Do you use denosumab for castration-sensitive prostate cancer with osseous metastases?

This is an important question but a complex one. Several issues are critical to consider: 1) bone anti-resorptive therapies like zoledronic acid have NOT been established to improve survival or reduce skeletal events in this setting of bone metastatic HSPC as compared to waiting for mCRPC. See CALGB...

At a minimum, the use of denosumab every 6 months in met HSPC should be considered. The frequency of denosumab should be decreased from the monthly use as patients with prostate cancer are living longer. The incidence of osteonecrosis appears to be higher with years of therapy and the risk of toxici...

Skeletal related events in patients with metastatic bone disease are mediated by osteoclasts induced bone destruction. Receptor activator of nuclear factor kappa-B ligand (RANKL), are expressed by cells of osteoblasts lineage and activate RANK receptors on osteocalsts and its precursors. This pathwa...

Great review! I am going to cut this out for my fellows. Anecdotally, I have seen several cases of profound hypocalcemia due to denosumab and invariably, it was in patients with hormone sensitive disease, which somewhat makes sense.