Bisphosphonates in Prostate Cancer: Where Are We and Where Should We Go?

Bone metastases are frequent occurrences in prostate cancer. The discovery that prostate cancer is a hormone-dependent can-cer substantially altered strategies for treating this disease. Hor-mone therapy has since become the focus of much of the thera-peutic improvement in the management of advanced prostate cancer. The use of hormone therapy prior to the appearance of metastases has resulted in improved survival in randomized studies and has led to the widespread use of early, as well as adjuvant, hormone therapy. One of the drawbacks of long-term hormone therapy has been reported in recent studies on the effects of androgen-deprivation therapy on bone metabolism. We now realize that bone loss is evident over time and that men who receive such therapy have an increased risk of osteoporotic fractures (1). The class of compounds known as bisphosphonates have gen