Results of DEXA scan in anticipation of December 12 MO visit. Impression: Bone Density within normal limits. Any reason to add Xgeva?

[Philly13]

I am asking the forum again to reinforce my inclination to not add Xgeva at this time. Tall_Allen, you have been very helpful. The results on the DEXA scan seem pretty good to me. I am untrained and would like to hear if anyone sees a reason to add a dose of Denosumab.

I have previously reported that my MO has been advocating for adding Xgeva to my treatment. The forum helped me process the wisdom of testing for indications it had value for me. I am not anxious to add new Side Effect possibilities. I currently take monthly Firmagon injections monthly and generic Zytiga with 5 mg of Prednisone.

December will mark 7 months of treatment.

DEXA scan (11-22-19) and discussion of Xgeva for increasing bone density.

1.Dexa results

a.AP lumbar spine T-score L1-L4 6.7

b.Corresponding bone mineral density: 2.065 g/cm2.

i.This value may be falsely elevated secondary to degenerative changes seen in the lumbar spine.

c.AP left hip lowest T-score: Femoral neck 0.8

: Corresponding bone mineral density: 1.170 to g/cm2.

d.AP right hip lowest T-score: Total proximal femur 3.3

: Corresponding bone mineral density: 1.579 g/cm2.

2.10-Year Probability of Fracture:

a.Major Osteoporotic: 10.3%

b.Hip: 0.4%

3.IMPRESSION: Bone mineral density is within normal limits.

I am 65 years old. Every report looking at my bones mentions degeneration of my lower back, but no alarm bells go off. Is a 10% chance of major Osteoporotic event something to deal with at this stage of treatment.

As Always, Thanks in advance for your thoughts on the subject.

Philly

[leo2634]

I've been on Xgeva injection for 20 months now with no significant side effects other than low calcium in which case it is stopped for a month until levels equal out again. My doc says it's a good idea with bone Mets .

[Philly13 in reply to leo2634]

Thanks. I have asked why it is a good idea and the CRNP said the same thing. "It is a good idea." I would like to understand what prophylactic purpose it serves before taking the treatment. My gut instinct is to wait until there is some sign that bone mineral density is degrading before starting the treatment.

[Magnus1964]

Xgeva strengthens bones to make it difficult for Pca to attack the bones.

Anyone spending time on ADT drugs can expect to loose bone mass .

[LearnAll]

I would like to delay use of powerful bone supportive meds as long as my DEXA shows normal level of bone density,. I check Bone Density every 3 to 4 months. It is harmless to check ..a non invasive test. .costs $50.

I believe COMB protocol (Vit D +K2 + Vegan Omega DHA + strontium with fat free one cup of yogurt can delay our use of stronger meds which can sometimes cause OsteoNecrosis of Jaw. Weightbearing exercise delays bone weakening. When bone density really start declining, I will consider things like Xgeva etc.

[Philly13 in reply to LearnAll]

Thanks. Your plan is what I would like to adopt. I now have a base reading to measure from. I don't lift as much as I would like but I do long sessions of cardio at least 3 times a week and sometimes have streaks of a couple of weeks without interruption. So far, there does not seem to be an issue. I look forward to seeing whether the Dock agrees.

[LearnAll in reply to Philly13]

You do not need to lift heavy weights. I walk 4 to 5 miles a day.. put weight straps on the wrists before walking ...do stretching yoga whenever I remember about bones.. Good nutrition, ideal body weights et c all contribute towards keeping bones healthy.

[ctflatlander in reply to LearnAll]

I would like to get periodic bone density tests at more frequent intervals. I'm on ADT and Xgeva, had IMRT,SBRT. My MO says Medicare won't pay for it if its less than 2 years of previous test. He says cost of test is $3000 out of pocket. How do I work around my Doc?

Thank you

Bob

[Philly13 in reply to ctflatlander]

Do some research, is my suggestion. First ask your internist to prescribe the test. That is what I did. The MO response was too slow.

