Metastatic prostate cancer patients have high rates of skeletal events – bone pain, fractures, spinal cord compression.
- Older age to begin with – pre-existing or de novo osteoporosis
- ADT causes osteoporosis
- Bony metastases cause bone fragility
Preventative treatment:
- Calcium and vitamin D supplementation
- Smoking cessation
- Weight bearing exercise
- Osteoporosis screening
Denosumab and zoledronic acid indicated for patients with bony metastases to reduce skeletal events and bone pain.
Palliative radiation therapy to painful bony metastases or those at risk of complications (spinal cord compression, fractures).
Also consider orthopaedic opinion for large bony lesions at risk of pathological fracture such as neck of femur, some may consider prophylactic fixation.