My dad, 75.5 years old was recently diagnosed with stage 4 prostate cancer with PSMA PET SCAN showing Mets to multiple distant lymph nodes and one met on the pelvic lymph node. He does not have any pain and got detected due to a constipation problem. His initial psa was 114 ng/ml, Gleason 4+4, he got orchiectomy and Casodex n within 3 weeks Psa was down to 4.66 ng/ml and is now on 1000 mg Abiraterone and 10 mg prednisone for 2 weeks. He got his dental cap refilling done as his MO said he may consider giving him zometa IV for bone strength.
Is zometa given only to people with multiple bone Mets as it is for your bone strength or is to be administered to people with distant lymph node mets also ? Also, what all dental work should be done before it ? As owing to his age dental work may arise in the future as well, which can’t be controlled from now. Also usually PCA metastasis happens to the bones, his is in the distant lymph nodes - does this affect his treatment and prognosis? I would really appreciate any guidance.
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"Zoledronic acid is an established adjunctive treatment and bone-targeted therapy for the supportive care of men with metastatic castration-resistant prostate cancer. Efforts to study its utility in earlier phases of metastatic hormone-sensitive prostate cancer has not shown superior outcomes compared with standard androgen deprivation therapy (ADT) or docetaxel alone."
Zoledronic acid for the treatment of prostate cancer.
Finianos A1, Aragon-Ching JB2.
Author information
Abstract
Prostate cancer remains the most common solid tumor afflicting men in the developed world. Metastatic prostate cancer is a source of great morbidity and mortality especially due to osseous involvement that gives rise to significant symptoms of pain or pathologic fractures or cord compression. Bisphosphonates had been widely used in the treatment of metastatic prostate bone metastases given their demonstrated benefit with a delay of skeletal-related events (SREs) but without prostate-specific antigen (PSA) response or overall survival benefit. Areas covered: In this review, the authors summarize the available literature on the clinical studies that led to the development and regulatory approval of zoledronic acid in men with metastatic prostate cancer. The authors also provide their expert opinion and future perspectives on this therapeutic. Expert opinion: Zoledronic acid is an established adjunctive treatment and bone-targeted therapy for the supportive care of men with metastatic castration-resistant prostate cancer. Efforts to study its utility in earlier phases of metastatic hormone-sensitive prostate cancer has not shown superior outcomes compared with standard androgen deprivation therapy (ADT) or docetaxel alone.
Zometa prevents the bone loss that often happens as a result of hormone therapy. That thinning of the bones can lead to fractures and spinal compression. Before taking it, he should have a DEXA scan to determine what his bone mineral density is. If he can maintain his bone strength with exercise, that is preferable because the side effects, such as the ones you are worried about increase with the number of years he is taking it. If he needs Zometa, tell his dentist, who will check him out thoroughly.
Lymph node only mets have a better prognosis than bone mets, which is, in turn, better than liver mets.
If he has osteopenia or osteoporosis then zometa or prolia may be right for your father. I am doing Prolia once every 6 months with no obvious side effects. You have to be careful about dental work when taking these drugs.
I take Zometa ... mine is a 15 minute infusion monthly. For me , Zometa has some extremely strong unpleasant side affects every month. I spend the 4 - 6 days after each treatment violently ill. Just imagine the worse case of flu you ever had and multiply that 10X.
The morning of your infusion remember to take a strong otc decongestant before you leave .. and take some sports drink with you to the infusion. After the infusion start drinking the sports drink immediately, drink several bottles of it as much as possible. you want to clean out the Zometa as fast as possible. Sooner helps a lot. If you start having chest bone joint pains and painful breathing ( feels like broken ribs ) , I use those cans of sports oxygen to huff to help get my breath back with such small inhales.
At first I would wake up in the middle Of the first night in a bone rattling cold shivers and trouble breathing. Jumping in hot Jacuzzi or hot bathtub quickly makes the cold chills disappear. Don’t hesitate to use your daily pain meds , even your break thru med if needed. Finally .... for me ... there is a psychological aspect to Zometa ... it creeps up on you over a couple days after the infusion and suddenly you may realize you need a little of your Xanax to get hold of the mental instability if you experience it ... then , for me, just VERY suddenly ... out of the blue ... 3 - 5 days later , you feel something let go of you . Just kinda suddenly you realize it quickly is “ letting go “. Then suddenly you feel pretty good. Still for a few days after the feel good part , minor stuff can hang around off and on.
If you have a lot of bone mets and low T, a treatment like Zometa Is probably very important to you . Myself I realize how important this infusion is to my continued quality of life ( collapsed vertebrae is bad ) , and although rough to experience Zometa is very important and I gladly live with the rough part to receive the benefits. It gets easier over time. You got this.
