Bone Density after long use of Casodex

HRS,

Welcome to the board. I wonder your age and any particulars of your diagnosis back to 1993 and the clinical stage attributed to you in 2000. I think that you are on hormonal therapy (HT) because of recurrence in 2000. When such occurs doctors typically recommend salvage radiotherapy (SRT) or a combination of RT plus HT. Have you done SRT or have you been on HT alone since 2000?

I am also curious about the results of image exams done in the past and the reason that took you to get a bone densitometry scan this time. Do you have symptoms like bone pain?

In any case, according to your comment the treatment is providing control so that you should continue it, but HT in long periods also deteriorates bone health and that may be one of the causes of your osteoporosis. Typically doctors recommend to PCa patients in hormonal therapies infusion of Prolia (every six or four months). There are also drugs that attack cancer in bone while helping in the treatment of osteoperosis, such as Xofigo, but I assume this not to be your case yet. Fosamax (Zoledronic acid) is the cheap way to protect against further deterioration.

Other causes of osteopenia/osteoporosis are the lack of vitamin D. I recommend you to get tested to verify what may be lacking in your diet. B12 is also required for better metabolism of vitamin D. Here is a link in regards to diets recommnended to PCa patients;

http://cancer.ucsf.edu/_docs/crc/nutrition_prostate.pdf 

Best wishes,

VGama 

Vasco has provided his usual thorough and comprehensive account of conditions and treatments, and as he has noted your history and longevity are an inspiration for us younger fellows in our 60's and 70's. Regarding the side effects of Prolia and bisphosphonates in particular, these can have profound impact on your oral health. If you still have any natural teeth (at your age!) you would likely be wise to have them extracted beforehand and/or any planned dental implants completed before initiating any treatment involving drugs in this class. Additionally if you may have dentures you should have a mandibular CT scan to verify the strength of your jaw, as these drugs may result in fractures of the jaw simply by the act of eating.

The femur neck is a traditionally tragic location for fracture, so extra care must be honored in your activities... surely no news to a man of your experience!

Prior to starting hormone therapy (at age 73),  I had my bone density checked to establish a baseline. Lo and behold, the results showed that I already had osteoporosis in my spine and osteopenia in my hips. What to do?

I read up on the drugs that could be used to maintain, as best as possible, bone health and decided, with the consent of my General Practioner, to get a one-time infusion of zoledronic acid (Reclast). I also talked with my dentist because of potential problems (such as necrosis of the jaw) resulting from this drug (and other bisphosphonates).  This issue of side effects has been mentioned in earlier posts in this thread. But the point I really want to make, and which hasn't been mentioned in this thread, is that exercise is really important. I am talking of exercises that specifically help to maintain bone density. Although I can't prove this, a NATURAL approach to (re)build bone is to be preferred over pharmacological ones (drugs). There are exercise classes that can help with this. I was fortunate to find a Bone Builders program in my area. Proper nutrition (calcium, vit D etc) is also very important for bone health.

Considering the age of the OP (almost 91) and his relatively good QOL, I would recommend appropriate exercise and nutrition to minimize further deterioration of bone density.

Here is a link to a website from an organization that offers more information:

https://www.nof.org/

HRS,

Sorry to hear of your situation.  

I had Robotic Assisted radical  prostatectomy surgery in Dec 2013. I was a Stage pT3bN1(post surgery pathology) when diagnosed. With a PSA of 69 and Gleason 7. I Was on Lupron for two full years, and had 8 weeks of follow up radiation to the Prostate Cavity. My Chemo Oncologist insisted that I should be put on Prolia.  My Surgeon and GP were against that.  Especially my GP (former student of mine).  He refused to put me on the Prolia, and the Chemo Oncologist and he had several "go arounds" about it.  Chemo Oncologist wouldn't prescribe it and said my GP had to do that.  So, we didnt' go on Prolia.  Then She (Chemo Oncologist) left tne Cancer Center.  I went with a PA instead of a doctor because they really weren't doing any treatments on me.  She (PA), then did a bone debsity scan, and insisted I go on Prolia.  I had lost a little density in my hips, but was not listed as  osteoporosis.  My testosterone had been down to 17.  It's back to normal right now.  So, then the PA left the Cancer Center.  My new Chemo Oncologist took me off the Prolia because of the sever pain and aches it was causing in my leg muscles and joints, and my jaw.    Also was having increasing muscle weakness in my legs.   He ( the new Oncologist) said I should have never been put on the Prolia from the start.  I didn't need it, because I was just down slightly in density, but had actually increased density in the rest of my body.  I'm taking Vit D and Calcium twice a day.  My GP put me on that from the start.  Then the original Chemo Oncologist said my Blood Calcium (from blood test results) was too high and told me to stop the Calcium and B12.  I will have a new bone density test in February to check progress.  If I'm holding steady we will stay off Prolia.  If not, my Onclogist said there are other ways of dealing with this concern.  The problem is, the damage is done.  My Muscles in my legs are back to feeling pretty good.   Most of the bone ache has subsided, however the arthritis in my hips has gotten worse and I am now walking with a cane all the time.  Still doing my weight lifting and spinner bike exercise.

I am not a doctor, and can only tell you what I've been through. However, my advise to you is make sure you understand what Prolia can cause. Be careful and ask as many questions as you can think of.   I had a very bad reaction to it.  From the start, my GP was telling me about diet and Exercise.  Which I had been and am still doing and watching.  Then we added the Calcium Supliments and Vit D.  If only I had listened to Jeff, I don't think I'd be dealing with the problems I am now.  My Urologist / Surgeon says the same thing.  At least all my doctors are on the same page now, and they are in touch weekly about shared patients. When you see those Ads on TV about Prolia,  Take them with a grain of salt.  I'm sure those women are actors.  At least from my experience.  If I felt that good, I'd say take the Prolia, but that isn't what I've experienced.  I agree with what has been stated above.  Get out and enjoy drives (nothing like a good Rumble in my Hemi Dodge Challenger, or a drive in my wife's Jeep Trail Hawk) , sunsets, thunder storms, snow, birds (especially when a red tailed Hawk lands on our deck and sits on the railing watching for prey), deer and bear (where we live), etc.  That's what my wife and I do.  

I wish you the best, and hope you find a  solution that works well for you.

Take Care

Love, Peace and God Bless

Will