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Advances in the Treatment of Castration-resistant Prostate Cancer
pain or need for surgery or radiotherapy. Bisphosphonates have been treatment are available. Empirical treatment approaches have generally
shown to be beneficial for prophylaxis of skeletal-related events in multiple been of little benefit, although active cytotoxic chemotherapy agents
myeloma and breast cancer, and there are some data to suggest benefit are now available. Systematic study and understanding of the basic
in prostate cancer, especially for zoledronic acid.
46
In particular, biology of prostate cancer is providing clues to new treatment
bisphosphonates may be useful in the prevention of bone pain.
47
possibilities. Many new agents and technologies are entering the clinic
However, there is by no means consensus that bisphosphonates should be and are likely to complement or even supplant older treatments.
used universally in patients with prostate cancer, nor what the optimum Unfortunately, there is still plenty of scope for improvement of the
clinical scenario for their use or the duration of therapy should be.
48
management of this disease. ■
Osteonecrosis of the jaw is a devastating but uncommon side effect of
long-term bisphosphonate use. Receptor activator of NF-κB (RANK) ligand Acknowledgements
plays an important role in osteoclast biology, and new agents such as IDD is supported in part by a Victorian Cancer Agency Clinician Researcher
denosumab, a monoclonal antibody specific for RANK ligand, are currently Fellowship and is an Honorary Australian National Health and Medical
being tested in clinical trials. Research Council Practitioner Fellow. IDD is a member of the following
Australian advisory boards: sanofi-aventis Taxotere, Pharmion satraplatin,
Conclusions Bayer Nexavar, Pfizer Sutent, Wyeth Torisel and Novartis RAD001. All
CRPC is a highly heterogeneous disease and its management is payments for this work are donated to the Austin Hospital Medical Research
complex. Treatment remains palliative and multiple modalities of Foundation to support research into urological cancers.
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