Bone Supportive Agents in the Management of Prostate Cancer in the UK

Dawn O'Shea

July 16, 2020

The findings of a survey of British Uro-oncology Group members suggests low use of bone supportive agents (BSAs) in men with prostate cancer. The survey highlights the need for guidelines on bone protection in men with advanced prostate cancer.

The responses, published in the  International Journal of Clinical Practice, indicate that uro-oncologists in the UK are cautious in their use of BSAs, particularly with respect to men with metastatic hormone-naïve prostate cancer (mHNPC) or non-metastatic disease. Only a third of respondents use BSAs in men with mHNPC.

The survey also found that BSAs are used more frequently during second- or third-line treatment in men with metastatic castration-resistant prostate cancer (mCRPC) rather than earlier in the course of the disease. However, in a small number of studies, earlier treatment with zoledronic acid has been shown to be beneficial.

For men with non-metastatic prostate cancer, more than three-quarters of respondents would never introduce a BSA at the time of androgen deprivation therapy (ADT); however, if the patient was considered to be at a higher risk of osteoporosis, 85% would use a BSA.

Zoledronic acid is the most widely used BSA to prevent SREs; the majority would never use pamidronate or ibandronate, and only 40 per cent would sometimes use denosumab.

Barriers to the use of BSA are most commonly lack of data (disodium pamidronate), lack of reimbursement (denosumab) and local guidelines (disodium pamidronate and ibandronate).

Despite the evidence available, fewer than 60% of respondents strongly agreed that BSAs are useful to treat pain and prevent skeletal-related events (SREs).

Many respondents do not routinely conduct dual-energy X-ray absorptiometry scans in their patients on long-term (neo)adjuvant ADT or even in the advanced disease setting.

The authors say the findings show a need to develop national evidence-based guidelines specific to bone protection strategies in men with advanced prostate cancer.

Payne H, Bahl A, O'Sullivan JM. Use of Bisphosphonates and Other Bone Supportive Agents in the Management of Prostate Cancer - A UK Perspective. Int J Clin Pract. 2020 Jul 12 [Epub ahead of print]. doi: 10.1111/ijcp.13611. PMID: 32654366.  Abstract.  

This article originally appeared on Univadis, part of the Medscape Professional Network.

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