Glucocorticoids & Bone demineralization.

[pjoshea13]

New paper below [1].

"Results from the ERA 223 trial of abiraterone combined with radium-223 among men with chemotherapy-naïve castration-resistant prostate cancer and bone metastases show no improvement in survival free from symptomatic skeletal events. We hypothesize that this finding might be attributable to bone loss induced by the concomitantly administered prednisone."

From 2010 [2] - a dog experiment:

"All animals received prednisone orally at a dose of 2 mg/kg of weight for 30 days" - resulting in "a loss of bone mass of approximately 14%".

In another 2010 non-PCa paper from the Netherlands [3]:

"High incidence rate of vertebral fractures during chronic prednisone treatment, in spite of bisphosphonate or alfacalcidol use."

-Patrick

[1] ncbi.nlm.nih.gov/pubmed/307...

[2] ncbi.nlm.nih.gov/pubmed/210...

[3] ncbi.nlm.nih.gov/pubmed/204...

[NPfisherman]

Thank you for posting, Patrick...so from those trials, I have to believe a fracture, possibly spinal is in my future--on zytiga, Lupron, and prednisone. I just had a bone densitometry test--results pending... People on alendronate had 1 fracture in 2.7 years. Currently I take Vit D and get my calcium through food intake. If you were me, what else might you do/advise...Thanks for your input in advance...

Fish

[Hidden in reply to NPfisherman]

The trial here is with Zytiga combined with Radium 223 so as long as you are not taking those together, you don't have a higher risk of fracture. It should be lower actually. Zytiga plus prednisone has increased the time to radiographic progression in trials.

accessdata.fda.gov/drugsatf...

[NPfisherman in reply to Hidden]

Thanks Gregg....I still worry...about everything.....as my MO said, "You are now hypersensitive to everything about your body as a result of your diagnosis"... It is true...I am into this early and trying to find the right supplements, diet, etc to maximize my fight, while I hang on for breakthroughs.... The same strategy that everyone here has... I had a bone densitometry study and hope all is well....lifting weights about 4 days a week, sometimes more...we do what we can...Good luck, amigo...

Fish

[Hidden in reply to NPfisherman]

As far as I could see in the trial data, the trials have shown a longer time to skeletal events which include fractures. Fractures can eventually develop, but it looks like the time until that happens is longer with Zytiga plus prednisone vs. Placebo.

[NPfisherman in reply to Hidden]

I was looking at incidence ...it was like 2.5 for placebo plus prednisone vs 5 for zytiga plus prednisone as I recall, but I may be wrong...It definitely delays the time to skeletal events...it's a worry.... one guy said it best....I'd just like a day when I didn't think about this...I'd like 2 hours myself... I do wonder if I dream about it...at least sleep may give some relief...

All the best, Gregg and thank for posting

Fish

[Hidden in reply to NPfisherman]

I get relief in my dreams when I can become awake when I'm dreaming. Did it last night and I feel great today.

[NPfisherman in reply to Hidden]

I did review your info on zytiga and it looked like those on zytiga plus prednisone had a higher level of fractures than those on placebo plus prednisone, but in our fight, it is all about survival:

cancer.gov/news-events/canc...

I am hopeful with a low tumor burden, and started early that this may last for a while...My MO has a guy similar to me that has been on zytiga and Lupron for 6 years without resistance, and still going...

This disease plays havoc with your mind...

Every new pain makes you wonder...

Have a great day,

Fish

[Hidden in reply to NPfisherman]

Yes, I just went through a bout of worry/depression about lower back pain. I have blood tests coming up, worrying about progression, etc. Another case of Prostate Specific Anxiety. I'm feeling better today about things, but it's always hanging over us like a flock of vultures.

[NPfisherman in reply to Hidden]

My MO says if a pain/ change happens in your body and goes away--try and relax--you're 60--if it stays and doesn't go away, contact me...Have some pains from playing BBall with my 28 year old son...the dude is solid...knocked me on my butt a few times...LOL...

Yes, this disease is like a flock of vultures flying over you...hoping some of the new trials for castrate resistance drugs will succeed, and will make them buzzards look a little further off..

Good luck, amigo...

Fish

[pjoshea13 in reply to Hidden]

Gregg,

Not a "flock". When vultures are circling above, some call that a "kettle". But if they are on the ground, they are called a "wake". Keep them circling. If they are neither circling or feeding, a group is called a "committee".

-Patrick

[Hidden in reply to pjoshea13]

Thanks for the terminology. It's funny that if they are not accomplishing anything it's called a "committee". Sounds like politicians.

[monte1111 in reply to Hidden]

Yeah. I got the circling of vultures as the pharmaceuticals. But they are at least extending our lives. So, vultures, parasites, saviors? A lot depends on what mood a person is in.

[RayF in reply to pjoshea13]

Better than a murder of crows!

[j-o-h-n in reply to pjoshea13]

If you're eating them during Superbowl they're called Buffalo wings...

Good Luck, Good Health and Good Humor.

j-o-h-n Tuesday 02/05/2019 634 PM EST

[RayF in reply to NPfisherman]

I've been having headaches off and on, some bad. I just kept my doc updated, and they sent me for a brain, MRI. It is negative, so I am relieved about that. I can live with a headache, I just want to know if it's cancer or not.

[NPfisherman in reply to RayF]

Here is a post from Todd Seals--he posts here--he had HA with Zytiga...

toddseals63.blogspot.com/20...

Take care,

Fish

[pjoshea13 in reply to NPfisherman]

Fish,

Estradiol [E2] is often neglected. Many know that it can be elevated in aging men. Should not be >30 pg/mL. But for bone health in men on ADT, it should not be <12 pg/mL. A low-dose Vivelle-Dot E2 patch will correct deficiency.

You don't mention vitamin K above. K2 will ensure calcium is transported to bone - & not packed into arterial walls.

-Patrick

[NPfisherman in reply to pjoshea13]

Patrick...I have never had an estradiol level...a vitamin K level either, but with vitamin K, it can effect blood clotting, which is something that anyone with a cancer must worry about since cancer leaves us in a hypercoagulable state...normal vitamin K sounds good.. The estradiol could help with the hotflashes but I don't want to end up a C cup from gynecomastia ( probably a B cup now--LOL).. ADT may be saving my life, but I feel no love for it... Some things for me to think about, and ask my MD...

Thanks for the input,

Fish

[pjoshea13 in reply to NPfisherman]

Fish,

Normal E2 for a man is 20-30 pg/mL.

If pg/mL goes below 12 pg/mL because T is castrate, there will bone loss.

The purpose of the Vivelle-Dot low dose E2 patch is to get E2 to about 20 pg/mL - that is still low for a man.

Vitamin K does not cause blood clots. A vitamin K deficiency, as caused by Warfarin, will slow coagulation. It's a lousy way of dealing with abnormal coagulation because Warfarin weakens bones & increases calcification of arterial walls.

Vitamin K is needed for the production of several coagulation factors, but their presence does not trigger coagulation. Clotting is a result of the 'coagulation cascade' & involves many coagulation factors. None of these factors make coagulation more likely.

-Patrick

[NPfisherman in reply to pjoshea13]

Thanks Patrick,

I had always heard from the PharmD I worked with that because cancer is a hypercoagulable state, to watch out for blood clots...The info below helps clarify what you said which is there is no known risk for excessive Vit K...thank goodness I eat my Broccoli...

ods.od.nih.gov/factsheets/V...

You are always a wealth of information... Thanks for clarification...Indeed, Vit K seems good for cancer...

Have a great day,

Fish