Metastatic Profile Osseous Metastases

It has long been recognized that both prostate and breast cancer belong to a well-defined group of tumors that readily metastasize to bone. One autopsy series reported that 64% and 66% of patients with metastatic breast and prostate cancer, respectively, had metastases to the bone.44 There are important differences, however, most notably being the pattern of bone metastasis seen in each of these cancers, i.e. typically osteoclastic in breast cancer and osteoblastic in prostate cancer. In an effort to further characterize this phenomenon, researchers have identified several osteoblast-stimulating factors produced by prostate cancer cells, such as bone mor-phogenic proteins, osteoblast mitogenic factor, prostatic osteo-blastic factor and bone phosphatase-elevating factor. Other studies have suggested that insulin-like growth factor binding proteins sequestered in the bone matrix, which normally inhibit the osteoblastic activity of insulin-like growth factors, may undergo PSA-dependent proteolysis, thereby resulting in the osteoblastic phenotype often observed in metastatic prostate cancer.45 Other evidence suggests that osteoclastic reactions similar to those seen in breast cancer may also be involved in prostate cancer, at least initially. Furthermore, just as clinical studies have demonstrated elevated parathyroid hormone-related protein levels in metastatic breast cancer, similar proteins have also been detected in patients with prostate cancer.44'46'47 It is interesting to note that recent data suggest that patients with osseous metastases from both of these cancers may benefit from treatment with bisphos-phanates, although these agents are thought to act primarily by inhibiting osteoclastic processes.48

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