Husband was dx with aggressive PC July 2014 at age 57, had RP done Aug. 2014 with Total GS 7. Then Nov. 2015 had a BCR and received 6 months ADT along with 39 IMRT treatments. All good until Mar. 2017 when PSA rose a little and by Oct. 2017 confirmed BCR again with rapid doubling times. Finally had a PSA high enough for MO to ordered Axumin on 8/29/18 - results showed a small right pelvic lymph node, all else clear. Started ADT 9/4/18, then had Orchiectomy Jan. 2019. Currently have PSA <0.01 & Testosterone <1.0 and have been since Jan. 2019. All CT's and Bone Scans have always been clear, only thing that has shown up was the node on Axumin.
MO wanted to start Prolia without ever doing a DEXA, we said no until we know if his bones are thinning. MO said insurance won't cover DEXA for men and it wasn't SOC, but if we wanted to pay she would order it... we said yes, we want it! The DEXA is scheduled with his CT's and Bone scan for end of this June. His follow-up with MO for results is July 8 and MO has first Prolia shot scheduled for that visit.
Question is - If DEXA comes back normal, would you start the Prolia, as MO advises for "Bone Health"? We're aware of possible serious side effect to the jaw with these drugs and don't want to start it if his DEXA is good, but don't know if he needs it anyway due to his ADT's then Orchiectomy. DH is NOT castrate-resistant yet, if that makes a difference.
If DEXA is good and we wait, how do we know when to start it... when do you repeat a DEXA (I know for women it's done every 2 years)?
Thanks in advance for all your knowledge and opinions, they are a true blessing to us!
Did the salvage radiation include treatment of the pelvic lymph nodes?
In the US, DEXA is covered by most insurance for men on ADT. Why start it before he has to? Side effects (like osteonecrosis) increase over time, and what is the point if his bones are dense without it? Weight bearing exercise may increase his bone mineral density, so that he never needs it.
The pelvic node was inside the area that was already treated with radiation and the RO said he could not radiate that same area, because it would cause damage.
Glad your thoughts are the same as ours, if it turns out his DEXA is normal, we didn’t see the need to start the Prolia. And yes I did find out that our insurance does cover it, so the MO shouldn’t have made that statement because it appears some insurance companies do cover it.
How often should he have the DEXA done?
Annually would catch any osteopenia. The X-ray dose is low.
Great, thank you so much!!
TA, why not use Celebrex along with Zometa (for bones). Wasn’t that combination shown to reduce deaths by over 20%?
That was only among men with distant metastases (M1)