The internet says there are places, in my neighborhood, you can get the scans for $125, but once my GP said no problem, I decided not to look further.

Philly

[ctflatlander in reply to Philly13]

Thank you, will be seeing her shortly and give it a shot. Bob

[LearnAll in reply to ctflatlander]

Depending on where you live..you might find private imaging centers who will do bone density scan for approx. $60. These imaging centers are for cash pay patients.

[ctflatlander in reply to LearnAll]

I live in Northeastern Vt. and it is doubtful I will find one but will look anyway. Thank you Bob

[carbide]

There is a dental (Jaws) issue with Xgeva. It can cause dead bone in Jaws.

My doctor will not put me on Xgeva until I have some teeth pulled - like 10 & get upper denture.

[Philly13 in reply to carbide]

Ouch. I did go to get my teeth checked. No issues at this time.

[Tall_Allen]

I agree with you. Your BMD is still fine for now, so why treat a problem you don't have? ONJ incidence increases with time spent on Xgeva or Zometa, so if you can maintain your BMD with weight-bearing exercise (and maybe estrogen patches), you can delay their use. Check blood calcium and Vitamin D blood levels and only supplement if low.

[Philly13 in reply to Tall_Allen]

Thanks. I won’t be starting with Xgeva for the time being.

[MateoBeach]

Yes in my opinion there are potentially 3 reasons to take it for prostate cancer patients even without osteoporosis. (Though if there is any one site of osteopenia then you can get the injections covered by Medicare.)

The first reason is osteoprotection: Reducing the risk of future "Skeletal Events" (fractures, etc.) from future possible bone mets. Getting ahead of it in other words.

Second is maintaining better bone mineralization in face of the inevitable ADT.

Third, and most interesting, is that in trials there was improved progression free survival in terms of new bony mets. This suggests the possibility (not yet fully proven) that denosumab may alter the microenvironment in bone and make it somehow less hospitable for new bone mets.

I am on Prolia injections for these reasons. Same medicine as Xgeva but at a reduced dosage schedule of 60 mg every six months.

Keeping up with dental care and hygiene is important with this to reduce jaw ON risk.

And adequate calcium intake, etc.

[Philly13]

Thanks. I have asked my team to provide information on why they believe it should be administered. Crickets so far.

I see the logic of your 3 reasons but to date I have not seen any information. Not from this forum, or other sources. I will do another search.

I agree the idea that there is evidence there is prophylactic value in the main battle would be interesting to me. If you have time to respond with the source of the improved progression free results, please post it.

Thanks

Philly

[Danielgreer]

I’m in a similar situation, I’ve been on ADT for about 7 months and my MO is recommending XGEVA but my bone density is in the normal range. My insurance company won’t cover it though but will cover it when the cancer comes back. Are you able to get insurance coverage in your situation.

[Philly13 in reply to Danielgreer]

My understanding is that it has been approved by Medicare administrators. It was teed up for me on my September visit. I resisted and asked for information about the benefits. They gave me a fact sheet on Xgeva in the office and sent me the same fact sheet when I requested it again by telephone.

[Danielgreer]

Thanks for your response. Interesting that Medicare will pay for it before the cancer comes back and my insurer won’t (I’m not Medicare eligible yet). May be the basis for a appeal? Anyway, I think I’ll talk to my MO first to see exactly why she’s recommending it before the cancer comes back given that I have normal density.

[Philly13 in reply to Danielgreer]

Big teaching hospitals like Penn Med seem to have leverage from my pre-Medicare days. My radiation oncology team fought for the Auximen PET scan with United Health care folks while my PSA was well below 2.

[catsup]

Hello Philly,I started with Zoladex and Xgeva for my bones when first diagnosed stage 4 with bone mets.

the Xgeva was to strengthen the bones. 3.1/2 years later my teeth started to fall out. thats the side effect of Xgeva. My oncologist immediately stopped it. So double check with your Doc before going on it. There are many other safer ways to strengthen your bones.

I am starting on radiation to my hip . Hopefully it will be successful and I can play golf this summer

Be safe