Pubic bone fractures in advanced mPC

[TKha]

Hello everybody. This is my first post in the forum. My father was diagnosed with advanced metastatic prostate cancer a month ago. PSA 575. Bone mets at multiple sites. He was diagnosed because he was having lots of bone pain, especially in the pelvis region. He could walk but sitting and getting up was painful, and there were general pains. Turns out he had two small fractures on the left pubic bone. Started ADT (casodex, lupron), zoledronic acid for bones. Had a radiation session too. A few days ago, he developed another fracture this time on the right pubic bone, a bit bigger one. Now very difficult to walk and he's so much in pain with only temporary relief from painkillers.

I searched a lot pubic bone fractures and mPC, but didn't find a lot of relevant results. I am curious as to why is that. Are such fractures common in advanced PC? I need help to chalk out the scenario for the future from those who have had more experience with this disease. Seeing my dad in pain is excruciating.

Thanks a lot.

[Tall_Allen]

Yes, such fractures are common. One or two zaps of SBRT to the affected area may stop the fracturing and relieve the pain. Chemo should help too. When he becomes castration-resistant, Xofigo may provide much relief. Here are the known therapies at this stage:

pcnrv.blogspot.com/2017/06/...

[TKha in reply to Tall_Allen]

Thanks for the reply and informative post. He did receive external beam radiation and the second fracture occurred after that. I don't know if it's same as SBRT that you're talking about.

[Tall_Allen in reply to TKha]

Hopefully, Xofigo and chemo will help stop the fracturing. He should add Celebrex, as suggested in the link..

[TKha in reply to Tall_Allen]

Thanks for the reply. The doc said Xofigo is for more later stage and first we'll try ADT plus zometa. Same for chemotherapy (later stage). They're following a more conventional route I think.

[Tall_Allen in reply to TKha]

That is not "conventional," it is not within the current standard of care.I think it is tragic that some doctors wait too long to give docetaxel, especially when there are multiple metastases. It has proven itself to be more effective when used earlier while the patient is still hormone sensitive. Xofigo is currently in clinical trials for use before castration-resistance sets in.

[TKha in reply to Tall_Allen]

I found a lot on the internet about Celebrex being bad for the heart?

[Tall_Allen in reply to TKha]

Celebrex is the only selective COX-2 inhibitor that was found NOT to be bad for the heart. As published in the New England Journal of Medicine, it had no worse effects on the heart than ibuprofen or naproxen:

nejm.org/doi/full/10.1056/n...

It is safer for long-term use for pain, because it doesn't have the GI side effects that NSAIDs cause. When combined with Zometa, there was a 22% increase in survival.

[cesanon in reply to Tall_Allen]

Tall Allen, do you have any opinion as to what extent, if any, is the following overview an exaggeration of the end stages of Prostate Cancer. It seems like once the cancer gets to the bones it is able to cause a lot of pain.

quora.com/What-happens-in-t...

healthunlocked.com/advanced...

[Tall_Allen in reply to cesanon]

Here's the latest analysis I've seen about it:

renalandurologynews.com/pro...

[cesanon in reply to Tall_Allen]

Thanks that link was helpful

[lincolnj8 in reply to Tall_Allen]

Nice link. Very informative..

[cesanon in reply to Tall_Allen]

Nice link. I found it very useful.

pcnrv.blogspot.com/2017/06/...

[TKha]

The doctor just noted it and said take rest, gave some pain medicine, etc. But as I searched the internet, while I did find fractures to be a common occurrence in advanced mPC but didn't find really any results for pubic bone fracture. My dad didn't have surgery so the cancerous prostate is still there.

[TKha]

BTW, his ichium bones (lower pubic bones, maybe) do not really show on x-ray, but shows they are heavily affected by mets. Is that common? Maybe that's putting pressure on the pubic bones.

[TKha]

He already got radiation to pelvis. How much time does it take for radiation to work? One fracture he got was after radiation. Thanks