Hopefully somebody can shed some light on the use of Prolia in HSPCa. Met with my MO today and he has strongly suggested that I begin Prolia 60mg every 6 months to delay the inevitable onset of ADT induced osteoporosis. I can find very little supportive literature for it's use in metastatic hormone sensitive PCa. His thought is that eventually I will become castrate resistant and then also most likely osteoporotic. At that point he would then use Xgeva. Prior to that point he feels the every 6 month dose of Prolia is sufficient. I can't find any supportive data on the use of Prolia in metastatic patients. Is this a rational approach? I am currently osteopenic with a BMD lumbar score of -1. Any feedback would be appreciated.
Good news on other labs, my PSA is down from 362 on 2/13/19 to 9.79 today. Also ALP down from 524 to 91 today. Happy as a pig in S@#t about those numbers.
Thank in advance for all the help from this site!
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Prolia is a low dose version of Xgeva. Side effects are cumulative with time and dose, so his advise makes sense. It might increase survival when used with Celebrex (it does with Zometa).
I have been on Prolia (denosumab) every six months since diagnosis in 2013 with metastatic PCa that has spread to my bones. I take Prolia every six months to prevent any type of skeletal related event (SRE). So far, touch wood, no side effects. Denosumab is a monoclonal antibody whereas Zometa (zoledronic acid) is a bisphosphonate. Denosumab is a drug that targets a protein known as RANK ligand. This protein regulates the activity of osteoclasts. If you ever took high school biology you will probably remember that osteoclasts are cells that break down bone and osteoblasts are cells that build up bone.
There have been one or two clinical trials that suggest Denosumab is more effective than Zometa (zoledronic acid)at delaying or preventing bone complications such as fractures. I think you are in good hands with your doctor and I would follow his advice. Good luck!
I was put on prolia in 2015 when I started ADT3 and IMRT to lymph nodes. In 2017 when a bone met was discovered, I went on monthly xgeva shots. I dropped down to quarterly xgeva shots after clean bone density scan .
Since ADT impacts bones negatively the use of prolia or xgeva provides some protection to bones. Of course if you get bone mets it makes sense as well. I am still hormone sensitive and started estradiol patches early this year to rid myself of adt side effects. It’s also proven to be less problematic for bones than standard adt.
My new MO gave me same advice after being on Xgeva for a short time with another MO. It is more for osteoporosis not strengthening bones where cancer has weakening them. You may later end up on Xgeva on a 3 month cycle.
As a caveat...I’m not a doctor. I’m not recommending anything, just reporting my own personal experience. Follow your PCa oncologist’s advice.
At Dx 4 1/2 years ago I was Stage 4 oligometastic with one tumor on the R. Inferior Pubic ramus. The urologist who diagnosed me recommended an OTC (Mail order only) supplement called Prosteon by Theralogix for bone health. (you can Google it for the ingredients). When I started my treatments at the Mayo Clinic in Jax my M.O. was aware of my using it, and was okay with it.
Four years later, I have no bone issues, no SRE’s, no bone pain, no new bone tumors, and my one original bone tumor that lit up my original scans like a bright star has faded into obscurity and has remained dormant for over 2 years (the scan reports call it “interval resolution”). My M.O. has me scheduled for my usual follow-up in December, and would like to include both an updated bone scan, and a bone density test (if Medicare and Blue Cross will cover them) just as a routine status check. He wants to hold off on adding denosumab and/or a bisphosphonate until my scans indicate that they are warranted.
As I mentioned at the beginning of this post, our situations are different, and I’m not qualified to dispense any advice, so follow the path that will give you the best results, and the advice of your M.O. (and experts in this forum like Tall_Allen). It’s my understanding that Prolia has very few side effects. My wife has been on it for several years with good results and no discernible side effects, so it should be safe to add.
My Docs had me take Reclast IV Infusion; last December was my fourth Infusion....however I am taking the Max: 150,000 IU Vit. D3 on a weekly basis. Prolia had been suggested but there was an issue ( with me mainly ) as to whether or not Prolia was an Biologic!
Any comments to set me straight would be appreciated.
Denosumab (Prolia, Xgeva) is a monoclonal antibody, as suggested by its "mab" ending. So it is a "biologic" medication. Though it is not "naturally" sourced, but produced in a lab facility. I'm not sure if that addresses your question. I receive Prolia 60mg every 6 months and take daily calcium supplement, and am happy to have this to help protect my bones!
My experience with Popular Drug Names vs Scientific Names is limited...I am only familiar with those medications that affect my personal condition...hence Prolia (Denosumab) could be confusing to some. My Imunity is already compromised, so perhaps my Docs gave me the Reclast Infusion vs Prolia.
I took Prolia due to osteopenia (T score -2.3), due to ADT. My baseline bone mineral density (BMD) was normal, but deteriorated significantly in under 2 years (Lupron & Casodex). After I stopped ADT, as my T recovered we discontinued the Prolia.
I had to have a clearance letter from my dentist before starting Prolia. There is a risk of jaw necrosis if you have dental work done (on the bone mainly). I don't know how common that risk is, but if it happens it can be quite troublesome.
There was a recommendation once to use the FRAX calculator, and only do Prolia if it indicated some specific level of fracture risk. You might consider some research into this. It's an online tool. sheffield.ac.uk/FRAX/index....
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