Bone micro‐environment in prostate cancer: impact, treatment and implications for nursing practice

Abstract

Prostate cancer is a substantial worldwide health care challenge. The disease is associated with detrimental effects on bone remodelling, mediated by the RANK/RANK ligand (RANKL) system. Androgen deprivation therapy (ADT) causes an imbalance in regular bone turnover, resulting in bone loss [cancer‐treatment‐induced bone loss (CTIBL)]. As prostate cancer progresses, bone metastases may develop, leading to a vicious cycle of increased bone turnover and tumour growth. In both cases, patients have reduced quality of life and an increased risk of fracture. However, data show that subcutaneous denosumab, a human monoclonal antibody that targets RANKL, is superior to the intravenous bisphosphonate zoledronic acid in delaying the onset of skeletal‐related events (SREs) and has a favourable safety profile in terms of nephrotoxicity and acute‐phase reactions. Urology nurse practitioners, as members of multidisciplinary teams, have an important role to play in assessing and helping to manage patients with bone‐related disease in prostate cancer. In this review, an overview of prostate‐cancer‐related bone disease is provided. Currently available pharmacological interventions for the different stages of the disease are discussed, and implications for urological nursing practice are suggested.