Bone care

[joancarles]

Hello friends! I am 51 years old and PCA stage IV. At the time of diagnosis PSA 1390. At present PSA 0.22, after 6 months treatment with ABIRATERONE.

It seems that there is a lot of bone spread.

How are you looking after your bones? Any advice?

[RyderLake2]

Hello joancarles, in addition to daily Vitamin D and Calcium, I receive once every six months an injection subcutaneously of Prolia (aka Xgeva). The medical name is denosumab. I am on a maintenance dose of 60mg. This drug is used to treat bone loss in men who are at high risk of bone fracture while receiving hormone treatment. Good luck!

[joancarles in reply to RyderLake2]

Thank you very much! I have listed all your recommendations to treat them with my doctor.

A hug and good luck

[Tall_Allen]

Xofigo can shrink bone mets and relieve bone pain, but it should not be combined with abiraterone. Zometa or Xgeva can prevent bone loss from the ADT. That can help prevent fractures and spinal compression. If you take one of them, ask to add Celebrex as well. If there are particularly large and painful bone mets, you can have them zapped with one or two doses of SBRT.

[joancarles in reply to Tall_Allen]

Thank you very much for the information. I have no pain, no discomfort. But I would like to give them the maximum so that they cause me the minimum of possible problems.

[Chazem in reply to Tall_Allen]

Why Celebrex?

[Tall_Allen in reply to Chazem]

Because the combination of Zometa and Celebrex in metastatic men increased survival by 22% in a major randomized clinical trial (STAMPEDE). Neither alone had any effect on survival, only when both were used together. Earlier retrospective studies had suggested that either might improve survival. Here are the published trial results:

ascopubs.org/doi/10.1200/JC...

[Chazem in reply to Tall_Allen]

Thanks

[Dan59 in reply to Tall_Allen]

I have been trying to switch to 3 month xgeva for a while, they say there is only evidence for the 4 week use, do you suppose they would use the zometa study. Do You have those results. Also is there any evidence adding celebrex to xgeva increases median survival, or do we assume that it will be the same as adding SOC+Zometa+celebrex. Thank You for your time

[Tall_Allen in reply to Dan59]

I assume they will be very much the same. Xgeva and Zometa both change the bone microenvironment similarly, decreasing osteoclast activity, although the way they accomplish it are different. COX-2 inhibition on top of that seems to make the bone less hospitable to cancer. Or maybe they synergistically are directly inhibitory or cytotoxic to the cancer. Since Celebrex has low toxicity, I can't think of a reason NOT to use it when taking Xgeva.

Below is the RCT that justified the 3-month dosing interval rather than monthly. There hasn't been a similar RCT for Xgeva. We do know that side effects (jaw necrosis) occur with longer use. Why not try the 3 month interval and see if your BMD is any lower?

ncbi.nlm.nih.gov/pmc/articl...

[Dan59 in reply to Tall_Allen]

Thanks Tall Allen, I will bring that paper when I go next, and the one on celebrex, maybe drop metformin and add celebrex, and ask for 3 month xgeva. I was heavily pretreated with zometa for well over 7 years but on the 3 month as per Sartor in 2007.

[JamesAtlanta]

I take a calcium supplement daily and also have an injection of Xgeva. I was taking Xgeva quarterly, but my MO at MD Anderson moved it to every 6-months. My bone density is fine, and she was concerned that there are not enough long term studies on any adverse impact of being on Xgeva for a long time.

Hope this helps!

James

[joancarles in reply to JamesAtlanta]

Many thanks! I take note of all the advice

[joancarles]

Many thanks! I take note of all the advice

[Dan59]

Joan Carlos, others have made excellent coments on supplement to support bone health, with your psa dropping so nicely , i am confident you will eventually see significant reduction in scans, It would be to early for xofigo in my opinion , but either zometa or xxgeva would be indicated, I did 3 month zometa for many years after my stage 4 dx bpsa148 ,gleason 10 with widespread metastatic disease to bone in 2006, I assume you are also on Lupron or zolodex. You have had a nice response , my psa nadir was actually 3. We had a great time in Barcelona a few years ago travelled accross Southern Pyrenees to San Sebastian then across northern Pyreness and Back to Barcelona. I wish you the best, you can see my history by clicing on my picture.

Dan

[joancarles in reply to Dan59]

Thank you very much! I see you have a great story. And I appreciate the attention you give to all of us. Barcelona is a beautiful city, I hope we have treated you very well.