Clinical & Experimental Metastasis

, Volume 36, Issue 3, pp 199–209 | Cite as

Effect of bisphosphonates on overall survival in subgroups of patients with prostate cancer

  • Congcong Wu
  • Wenjun Chen
  • Jian Wu
  • Xi Zhang
  • Xuanzhang Huang
  • Ruifang Lin
  • Baoling Zhu
  • Hua JiangEmail author


Adjuvant therapy with bisphosphonates in prostate cancer is effective in improving bone mineral density and thus reducing fractures and skeletal-related events. We analyzed the effect of bisphosphonates on overall survival (OS) in subgroups of patients with prostate cancer. A systematic literature search was conducted of the PubMed database and the bibliographies of related studies. The long-term OS rates were extracted from every eligible trial. The hazard ratio (HR) was pooled with the fixed effects model, and preplanned subgroup analyses were performed. The search yielded 112 articles, of which 10 articles with 13 patient subgroups met the eligibility criteria. The meta-analysis of all 13 subgroups showed that adjuvant bisphosphonate therapy did not significantly improve OS versus the control group (HR = 0.961, 95% CI 0.899–1.026, p = 0.233) with low heterogeneity (I2 = 13.47%, degrees of freedom = 12, p = 0.336). There was no significant improvement in OS with the addition of bisphosphonates in the major subgroup analyses (metastatic (M1) versus non-metastatic, clodronate versus zoledronic acid, castration-sensitive prostate cancer (CSPC) versus castration-refractory prostate cancer). When the subgroups were further divided, adjuvant bisphosphonate therapy significantly improved OS in patients with CSPC + M1 (HR = 0.874, 95% CI 0.778–0.982, p = 0.023; I2 = 0.0%, degrees of freedom = 3, p = 0.579). Our study demonstrated that bisphosphonates do not significantly improve long-term OS in patients with prostate cancer. However, adjuvant bisphosphonate therapy significantly improves OS in the subgroup of patients with CSPC + M1.


Prostatic neoplasms Overall survival Bisphosphonates Meta-analysis 



We thank Kelly Zammit, BVSc, from Liwen Bianji, Edanz Editing China (, for editing the English text of a draft of this manuscript.


No specific funding was received for this study.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This study does not contain any studies with human participants or animals performed by any of the authors.


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© Springer Nature B.V. 2019

Authors and Affiliations

  1. 1.Department of Chemotherapy and RadiotherapyThe Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical UniversityWenzhouChina
  2. 2.Kidney Disease Center, The First Affiliated Hospital, College of Medicine, Zhejiang University, The Key Laboratory of Nephropathy and the Kidney Disease Immunology Laboratory, The Third Grade LaboratoryHangzhouChina

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