Prostate cancer is a substantial worldwide health care challenge. The disease is associated with detrimental effects on bone remodelling, mediated by the RANK/RANK ligand (RANKL) system.
Androgen deprivation therapy (ADT) causes an imbalance in regular bone turnover, resulting in bone loss [cancer-treatment-induced bone loss (CTIBL)]. As prostate cancer progresses, bone metastases may develop, leading to a vicious cycle of increased bone turnover and tumour growth. In both cases, patients have reduced quality of life and an increased risk of fracture. However, data show that subcutaneous denosumab, a human monoclonal antibody that targets RANKL, is superior to the intravenous bisphosphonate zoledronic acid in delaying the onset of skeletal-related events (SREs) and has a favourable safety profile in terms of nephrotoxicity and acute-phase reactions.
Urology nurse practitioners, as members of multidisciplinary teams, have an important role to play in assessing and helping to manage patients with bone-related disease in prostate cancer. In this review, an overview of prostate-cancer-related bone disease is provided. Currently available pharmacological interventions for the different stages of the disease are discussed, and implications for urological nursing practice are suggested.
Written by:
Drudge-Coates L, Turner B Are you the author?
King's College Hospital NHS Foundation Hospital Trust, Denmark Hill, London, Department of Urology, Homerton University Hospital, Homerton Row, Hackney, London
Reference: Intl J Urol Nurs. July 2012. 6(2) 83-90
doi: 10.1111/j.1749-771X.2012.01148.x
