Many of our doctors are constantly vigilant about our developing skeletal related issues.   Having advanced prostate cancer and receiving treatment for this disease increases our odds of developing skeletal issues which affect both our quality of life and our mortality.

Drugs like denosumab (Xgeva) and zoledronic acid (Zometa) are important in delaying the onset of skeletal related event complications, however neither of these drugs improve survival nor delay mortality. They both are beneficial and have an important role in delaying the complications of bone metastases in men with metastatic castrate resistant prostate cancer (mCRPC).

The two new “super” ADT drugs that have recently been FDA approved, Abiraterone acetate (Zytiga) and enzalutamide (Xtandi) have both also demonstrated a decrease in skeletal related events as well as a survival advantage.

The newest FDA approval, radium-223 (Xofigo) also delays symptomatic skeletal events.

Radium-223 not only demonstrated a statistically significant delay in the development of skeletal events, it is the first bone-targeted agent that actually improves survival (Xtandi and Zytiga do not target bone). There are other radio-pharmaceuticals, however none have demonstrated a survival benefit.

It is important to identify men as early as possible to insure they get the maximum possible benefit of any therapy.

How to sequence these drugs is still uncertain. We need additional studies examining the best sequences and in advancing our understanding of which specific treatment will best benefit which particular man. I look forward to additional research along with its peer-reviewed data.