Prostate cancer treatments, particularly hormone therapy (ADT) can have a significant effect on speeding up the process of thinning and weakening the bones. There are some available treatments (Zoledronic acid aka Zoladex and denosumab aka Xgeva) which are designed to slow down or reverse this process; however, they are known to have many adverse side effects themselves. These side effects can include severe fractures of the femur which could limit survival and cataracts. For this reason, these treatments are usually used later, when men become castrate resistant and metastatic.
An application has been made to the FDA for apalutamide, a possible hormonal treatment for men who are castrate resistant, but not yet metastatic.
Two game changing trials demonstrated that the early use of Zytiga along with hormone therapy (ADT) can provide a significant survival advantage for men with aggressive, hormone naive prostate cancer. The data is very clear for men with metastatic disease, but there remains some controversy if this holds up for men who are not metastatic.