Bisphosphonates for Nonmetastatic Prostate Cancer?

Metastatic prostate cancer often spreads to bone: 80% to 90% of patients with advanced disease manifest bone metastases. Bisphosphonates are used widely in prostate cancer patients, both in the early androgen-deprivation setting to prevent osteoporosis and in the castrate metastatic setting to decrease the likelihood of skeletal-related events (i.e., pathologic fracture, new bone metastases, and requirement for radiotherapy).

In the early 1990s, British investigators initiated a series of trials to determine whether the oral bisphosphonate clodronate might alter the natural history of bone metastases in prostate cancer. They hypothesized that bisphosphonates most likely would be beneficial when osteolysis from prostate cancer was minimal. On…