Yuen, K.K., Shelley, M., Sze, W.M., Wilt, T., & Mason, M.D. (2010). Bisphosphonates for advanced prostate cancer. Cochrane Database of Systematic Reviews 2010(2).
To determine the effectiveness of bisphosphonates in relieving the bone pain of patients with bone metastases from prostate cancer
The final sample of 10 studies included placebo-controlled and active controlled studies of patients with prostate cancer and confirmed bone metastases.
Compared to patients receiving placebo, a higher proportion of patients receiving bisphosphonates reported a decrease in skeletal events. Use of bisphosphonates was associated with increased nausea. Findings supported the use bisphosphonates for reduction of the bone pain associated with prostate cancer. However, findings did not show that bisphosphonates made any difference in analgesic use or consumption.
This review was limited to prostate cancer patients with bone metastases. Authors noted that findings were influenced by the way in which studies were analyzed. In general, analysis of the number of evaluable patients favored bisphosphonates, but intention-to-treat analysis revealed no difference between treatments. Invesigators also saw that results differed according to how data from active study arms were handled. In one key study, when data from study arms were analyzed individually, meta-analysis was significant; however when data from active arms were combined, investigators noted no statistical difference relating to bisphosphonate use.
Bisphosphonate appears to have a role in decreasing pain and skeletal complications in patients with metastatic prostate cancer. Nausea appears to be the most frequent side effect associated with bisphosphate use. Data are insufficient to allow researchers to determine the most appropriate bisphosphonate choice, dose, or route of administration. More research is needed to determine the most effective treatment schedules and cost-effectiveness.