Best wishes
Of course everyone is different, your experience may vary considerably . ( hopefully ).
Given the severity of your reactions to Zometa, I would think that would justify switching to Prolia, a subcutaneous (not IV) injection given every 6 months. Adequate supplemental Calcium and vitamin D should be maintained to prevent hypocalcemia.
You’d think there would be alternatives that would be effective. I’ve mentioned the side effects at the infusion clinic ... there they are macro focused on the infusion and no doubt hear this stuff all the time. They think my experience is common and expected. They do give you the decongestant and sports drink advice. My onc doc thinks I’m tolerating it well , he says ( guess if you don’t hit E.R. afterward you are good to go ) and since my treatment is holding at undetectable... wants to stay with what’s working ... until it doesn’t.
No doubt the physicians experience , diagnostic bone scans and other diagnostic details play the major role in the decision.
It’s messy for a few days then gone and the benefit is substantial.... I got this 💪💪💪 👍
My onc doc asked why I was hitting myself in the head with a hammer .....
I told him .... I do this because it feels so good when I stop.
I've been on Zometa for a year and a half now without any discernible side effects. Of course, it's a bit difficult to determine the cause of any aches and pains - from the therapy, the cancer itself, some non-cancer problem or "idiopathic". We're all individuals and can expect to react differently.
I get to sit around in the infusion clinic for a while on my Zometa days . Seems like everyone I meet receiving Zometa usually has breast cancer, even a guy with it. Two guys I’ve met have prostrate cancer . One thing nearly all of them has , like me , is severe bone pain after the infusion. I don’t have the swollen feet and swollen hands problems most of the others have but I definitely do get the severe bone pain and headaches, same as the others. I seem to get off better than many because I don’t experience any liver issues ,so far , but I do have to take the calcium with D supplements to off set body chemistry effects of treatment. You can google “ severe bone pain with Zometa “ to see That bone pain is the number one side effect and trouble breathing is the eighth mentioned side effect after several blood chemistry changes. Additionally the FDA has issued a health alert “ severe musculoskeletal pain a risk with bisphosphonates “ that you can google as well.
Count your lucky stars you are not experiencing the bone pain side effect because it can be severe for many that receive it. Although , for me, the Zometa side effects is a smorgasbord of unpleasantness... still I strongly want to get the treatment because I know I need it with the massive widespread met load I have. It’s just a few days of down time a month to help keep my leg bones from snapping and my vertebrae from collapsing. For sure it’s nothing like the side effects chemo therapy people frequently experience .... its all good. We got this 💪💪💪.
We are all brothers. I count myself extremely lucky that I don't have bone pain - it's the worst pain there is. And my heart goes out to all the brothers who do have it.
I do seem to have shrunk. I haven't changed my clothes size at all but I used to be able to rest my chin on the top of my wife's head and now my chin is at her eye brow level. A bit bizarre. I still stand as straight as ever.
My advice is to go with what Tall_Alan said. My husband's doctor wanted to put him on it as soon as he was diagnosed but husband decided (and I agreed) to wait until further along. He's 2.5 years in and he's going to ask his MO do order another dexa scan so we can see where he is on bone health. Depending on those scores, he'll then decide whether to start bisphosphonates. He's been diligent on his mouth care (hadn't gone to the dentist since his 20's!) once we discovered would be a future treatment path. He's Gleason 4+3, current PSA >.06, Currently on Lupron/Zytiga and finished Provenge in April.
Earlier on this Forum a number of participants said that slower infusion of Zometa reduced the side effects. The 15 minute infusion is the minimum recommended time. I ask my MO to order 30 plus minutes and I have had few side effects.
We had a visit and i requested the MO for a dexa scan, but he said since he has one detectable pelvic bone met and has had bilateral orchiectomy and is on zytiga and prednisone, it would be advisable to take two 3 monthly Zoledronic acid IV's for bone strength. Post that we can decide if we would continue the regime or not, but atleast 2 3 monthly infusions should be taken. So we went ahead with the 15-20 mins infusion and dad had flu symptoms and nausea with vomiting for 2 days, which subsided then with some stemetil and then the nausea came back again on the 5th day. He is very fatigued and though is active, sleeps a lot more than he did earlier and is very lazy (don't know if it is the ADT regime or the zometa). Exercise has taken a back seat- just goes for a walk once in 4 days or so, once he is recovered from the nausea and zoledronic acid IV we will push him to exercise more.
On the good news front, the PSA post one month on Zytiga is 0.837. Hope it goes even lower and stays there for a long long time. The liver numbers were normal, though the 10 mg prednisone caused elevated blood sugar levels. The MO now has him on 5 mg prednisone. Have read on adding Celebrex to the Zoledronic acid for 22% increased survival. I will ask the MO about it during our next meeting.
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