Background: Although the adjuvant therapy of bisphosphonates in prostate cancer is effective in
improving bone mineral density, it is still uncertain whether bisphosphonates could decrease the risk of Skeletal-
Related Event (SRE) in patients with prostate cancer. We reviewed and analyzed the effect of different types of
bisphosphonates on the risk of SRE, defined as pathological fracture, spinal cord compression, radiation therapy
to the bone, surgery to bone, hypercalcemia, bone pain, or death as a result of prostate cancer.
Methods: A systemic literature search was conducted on PubMed and related bibliographies. The emphasis
during data extraction was laid on the Hazard Ratio (HR) and the corresponding 95% Confidence Interval (CI)
from every eligible Randomized Controlled Trial (RCT). HR was pooled with the fixed effects model, and
preplanned subgroup analyses were performed.
Results: 5 RCTs (n = 4651) were included and analyzed finally after screening 51 articles. The meta-analysis of
all participants showed no significant decrease in the risk of SRE when adding bisphosphonates to control group
(HR = 0.968, 95% CI = 0.874 - 1.072, p = 0.536) with low heterogeneity (I2 = 0.0% (d.f. = 4) p = 0.679). There
was no significant improvement on SRE neither in the subgroups with Metastases (M1) or Castration-Sensitive
Prostate Cancer (CSPC) (respectively HR = 0.968, 95% CI = 0.874 - 1.072, p = 0.536, I2 = 0.0% (d.f. = 4)
p = 0.679; HR = 0.954, 95% CI = 0.837 - 1.088, p = 0.484, I2 = 0.0% (d.f. = 3) p = 0.534).
Conclusion: Our study demonstrated that bisphosphonates could not statistically significantly reduce the risk of
SRE in patients with prostate cancer, neither in the subgroups with M1 or CSPC.