New Tools for the Urologist in the Management of Patients with Bone Metastases

ObjectivesBone metastases are common among patients with hormone-refractory prostate cancer and advanced renal cell carcinoma. Moreover, androgen-deprivation therapy (ADT) in patients with early prostate cancer has been associated with bone loss. Current guidelines for monitoring and managing bone health in patients with prostate cancer are evolving to optimize patient screening and treatment.MethodsMedline keyword searches and reviews of presentations from recent international symposia were performed to identify new tools for screening for bone metastases. In addition, guidelines and consensus recommendations were reviewed to identify bone health issues and their management in patients with genitourinary cancers.ResultsMalignant bone disease contributes heavily to the burden of disease in patients with advanced prostate cancer. Furthermore, fractures are associated with decreased survival. The introduction of zoledronic acid has extended the skeletal health benefits of bisphosphonate therapy to the genitourinary cancer setting. Diagnosis of bone metastases while patients are still asymptomatic could allow the initiation of therapy before skeletal complications occur, thereby possibly delaying their onset. Recent analyses have identified risk factors for metastasis to bone, allowing urologists to better mobilize potentially limited resources for bone scans in their clinics. Moreover, algorithms for monitoring and treating bone loss in patients undergoing ADT may allow early detection and treatment of bone mineral density declines, thereby preserving patients’ functional independence throughout the continuum of care.ConclusionsThe introduction of zoledronic acid and updated monitoring and treatment algorithms may aid in the maintenance of bone health in patients with genitourinary cancers.