Bone health agent use falls in Dutch metastatic prostate cancer cohorts

An observational study published in JNCI examined bone health agent (BHA) use and symptomatic skeletal events (SSEs) in bone-metastatic castration-resistant prostate cancer. Investigators compared 2,115 patients in the Dutch CAPRI-3 registry (2016–2021) with 1,923 in CAPRI-2 (2010–2015). Analyses of clinical evolution and skeletal outcomes included 1,792 patients receiving life-prolonging drugs, grouped by no BHA use or initiation within four weeks versus later relative to the first life-prolonging drug.

The contemporary cohort was older (75 versus 73 years) and had greater comorbidity: 44% versus 13% had a Charlson Comorbidity Index of at least 5. Prior life-prolonging treatment in the metastatic castration-sensitive setting increased from 0% to 35%. BHA use declined from 60% to 28%, with only 8% receiving guideline-recommended initiation timing. Overall SSE incidence nevertheless decreased from 0.26 to 0.21 events per patient-year.

Early BHA initiation was predominantly used in high-risk disease. This group had the highest SSE density, at 0.29, and shorter median SSE-free survival than patients without BHA treatment (8.7 versus 14.6 months; p<0.001). These observational comparisons do not establish that early BHA treatment worsens outcomes; treatment selection and changes in patient characteristics complicate interpretation. The findings highlight limited guideline-timed bone protection and the need to identify patients most likely to benefit. Only the abstract was available for assessment.