Background
Bone is the most frequent site of metastases from prostate cancer, both of endocrine sensitive disease and of castration-resistent disease. Skeletal Related Events (SRE) due to bone metastatic lesions increase morbidity. The treatment is based on endocrine therapy, chemotherapy, radiotherapy; the therapy scenario is changing due recently introduced new agents (abiraterone acetate, enzalutamide, vaccines, etc.). Bone metastatic prostate cancer patients are often treated with antiresorptive agents, such as Bisphosphonates (BPs), including Pamidronate, Zoledronic Acid, Ibandronate, or an anti-RANKL agent, Denosumab. All these agents are associated with adverse events, including Osteonecrosis of Jaw (ONJ) that can occur in 0–18% of prostate cancer pts. Preventive (risk reduction) measures before BP and Denosumab treatment (dental visit, dental RX, eventual teeth extractions, dental care, denture fitting) have been recommended.
Materials and methods
We reviewed all prostate cancer patients affected by bone metastases observed by our team at the Oncology Unit in years 2005–2013. They were classified as: a) Hystoric group (patients already under BP treatment on 2005); b) Prevention group (patients undergoing preventive measures before BP therapy start); c) Screening group (patients treated with BPs, not receiving prevention due to several reasons, on years 2006–2013).
Results
We followed 56 pts treated with BPs and/or Denosumab. ONJ was observed in 4/56 pts (7.1%). In the Historic group we observed ONJ in 1 out of 3 pts, and in the Screening group in 1 out of 5 pts (globally: 2/8, 25%); in the Prevention group in 2 out of 48 patients (4.1%). Further 5 ONJ cases in prostate cancer patients were referred to our Multidisciplinary Team by other neighbour hospitals (all not receiving preventive visit).
Conclusions
Prostate cancer patients are at high risk of ONJ. The preventive measures can minimize the rate of ONJ and are recommended.
References
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