[The role of corticoids in the management of advanced prostate cancer.] / Corticoides en el manejo del cáncer de próstata avanzado.

Prostate cancer is the most frequent malignant tumor in males in developed countries and represents the second cause of cancer death. Over the last years, the number of treatments available for patients with advanced prostate cancer has improved significantly, achieving better disease control and notably better overall survival (1). Corticosteroids have been extensively used in the treatment of castration resistant prostate cancer due to their palliative benefits on symptoms secondary to their potent anti-inflammatory activity and their demonstrated antitumor activity. At present time, we have a wide therapeutic arsenal for patients with metastatic prostate cancer and concomitant medication with corticosteroids may counteract adverse events of the main validated therapies. Nevertheless, long term exposition to corticosteroid treatment required by prostate cancer patients may have negative implications in terms of development of potential adverse events and, in certain cases, even facilitating disease progression.

Corticoides en el manejo del cáncer de próstata avanzado / The role of corticoids in the management of advanced prostate cancer

El cáncer de próstata es el tumor maligno más frecuente en el varón en países desarrollados y constituye la segunda causa de muerte por cáncer. En los últimos años, el número de tratamientos disponibles para pacientes con cáncer de próstata avanzado ha aumentado significativamente, consiguiendo mejor control de la enfermedad y una mejoría notable de la supervivencia global (1).Los corticosteroides han sido ampliamente utilizados en el tratamiento del cáncer de próstata resistente a castración por sus beneficios paliativos de síntomas debido a su potente actividad anti-inflamatoria y por su actividad antitumoral demostrada. En el momento actual disponemos de un amplio arsenal terapéutico para los pacientes con carcinoma de próstata metastásico y la medicación concomitante con corticoides puede contrarrestar los efectos adversos de las principales terapias validadas. Sin embargo, la exposición a largo plazo al tratamiento corticoideo que precisan los pacientes con cáncer de próstata avanzado puede tener implicaciones negativas en cuanto al desarrollo de potenciales efectos adversos e incluso en algunos casos facilitando la progresión de la enfermedad

Prostate cancer is the most frequent malignant tumor in males in developed countries and represents the second cause of cancer death. Over the last years, the number of treatments available for patients with advanced prostate cancer has improved significantly, achieving better disease control and notably better overall survival (1). Corticosteroids have been extensively used in the treatment of castration resistant prostate cancer due to their palliative benefits on symptoms secondary to their potent anti-inflammatory activity and their demonstrated antitumor activity. At present time, we have a wide therapeu adretic arsenal for patients with metastatic prostate cancer and concomitant medication with corticosteroids may counteract adverse events of the main validated therapies. Nevertheless, long term exposition to corticosteroid treatment required by prostate cancer patients may have negative implications in terms of development of potential adverse events and, in certain cases, even facilitating disease progression

SEOM guidelines for the treatment of bone metastases from solid tumours.

Bone metastases are a common and distressing effect of cancer, being a major cause of morbidity in many patients with advanced stage cancer, in particular in breast and prostate cancer. Patients with bone metastases can experience complications known as skeletal-related events (SREs) which may cause significant debilitation and have a negative impact on quality of life and functional independence. The current recommended systemic treatment for the prevention of SREs is based on the use of bisphosphonates: ibandronate, pamidronate and zoledronic acid- the most potent one- are approved in advanced breast cancer with bone metastases, whereas only zoledronic acid is indicated in advanced prostate cancer with bone metastases. The 2011 ASCO guidelines on breast cancer, recommend initiating bisphosphonate treatment only for patients with evidence of bone destruction due to bone metastases. Denosumab, a fully human antibody that specifically targets the RANK-L, has been demonstrated in two phase III studies to be superior to zoledronic acid in preventing or delaying SREs in breast and prostate cancer and non-inferior in other solid tumours and mieloma; it's convenient subcutaneous administration and the fact that does not require dose adjustment in cases of renal impairment, make this agent an attractive new therapeutic option in patients with bone metastases. Finally, in a phase III study against placebo, denosumab significantly increased the median metastasis-free survival in high risk non-metastatic prostate cancer, arising the potential role of these bone-modifying agents in preventing or delaying the development of bone metastases.