Management of bone mestastases in prostate cancer

Winston Tan, MD of Mayo Clinic, Jacksonville, FL discusses the impact of cancer on the bone micro-environment. Bone metastasis is debilitating to patients, for example prostate cancer patients becoming bedridden due to bone pains. He emphasizes the importance of understanding what other factors can be targeted in the treatment of prostate cancer. Part of the micro-environment includes the macrophages, the immune factors that feed the system, the factors that affect osteoblast function and the vascular-endothelial factors. Dr. Tan briefly describes the bone microenvironment as anything else outside the cancer that enhances its growth and maintenance, thereby causing debilitation. The bone is crucial to the process of metastasis and a lot of cancer treatments have focused on the actual cancer, rather than the bone which is a consequence of the cancer itself. Clinicians have been very successful in treating bone metastasis, using bisphosphonates, which help to decrease fractures, reduce the incidence of spinal cord compression, decrease hypercalcemia and the need for neurosurgery and radiation to those bones. Although most of the supportive and palliative care has benefits, none of the specific bone treatments so far have been successful in improving survival except for one. In prostate cancer, there is a drug known as Radium 223, an alpha emitter which has been shown to improve survival for patients with castrate resistant metastatic prostate cancer with metastasis to the bone. Recorded at the Multinational Association of Supportive Care in Cancer (MASCC) and International Society of Ocular Oncology (ISOO) 2016 Annual Meeting on Supportive Care in Cancer held in Adelaide, Australia.

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