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CTIBL Prostate Denosumab — SCE Medical Oncology MCQ

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EasyUrological CancersCTIBL Prostate DenosumabSCE Medical Oncology

A 75-year-old man with mCRPC on ADT + enzalutamide develops osteoporosis (T-score -3.0). He is already on calcium and vitamin D. What bone-protective agent is appropriate for cancer treatment-induced bone loss (CTIBL) in prostate cancer?

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Correct answer: A — Denosumab 60 mg SC 6-monthly (bone health dose, NOT the 120 mg metastatic dose)

Cancer treatment-induced bone loss (CTIBL) in prostate cancer on ADT is managed differently from bone metastases: the BONE HEALTH dose of denosumab is 60 mg SC every 6 months (NOT the 120 mg monthly oncology dose for skeletal-related event prevention). Alternatively, zoledronic acid 4 mg IV 6-monthly can be used. The distinction between bone health (osteoporosis prevention) and bone metastasis management dosing is frequently examined. FRAX assessment guides intervention thresholds.

Reference: NICE NG131; ESMO 2024 Bone Health; BNF Denosumab dosing