Treatment of Bone Metastases in Castration-Resistant Prostate Cancer
This protocol applies to patients with castration-resistant prostate cancer (CRPC) who have bone metastases, where symptomatic bone-dominant multiple skeletal metastases are not the dominant site of disease.
In this population, bone-targeted therapy is recommended regardless of whether skeletal symptoms are present. Current evidence supports initiating treatment proactively — without waiting for symptoms to develop — and continuing it throughout the course of the disease.
The structured approach involves a specific bone-targeted agent, initiated at one interval and then de-escalated to a less frequent schedule after an initial treatment phase. The complete regimen, dosing schedule, and de-escalation criteria are detailed in the full protocol.
References
DOI: 10.1016/j.annonc.2020.07.019
- Zoledronate or denosumab is recommended in patients with CRPC and bone metastases, whether they are symptomatic or not.
- Most patients selected for treatment with zoledronate can de-escalate this agent safely to administration every 12 weeks, preferably after monthly treatment for 3-6 months.
- Denosumab should be administered every 4 weeks.
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