Denosumab if bone strength increasing on ADT?

[Rodeoz15]

Hi everyone, my father was diagnosed with Stage 4 PCa last year (multiple bone mets). He has responded well to ADT so far with PSA dropping from 500 to 0.65 in 14 months and corresponding decrease in PSMA avidity seen in scans.

At the time of his diagnosis he was advised Denosumab because a Dexa scan showed osteoporosis. He never took these injections - he is a difficult patient with poor compliance to medicines. A repeat Dexa after a year shows that his bone strength has actually increased. Previous T score of -3.7 in the Femur neck is now -1.7 for example.

Considering his bones seem to have gotten better, is there any point in making him start Denosumab now? He finally seems to be willing to adhere to medicines after some counselling but I am wondering if he requires these in the first place! Docs seem to be having varied opinions. One says a maintenance dose of 6 months while another says monthly as standard practice.

Many thanks!

[RyderLake2]

Hello, My recommendation, for what it is worth is to take a maintenance dose of Prolia aka Xgeva (denosumab) every six months. It will lessen the chance of a fracture or skeletal related event (SRE). I have been on this for nine years now with few, if any, side effects.

[Muffin2019 in reply to RyderLake2]

I have had good response to xgeva, almost 2 years on it and no new Mets with no side effects either, 1 year of every month now once every 3 months with the eligard shot. Scans show osteoporosis, some degeneration in the knee, ankle and wrist, also stenosis in the spine which is genetic as is the osteoporosis, arthritis showed which is again genetic, such fun getting older.

[dhccpa in reply to RyderLake2]

How often do you get it?

Have you had dental implants during that period? If so, how did it go? Thanks.

[RyderLake2 in reply to dhccpa]

Hello, As mentioned before I get a maintenance injection of Prolia (denosumab) every six months and have for the past nine years. No dental implants but my dentist is certainly aware that I take this drug. My family doctor insists that I have a blood test to check my creatinine levels (kidney function) prior to every Prolia injection.

[dhccpa in reply to RyderLake2]

Thanks. I've been getting a quarterly shot for 2.5 years (missed one). I didn't know it affected creatine but will look it up. I have been taking a creatine supplement for 18 months, blood level in normal range (up from below normal before I began supplement).

[john4803 in reply to RyderLake2]

Would you mind sharing how much it costs? I have started monthly injections.

[RyderLake2 in reply to john4803]

Hello, I am not at home right now. As soon as we get home I will look it up and let you know. A couple of things you should know, First, I am only on a maintenance dose which means I receive an injection once every six months. Second, I live in Canada, so drug costs are usually cheaper than they are in the USA. I will get back to you in the next day or so on what the local pharmacy charged me for Prolia (denosumab).

[Tall_Allen]

He may be able to avoid fractures if he takes a milder bisphosphonate like alendronate for now. Other options include more increasing his weight-bearing exercise (with his doctor's permission) or an estrogen patch (with tamoxifen).

[garyjp9 in reply to Tall_Allen]

Thanks TA, what purpose does the tamoxifen serve?

[Tall_Allen in reply to garyjp9]

The estrogen patch can cause gynecomastia. Tamoxifen prevents it. I understand that tamoxifen can now be made as a patch by a compounding pharmacy.

[garyjp9 in reply to Tall_Allen]

Thank you

[KAgolf in reply to Tall_Allen]

hi T_A do you know if Raloxifene would work in place of Tamoxifen? just curious.I was put on Raloxifene almost 30 years ago as a breast cancer preventative that works as well as Tamoxifen but without potential side-effects for us women.

The bonus is Raloxifene was developed as Osteoporosis drug, so we get a two-fer.

My point is that IF Raloxifene would work as well as Tamoxifen, wouldn't that be a good option because of the extra benefit of Osteoporosis drug?

[Tall_Allen in reply to KAgolf]

Someone on this site used raloxifene instead of tamoxifen for gynecomastia because it didn't depress his testosterone and he was on intermittent hormone therapy and wanted his testosterone levels to come back quickly. I can't say if that always occurs in men or if it was peculiar to him.

Estrogen is a good drug to prevent osteoporosis and hot flashes. I don't know how effective raloxifene is compared to estrogen. There is very little research on its use in men.

[KAgolf in reply to Tall_Allen]

thanks

[pjoshea13]

Hi,

Has his estradiol [E2] been measured? ADT causes E2 to fall. If E2<12 pg/mL he should use a low-dose E2 patch before using one of the drugs mentioned. It's better to correct a deficiency before jumping to a drug that might have serious side effects, IMO.

Best, -Patrick

[Rodeoz15 in reply to pjoshea13]

I will get his E2 checked. Thanks!

[KAgolf in reply to pjoshea13]

My Hubby's MO ignores my requests for E2, HDT, and SHBG tests--says "those aren't normal tests we do". the last time he said that I said " I don't care if those are "normal" tests or not, we want them done"..........still no orders for them....so want to find a new MO

[tango65]

I would repeat fhe dexa scan. The change you describe is rare for a person in ADT. Does he have other areas with a T value of minus 2.5 or higher?

[Rodeoz15 in reply to tango65]

Yes one part of the Femur is still below 2.5 but it was -3.5 originally. So it also seems to have improved.

[tango65 in reply to Rodeoz15]

So, he still has osteoporosis and he should be treated to prevent bone fractures.

[Grandpa4]

An spontaneous increase in hip bone density does not usually mean your bone density improved. Usually it means you developed bone spur in your hip from osteoarthritis . Spontaneous improvement in bone density without therapy does not make sense.

[Magnus1964]

I have injections every three months.

[London441]

Below -2.5 is not good. You really want to avoid hip fracture, nothing is more important.

Agreed that bone strengthening on ADT is unlikely. I would try to get him on a bisphosphonate and check the E2 as suggested.

How much exercise does he do and what kind?

[Rodeoz15 in reply to London441]

Thanks. Only lot of walking and a few squats. Nothing else.

[London441 in reply to Rodeoz15]

Try more squats, many more. It will change your life, and strengthen your bones as a side benefit 😀

[Pte82]

Rodeoz15, annatto tococotrienol offers bone building benefits and others too. Always consult with the health care professional treating him before using any supplement.

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

pubmed.ncbi.nlm.nih.gov/295...

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

dougcookrd.com/annatto/

[Miccoman]

I've been on both Prolia and Xgeva (denosumab) since 2015. Prolia first for a year, then Xgeva.

When I went on Xgeva it was once a month, but when I discovered that can be given every 3 months I changed to that schedule (my research MO @ Moffitt Cancer Center in Tampa said research shows no significant response difference in monthly vs quarterly injections).

NOTE: the change was after taking Xgeva monthly for a year so the drug had time to build up in my system before I went on a "maintenance" routine. It also helps that my DEXA scans have continually improved.

Your mileage may vary, of course, and others here may have better info. Good luck!