Do you offer either zoledronic acid or denosumab for patients with mCSPC with lytic metastases at baseline due to intraductal histology or high grade pathology?

This is an interesting question that we do not directly have evidence for. I usually do not offer patients bone protective therapy in this setting. Bone-protective therapy, in my opinion, is beneficial in preventing fractures, really for two reasons:

1. Pathologic fractures. mAPMS disease (formerly mC...

Lytic skeletal metastases are uncommon in metastatic castration-sensitive prostate cancer (mCSPC). Unlike blastic lesions, true lytic metastases are missed on conventional bone scans but are typically detectable on CT imaging. PET/CT offers the greatest sensitivity. In a PSMA PET/CT–based study, lyt...

In my opinion, essentially all patients with osteolytic lesions from any cancer type should receive bisphosphonates. The pathophysiology of lytic lesions is overactivity of osteoclasts. Bisphosphonates directly inhibit osteoclasts; they thus directly address the underlying disease process. A nice th...