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Bone Density after long use of Casodex

HRS
Posts: 5
Joined: Dec 2017

Bone Density after long prostrate cancer control.

I had a radical prostatectomy in 1993 and everything was fine until 2000 when my PSA jumped to 50-60.  The PSA has been controlled with Leuprolide & for the last 4 years with casodex and my PSA is still only 0.4 or so.

 

However, after being on Leuprolide & casodex for so long, now my problem is bone density of both femurs, which at the femur neck is -3.5, averaging overall -2.7 for osteoporosis.

 

There are drugs to help osteoporosis, but most are for postmenopausal women androgen hormones and increase testosterone levels. 

 

As I understand it, prostrate cell feed on testosterone and casodex keeps those levels down (mine is 0.0).  What medicines should I take to control my bone density and still keep my prostate cancer under control?

VascodaGama's picture
VascodaGama
Posts: 2958
Joined: Nov 2010

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 

HRS
Posts: 5
Joined: Dec 2017

VGama,

Thank you for your response. 

To answer your questions:

 

In 1993 I was 66 yrs. old (I’m 90.7 now) and chose a radical prostatectomy over other treatments because my Urologist determined by biopsy my cancer was advanced.  After surgery I had a PSA test every year or so until 2000 when it had increased to some 50-60, indicating that all the prostrate cells were not removed by surgery & I started getting Leuprolide shots every 3-4 months which controlled my PSA.  ( No radiotherapy ) My Urologist from 2000 – 2012 ordered 3 bone scans, with last in 2011 with results:

The T score of the lumbar spine is -l .2, which is osteopenic,
The T score of the left hip is -1.6, which is osteopenic
.

 

In 2012 I moved to a new city and chose a Oncologist MD for my PC and he put me on Casodex rather than Leuprolide shots. My PSA, run every 6 months, has remained low at 0.2- 0.4.  I have no long bone pain.

 

In December 2017, I decided I better check my bone density, knowing that hormone treatment affected bone density and the femur neck T score is -3.5, averaging overall -2.7 for osteoporosis. My spine was OK, averaging 0.2 (lowest was L1 region = -1.6)

 

I take Calcium with B12, and in 2015, my blood assay for Vitamin B12 = 411, Folate = 19.4. Vitamin D = 55.  All other blood chemistries are normal.

 

My Oncologist has recommended a shot every 6 months, probably Prolia. 

 I will seek additional information on your recommendations. My main concern now is making sure treatment for bone density doesn’t impact my cancer treatment.

 

Thank you for your comments & assistance.

 

Hal

 

 

VascodaGama's picture
VascodaGama
Posts: 2958
Joined: Nov 2010

Hal,

Thanks for the story. Your long fight and believing in victory by standing positive on the matter is excellent. There are not many 90ths in this forum but the ones that report have astonishing stories like that of yours. You guys are superb persons providing us, youngsters, the inspiration to believe that we also can do what, at beginning, seems so difficult to accomplish. Life after a diagnosis is not easy. One needs to learn to accept it and trust our newer we.

Please note that in my previous post I have mistakenly written the drug name Xgeva instead of Xofigo. Xgeva or Prolia are the same (denosumab) drug. Xofigo (radium 223) is a drug to tackle bone metastases. In such regards, you did not comment having results from image exams confirming cancer in bone so that I believe you should just care for the bone loss. This is a condition common in aging due to our body rhythms. They are periods in our life when the internal "body clock" is affected by the environment or by drugs/food we take or that are lacking and not balanced in our way of living. We all experience that independently of being male or female and the treatment is equally done to men and women.

I think you are worried with treatments involving androgens to balance the clock, such as the HRT (estrogens) typical of women or TRT (testosterone) in men. No doubts that both androgens manage to revive the bandit in its struggle for survival, however these do not manage to cause mitosis (cells duplication) so easily. In any case I would avoid TRT and try balancing the situation via diets and soft physical fitness programs proper for your life style, if possible. Prolia and Zoledronic Acid (both recommended drugs for PCa guys) are proper and do not interfere with the antiandrogens (Casodex) action on the cancer.

I think you can start a bisphosphanate however these drugs got attached conditions, risks and side effects that you need to take into consideration when choosing. I would get the opinion of the oncologist but would do previous investigation about other health status and requirements which may prohibit the use of those drugs. For instance, Prolia is contraindicated in people with low blood calcium levels and Zoledronic Acid can lower calcium levels in the blood dangerously. All bisphosphanates are linked to the condition of osteonecrosis of the jaw so that one should get any dental job done before starting the treatment. These drugs' most common side effects are joint and muscle pain in the arms or legs.

Get your lipids checked, calcium and vitamin conditions, and get a testosterone test to verify any hypogonadism condition. Please read the following links regarding a list of drugs and their comparisom:

https://treato.com/Prolia,Zoledronic+Acid+(aclasta)/?a=s 

https://www.gov.uk/drug-safety-update/denosumab-xgeva-prolia-intravenous-bisphosphonates-osteonecrosis-of-the-jaw-further-measures-to-minimise-risk

https://www.drugs.com/drug-class/bisphosphonates.html

Best wishes the New Year.

VGama

RobLee's picture
RobLee
Posts: 259
Joined: Feb 2017

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!

 

HRS
Posts: 5
Joined: Dec 2017

Vascoda & RobLee

 

Gentlemen, thank both of you for your help and information,

 

Guess I need to do some literature work that Vascoda recommended before I make any decision on treatment. Both of you are most kind in your comments on my perseverance, and I thank you for them, but one just takes life’s problems as they are presented and enjoy the gift of another sunrise.  

 

Seven years ago, I had a Technetium-99 scan done that showed only mild arthritis in spine and nothing in long bones, but that was the time my bone density was.  Perhaps I should have another test done, however I have no pain in bones as yet.  So Vascoda, major mitosis evidently is not occurring. (recalling my Cellular Physiology course from Oh, so long ago), but stopping Casodes my PSA rapidly rises, meaning the little devils are somewhere.

 

RobLee, your info on jaw problems is appreciated, because I had not given much thought to that.  I still have teeth on lower jaw & have a partial there, so what to do needs thought.  I need to balance how much repair drugs will give me against the side effects.  I remain active, live alone with my dog, as I wish, for my children are scattered.  I stopped riding my horse in the Arizona desert 30 years ago, but drive my car to the empty lands to watch the sunset & hear the quail call.

 

Hal

Old Salt
Posts: 720
Joined: Aug 2014

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
Posts: 5
Joined: Dec 2017

Old Salt,

Perhaps that is a good thing to do.  I get some exercise walking every day some 1/2 mile in the afternoon, but a specific program might be better.

thanks for the suggestion, that might see a faster effect than drugs.  I'l find a program & do it.

Hal

Will Doran
Posts: 207
Joined: Sep 2015

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

HRS
Posts: 5
Joined: Dec 2017

Thank you Will,

 

You have had a very difficult time & I greatly appreciate your helping with your story with Prolia. 

 

I have pretty much decided not to take Prolia because of the side effects & treat my bone density with exercise & Calcium pills.  My bone density is not extremely bad & at my age should only decrease some in the next 2 or 3 years.  After all, how much time do I really have?  While I’m in good health I really can’t expect 5 more years & if I’m careful I should not have a femur break.  Just playing the odds.

 

Your experience with Prolia has strengthened my opinion of Prolia for my case & I really appreciate your comments.  I’ll watch for a hawk to remind me of your story.

 

Hal

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