ESMO recommends initiation of bone-targeting agents at diagnosis of bone metastasis, with denosumab as a product of choice vs zolendronate⁸

Metastatic bone disease treatment algorhythm includes denosumab for patients with mCRPC⁸

ESMO highlights:⁸

• Denosumab or zoledronate is recommended in
  patients with CRPC and bone metastases, whether
  they are symptomatic or not [I, A].
• From efficacy, convenience and renal health perspectives, denosumab is the preferred agent.
• In the randomized trial in men with bone metastases from CRPC, denosumab delayed the time to first SRE and showed 18% reduction in cumulative SREs over zoledronate.⁹
• Bisphosphonate treatment is recommended  to suppress rebound osteolysis if denosumab is discontinued for 6+ months [III, B].