Bone Metastases and Health in Prostate Cancer: From Pathophysiology to Clinical Implications
by
, , , , ,
Cinzia Baldessari
1
,
Stefania Pipitone
1,
Eleonora Molinaro
2,*,
Krisida Cerma
3,
Martina Fanelli
4,
Cecilia Nasso
1,5,
Marco Oltrecolli
1,
Marta Pirola
1,
Elisa D’Agostino
1,
Giuseppe Pugliese
6,
Sara Cerri
1,
Maria Giuseppa Vitale
1,
Bruno Madeo
7,
Massimo Dominici
1 and
Roberto Sabbatini
1 1
Department of Oncology and Hematology, Azienda Ospedaliero Universitaria of Modena, 41125 Modena, Italy
2
Oncology, AUSL of Modena Area Sud, Sassuolo-Vignola-Pavullo, 41121 Modena, Italy
3
Oncology Unit 1, Department of Oncology, Veneto Institute of Oncology IOV—IRCCS, 35128 Padova, Italy
4
Department of Oncology, Azienda Ospedaliero Universitaria S. M. della Misericordia, 33100 Udine, Italy
5
Medical Oncology, Ospedale Santa Corona, 17027 Pietra Ligure, Italy
6
Department of Oncology and Hematology, Univerity of Modena and Reggio Emilia, 41125 Modena, Italy
7
Unit of Endocrinology, Department of Medical Specialities, Azienda Ospedaliero Universitaria of Modena, 41125 Modena, Italy
*
Author to whom correspondence should be addressed.
Cancers 2023, 15(5), 1518; https://doi.org/10.3390/cancers15051518
Submission received: 20 January 2023
/
Revised: 15 February 2023
/
Accepted: 24 February 2023
/
Published: 28 February 2023
(This article belongs to the Special Issue Prostate Cancer Metastasis)
Simple Summary
Bone metastases and health are crucial issues in prostate cancer patient management. The aim of our review was to describe the biology of bone metastases and their clinical implications in prostate cancer patients, and current therapeutic strategies. In addition, “bone health” should be evaluated and specific treatments considered. In this way, we aimed to attract attention to the risk of both “bad” bone health and bone metastasis, and also to the available care options for these patients.
Abstract
Clinically relevant bone metastases are a major cause of morbidity and mortality for prostate cancer patients. Distinct phenotypes are described: osteoblastic, the more common osteolytic and mixed. A molecular classification has been also proposed. Bone metastases start with the tropism of cancer cells to the bone through different multi-step tumor–host interactions, as described by the “metastatic cascade” model. Understanding these mechanisms, although far from being fully elucidated, could offer several potential targets for prevention and therapy. Moreover, the prognosis of patients is markedly influenced by skeletal-related events. They can be correlated not only with bone metastases, but also with “bad” bone health. There is a close correlation between osteoporosis—a skeletal disorder with decreased bone mass and qualitative alterations—and prostate cancer, in particular when treated with androgen deprivation therapy, a milestone in its treatment. Systemic treatments for prostate cancer, especially with the newest options, have improved the survival and quality of life of patients with respect to skeletal-related events; however, all patients should be evaluated for “bone health” and osteoporotic risk, both in the presence and in the absence of bone metastases. Treatment with bone-targeted therapies should be evaluated even in the absence of bone metastases, as described in special guidelines and according to a multidisciplinary evaluation.
