Treatment of Bone Metastases in Urologic Malignancies

Abstract

The skeletal system is the most common site of metastatic cancer spread. Bone metastases are often associated with severe morbidity, pain and functional impairment. Timely diagnosis and proper treatment may decrease morbidity, improve quality of life and in some cases even improve survival. External beam radiotherapy may effectively give pain relief in patients with painful bone metastases. In bone metastases from castration-resistant prostate cancer or urothelial bladder cancer, treatment with zoledronic acid or denosumab may reduce skeletal-related events. In contrast to castration-resistant prostate cancer, in patients with bone metastases from bladder cancer such treatment may even improve survival. On the other hand, the efficacy of these agents is questionable in patients with bone involvement from metastatic renal cell carcinoma or germ cell tumors. When bisphosphonates or denosumab are considered in such cases, the potential benefits of treatment should be critically weighed against the risk of side effects. In germ cell tumors, bone metastases may be cured by cisplatin-based chemotherapy, however, there are only limited data on the specific management of residual disease. Oligometastases may be treated by stereotactic radiotherapy or - especially in patients with renal cell carcinoma - by surgical resection and endoprosthetic replacement. Limited data are available on the management of bone involvement in germ cell tumors. Decisions on the resection or local radiotherapy of residual disease should be individualized considering the overall response and the feasibility and risks of resection.

Cytochrome P450 17A1 Inhibitor Abiraterone Acetate Counteracts the Heat Shock Protein 27's Cell Survival Properties in Prostate Cancer Cells

“…mCRPC is yet one of the most diagnosed malignant diseases and remains the second-leading cause of tumour-associated deaths in male in the Western hemisphere [4]. Depending on local tumor progress and the presence of lymph node and bone metastasis, overall survival of mCRPC averaged 1.5 years during the last 2 decades [5,6]. Before 2010, docetaxel was the only available substance, which improved overall survival [7,8].…”

Bone scan with technetium 99m-methyl diphosphonate, the missing link in the initial staging of muscle-invasive bladder carcinoma

“…About 20-25% of newly diagnosed BCas are muscle-invasive, and 5-10% are metastatic by the first manifestation. Bone is one of the most common sites of BCa metastases, and up to 27% of muscle-invasive TCCs present with bone metastases [13,14]. Early treatment is crucial for invasive BCa; studies have shown that delayed cystectomy can decrease survival rates for more than 3 months [6].…”

Clinical Value of ¹⁸F-Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography in Upper Tract Urothelial Carcinoma: Impact on Detection of Metastases and Patient Management

“…The patients were managed according to the following treatment strategies: patients without distant metastasis were treated with RNU with or without regional LN dissection (LND) in accordance with the previous report [25], patients with locally advanced disease or clinical LN metastasis were treated with radical surgery including extended LND according to the PET/CT findings with or without neoadjuvant chemotherapy, and patients with visceral metastasis or recurrent disease received palliative chemotherapy, radiotherapy, and/or palliative care [26]. All the patients gave informed consent to participate in this protocol.…”