Progression of bone
metastases is the primary cause of death in
prostate cancer, and skeletal-related events (SREs), including
pathologic fractures,
spinal cord compression, radiation, or surgery to bone can impair patients' quality of life. Over the past decade, the development of
cytotoxic agents,
androgen-receptor-axis-targeted
therapies (ARATs), and radioligand
therapies has prolonged overall survival of
prostate cancer patients with bone
metastases and reduced the risk of SREs. The use of bone-modifying agents has also contributed to the reduced risk of SREs. Initial use of a
cytotoxic agent,
docetaxel, or an ARAT agent with
androgen deprivation
therapy (ADT) is the current approach to metastatic
castration-sensitive
prostate cancer. However, there is no consensus on the optimal medication for upfront use in combination with ADT, or on specific patient selection. Recently, next-generation imaging modalities, such as whole-body magnetic resonance imaging and prostate-specific membrane
antigen-positron emission tomography have been utilized to detect bone
metastases at an early stage. In addition,
metastasis-directed
therapy, such as stereotactic body
radiation therapy, has been attempted. In the future, patients with bone metastatic
prostate cancer will be divided into subgroups and their treatment options will be tailored to their specific characteristics.