Management and Prevention of Bone Complications in Metastatic Castration-Resistant Prostate Cancer

In the United States, prostate cancer accounts for 25% of all new cancer diagnoses, making it the most common newly diagnosed cancer in men. It also accounts for 10% of all cancer deaths in the United States. Prostate cancer has a very high propensity for metastasizing to bone, at which time it is considered incurable and is associated with a high degree of morbidity and mortality. Even in the absence of metastasis, the increased bone loss and associated skeletal complications resulting from cancer and cancer therapies lead to a high degree of morbidity and mortality. This activity discusses the current and emerging therapies used to improve the management of bone disease in men with prostate cancer. Emerging clinical trial data is also discussed.

Release date: August 31, 2010
Expiration date: August 31, 2011
Estimated time to complete activity: 30 minutes

Jointly sponsored by Curatio CME Institute, H. Lee Moffitt Cancer Center & Research Institute, the Bone and Cancer Foundation, and the Cancer and Bone Society

This activity is supported by an educational donation provided by Amgen.

Hardware/Software Requirements

Javascript-enabled browser
Active Internet connection
Adobe Acrobat Reader
Adobe Flash Player plugin v.8.0+

Target Audience
This activity has been designed to meet the educational needs of urologists, urologic oncologists, medical oncologists, and other health care providers who manage patients with prostate cancer that has metastasized to bone or has the potential to metastasize to bone.

Learning Objectives
After completing this activity, participants should be able to:

Describe the clinical impact that bone loss and bone metastases have on the development of skeletal-related events, reductions in quality of life and survival
Outline the current standards for the prevention and treatment of prostate cancer-related bone disease
Evaluate the clinical data and assess the risks and benefits associated with current and emerging therapies for the treatment and prevention of bone disease in prostate cancer patients
Educate patients with clear, concise information on the risks associated with various bone-sparing agents and the risks of complications associated with a lack of treatment
Formulate and implement a practical plan for overcoming barriers and providing optimal management and prevention of bone loss and bone-related complications

Faculty
Celestia S. Higano, MD
Professor of Medicine
University of Washington School of Medicine
Seattle, Washington

Steering Committee
Matthew R. Smith, MD, PhD—Chair
Associate Professor of Medicine
Harvard Medical School
Massachusetts General Hospital Cancer Center
Boston, Massachusetts

Celestia S. Higano, MD

Joel B. Nelson, MD
Frederic N. Schwentker Professor and Chairman
Department of Urology
University of Pittsburgh School of Medicine
Pittsburgh, Pennsylvania

Fred Saad, MD, FRCS
Professor and Chief of Urology
Director of Urologic Oncology
University of Montreal Endowed Chair in Prostate Cancer
University of Montreal Hospital Centre
University of Montreal
Montreal, Quebec, Canada

Accreditation Statement
This activity has been planned and implemented in accordance with the Essential Areas and Policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of Curatio CME Institute, H. Lee Moffitt Cancer Center & Research Institute, the Bone and Cancer Foundation, and the Cancer and Bone Society. Curatio CME Institute is accredited by the ACCME to provide continuing medical education for physicians.

Credit Designation
Curatio CME Institute designates this educational activity for a maximum of 0.50 AMA PRA Category 1 Credit™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

Method of Participation
There are no fees for participating in this CME activity. To receive credit during the period August 2010 to August 31, 2011, participants must (1) read the learning objectives and disclosure statements, (2) study the educational activity, and (3) complete the presurvey, postsurvey, and activity evaluation form.

The evaluation, postsurvey, and certificate can be accessed at the end of the activity. Please e-mail any questions to cmeinfo@curatiocme.com.

Medium
This activity is offered as an Internet activity on BoneOncologyTX.com. Offering this CME activity online allows participants to learn on their own time and at their own pace. The interactive nature of the activity allows participants to become engaged and offers visual, written, and spoken education to suit many learning styles.

Disclosure
In accordance with the ACCME Standards for Commercial Support, all CME providers are required to disclose to the activity audience the relevant financial relationships of everyone in a position to control content of an educational activity. A relevant financial relationship is a relationship in any amount occurring in the last 12 months with a commercial interest whose products or services are discussed in the CME activity content over which the individual has control. Relationship information appears below:

Celestia S. Higano, MD, has disclosed the following relevant financial relationships:

Speaker

Amgen, GTX, AstraZeneca

Dr. Higano discusses the unlabeled or investigational use of a commercial product.

Joel B. Nelson, MD, has disclosed the following relevant financial relationships:

Speaker	Astra Zeneca
Consultant	Amgen, Millennium/Takeda, Roche

Fred Saad, MD, FRSC, has disclosed the following relevant financial relationships:

Speaker, Consultant

Amgen, Novartis

Matthew R. Smith, MD, PhD, has disclosed the following relevant financial relationships:

Consultant

Amgen, GTx, Novartis

Curatio CME Institute
Matthew Horn, MD, Medical Director, has disclosed no relevant financial relationships.
Jonathan S. Simmons, ELS, Managing Editor, has disclosed no relevant financial relationships.
Derek Warnick, CME Director, has disclosed no relevant financial relationships.

H. Lee Moffitt Cancer Center & Research Institute
Claire A. Modarelli, Manager, Continuing Education and Conference Planning, has disclosed no relevant financial relationships.

Bone and Cancer Foundation
Charlene Waldman, Executive Director, has disclosed no relevant financial relationships.

Cancer and Bone Society
Jeanette Ruby, Director of Development, has disclosed no relevant financial relationships.

Disclaimer
The information presented in this activity is for continuing medical education purposes only and is not meant to substitute for the independent medical judgment of a physician regarding diagnosis and treatment of a specific patient’s medical condition.

Unapproved Product Use
This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the US Food and Drug Administration. Curatio CME Institute, H. Lee Moffitt Cancer Center & Research Institute, the Bone and Cancer Foundation, the Cancer and Bone Society, and Amgen do not recommend the use of any agent outside the labeled indications.

The opinions expressed in this educational activity are those of the faculty and do not necessarily represent the views of Curatio CME Institute, H. Lee Moffitt Cancer Center & Research Institute, the Bone and Cancer Foundation, the Cancer and Bone Society, or Amgen. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.

Generic Name	Trade Name	Approved Use (if any)	Unapproved/Investigational Use
Alendronate	Fosamax	Treatment and prevention of osteoporosis in women; treatment of osteoporosis in men; treatment of glucocorticoid-induced osteoporosis in men and women; Paget’s disease in men and women	Treatment and prevention of bone metastasis; treatment and prevention of cancer therapy–induced bone loss
Denosumab	Prolia	Treatment of postmenopausal women with osteoporosis at high risk for fracture	Treatment and prevention of bone metastasis; treatment and prevention of cancer therapy–induced bone loss
Ketoconazole	Nizoral	Treatment of systemic fungal infections; treatment of patients with severe recalcitrant cutaneous dermatophyte infections who have not responded to topical therapy or oral griseofulvin, or who are unable to take griseofulvin	Treatment of prostate cancer; block production of testosterone
Zoledronic acid	Zometa (oncology in U.S.) Reclast (osteoporosis in U.S.) Aclasta (outside of U.S.)	Treatment of hypercalcemia of malignancy; multiple myeloma; solid tumors with documented metastasis to bone (in conjunction with standard antineoplastic therapy); prostate cancer that has progressed after hormonal therapy (U.S. FDA approved indications only)	Prevention of bone metastases; treatment and prevention of cancer therapy–induced bone loss

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