Two years Results

[Pheart2]

Hello Everyone,

I am reading this forum every day and getting very valuable information. Thank you so much. My hats off to all of you for sharing your experience and knowledge over here and providing much-needed compassion to each other.

My Case:

Age 73. First diagnosed with advanced PC in October 2019.

Biopsy results: 5 of 12 GS 10, 2 of 12 GS 9, and 5 of 12 Benign.

PSA 3.5.

Scans Results: Only one Met Increased uptake in S1.

Genetic test: negative

My case was reviewed by three MOs and it was concluded that although I have a high Gleason score, based on CHAARTED and LATTITUDE I have the low-volume low-risk disease (no visceral involvement, 1 site of bony disease). So it was recommended to follow the STAMPEDE trial.

Treatments:

1)Lupron shot every 3 months effective December 2019.

2)Radiation to Pelvic for 4 weeks February 2020

3) Abiraterone 250 mg with a low-fat breakfast + Prednisone 5 mg every day effective January 2020

Results:

04/14/20 PSA<0.03, 06/09/20 PSA<0.03, 07/31/20 PSA<0.03 & 09/30/20 PSA<0.03, 12/1/20 PSA<0.03, 2/1/21 PSA<0.03, 4/1/21 PSA<0.03, 6/1/21 PSA<0.03, 8/1/21 PSA<0.03, 10/1/21 PSA<0.03,

Testosterone <3 ng/dl

05/02/20 & 09/02/20

CT scans Normal

Bone Scans:

Less uptake in S1. No evidence of new bone metastasis disease.

03/19/2021 and 10/14/21

CT scans Normal

Bone Scans:

Tracer uptake associated with sclerosis in S1 is Slightly less pronounced compared to the prior exam. There is no new focus of tracer uptake suspicious for new osseous metastatic disease.

LifeStyle:

Exercise: Weight Training workout with a trainer 3 times/week + remaining days walking on a treadmill or outside

Diet: Plant-based + Fish every other day

Everything looks good, right? Well, yes and no. After reading this site regularly, I realized that my MO had never sent me to get a Bone Density Test. So last month I got a prescription from my Physician and got that done. Results are not so good. It says I have Osteopenia. Spine T score of -1.8, Neck T score of -1.5, left heap T score of -1.1,

Questions: Consulted Endocrinologist. First, he recommended Fosamax but after reviewing blood work and further discussions with me (no other risk factors) decided to put me on Vitamin D3 5000 IU daily,(I am on 2000 now), and Calcium 1200 mg through diet (no supplements) and of course Weight-bearing exercise program (which I'm doing it anyway). Since the next test would be after 2 years, what other biomarkers to watch in between? according to blood work calcium, Vitamin D and Alp are in the normal range. The sad part is since no test was done prior to starting ADT I have no baseline. This could be due to normal age-related wear and tear or two years on Prednisone. I think both. Even though I'm on 5 mg.

So is this the right treatment to follow for Osteopenia? The heap number is very close to the normal range but the spine is the concern. Thanks to everyone.

Written by

[Tall_Allen]

Very high doses of Vitamin D like that rob calcium from the bone and cause osteopenia:

jamanetwork.com/journals/ja...

Annual Dexa scan.

[Pheart2 in reply to Tall_Allen]

Very interesting article. So what’s the remedy for mild osteopenia like I have. Take calcium supplements instead of increasing vitamin D 3? Thank you.

[Tall_Allen in reply to Pheart2]

No. Calcium supplements are associated with worse PCa:

cebp.aacrjournals.org/conte...

ncbi.nlm.nih.gov/pmc/articl...

Exercise more. If necessary, add estrogen patches (with tamoxifen patches) may be enough.

[CAMPSOUPS in reply to Tall_Allen]

Thanks as always for your input(s).

On Zometa and Celebrex.

MO advised to take Calcium supplement to replace in the blood that which is reduced by Zometa.

I bet I should have Calcium monitored in blood labs and take it if deficient rather than just "because" ?

Here is a quote with better wording on the Zometa/Calcium issue:

bisphosphonates reduce calcium efflux from bone into the circulation, leading to the development of hypocalcemia.

