Bisphosphonates treatment in metastatic prostate cancer

The skeleton is the third most common site for cancer to spread after the liver and lungs. Malignancies that can cause destruction of skeletal bones include multiple myeloma and metastatic diseases of the lung, prostate and other solid cancers. The clinical complications include pain, fractures, compression of the spinal cord and hypercalcemia of malignancy. Bisphosphonates are bone-seeking agents originally designed to treat loss of bone density. Accumulating data show that they are effective in diseases in which there is upregulation of osteoclastic or osteolytic activity. Bisphosphonates can reduce skeletal-related events and bone pain, as well as reduce the adverse effects of androgen deprivation therapy on skeletal integrity. However, it is clear that bisphosphonates do not represent a decisive treatment in the care of metastases but a therapeutic choice in synergy with regular anti-tumor drugs. The preclinical and clinical data to support this are reviewed here