[Tall_Allen in reply to CAMPSOUPS]

With Zometa, the effect is usually extreme, so that prophylactic beefing up of calcium and Vitamin D is reasonable. But I agree with you that even then, blood tests should be the guide.

[E2-Guy in reply to Tall_Allen]

'Doctor Tall'...how can any one person know so damn much!👨‍⚕️

[cesces in reply to E2-Guy]

Agreed

And he seems to be getting better year by year.

[E2-Guy in reply to cesces]

He is the 'Encyclopedia of Prostate Cancer'!

[cesces in reply to E2-Guy]

More than that he is able to integrate all that info into thoughtful analysis and recommendations.

[E2-Guy in reply to cesces]

I think he also knows almost every good hospital and doctor in the entire world!

[HopingForTheBest1 in reply to E2-Guy]

We are all so thankful for his participation and guidance.

[j-o-h-n in reply to E2-Guy]

Answer: From time to time he consults with me (he's a good scribe too).....

Good Luck, Good Health and Good Humor.

j-o-h-n Saturday 10/30/2021 1:13 PM DST

[monte1111 in reply to j-o-h-n]

Calling Dr. j-o-h-n, calling Dr. j-o-h-n.

[j-o-h-n in reply to monte1111]

Sorry I'm busy teaching one of those beautiful young nurses "the front Heimlich maneuver, and simultaneously the mouth to mouth maneuver.".....my moto: never let an opportunity go to waste...........

Good Luck, Good Health and Good Humor.

j-o-h-n Saturday 10/30/2021 7:47 PM DST

[London441]

Your dexa scan reveals not only your bone density but your composition overall of course. Therefore every bit as important as your T scores is your lean mass and body fat. Since the ADT slows metabolism, wastes muscle and adds fat you can determine how well your exercise is working.

You say you are doing weight bearing exercise and I believe you, but the term by itself says little. The range of benefit is huge due to overall fitness and strength level ,intensity, duration of sessions, the quality of workouts in general.

Sarcopenia is a given on ADT. What you’re experiencing is not ‘normal age related wear and tear’, prednisone or not. It is normal age related wear and tear that is being GREATLY exacerbated and accelerated by ADT.

Supplementation with Vitamin D and calcium fir bone strength on ADT is nothing compared to what getting stronger can do for you. We can always do more, most of us much more.

How long have you been lifting consistently?What is your height and weight, your body fat percentage?

[Doseydoe]

Eat, drink and be merry.... Enjoy your life and be kind to those you meet. We never know when it will all end so live with passion while you can.

[HopingForTheBest1 in reply to Doseydoe]

Thanks for your encouraging words. We are trying as best we can and hoping for the best.

[j-o-h-n]

Unfortunately we are like my 1986 Yugo ragtop..... The older it gets the worse it runs....

Good Luck, Good Health and Good Humor.

j-o-h-n Saturday 10/30/2021 1:17 PM DST

[monte1111 in reply to j-o-h-n]

You have a Yugo that runs? Priceless. Were those made in Greece?

[j-o-h-n]

They were greased in Greece..... Unfortunately, there aren't any brakes on this classic car so I'm sending it to my ex-wife as a birthday gift. Please don't accidently tell her about the brakes but you can tell her it's a speed demon...........

Good Luck, Good Health and Good Humor.

j-o-h-n Saturday 10/30/2021 8:21 PM DST

[cesces]

Yes. Best place on the internet for this kind of information.

[Jalbom49]

Vitamin K2 takes calcium from soft tissues and puts it in bones and teeth. It’s in grass fed butter and beef liver. It’s available as a stand alone supplement or with Vitamins A and D, which are synergistic with K2. In Japan megadoses of K2 are used to prevent osteoporosis; this is also available here.Reference: Vitamin K2 and the calcium paradox.

[timotur]

I had a baseline Dexa of -1.5 and it fell to -2.1 after 18 months of Lupron, so yes, ADT can cause a dramatic fall in bone density. I'm eating more natural sources of calcium now, and hope I can reverse this after stopping ADT a year ago.