My dad has been on zometa and Lupron and his PSA has been undetectable. He got a new doctor and they want to take him off the zometa and put him on prolia. Why would they do it? I have read awful things about prolia!
update: my dad is stage IV, mets everywhere. No pain, no issues so far BUT this new doc all of a sudden wants to make this change and we can’t get answers why.
he’s also on xtandi.
Prolia is for non-metastatic men. Does he have osteoporosis on a DEXA scan? If so, he may only need alendronate. Long-term use of those medicines have cumulative side effects. They are usually reserved for men who are castration-resistant.
Not sure about the scan. My fault though, I should have mentioned, my dad is stage IV, Mets everywhere. We just don’t understand (and no one is giving answers) why they’d all of sudden change his Zometa to Prolia when everything has been fine.
Everything is not fine. Those drugs can have serious side effects in men who take them for a long time. He must have a DEXA scan to diagnose osteoporosis before any of those drugs are given. There is no reason to take them and good reason not to take them if his bone mineral density is normal. They are only indicated in men who are castrate resistant.
well regardless he’s been on the Zometa for almost a year. Again, we just don’t know why there’s a sudden switch from Zometa to Prolia.
Again, it is dangerous to stay on it, especially if there is no reason to take it in the first place.
what the doctor is said is that basically you want to stay on these meds as long as you can until you become resistant. He said we’re trying to buy my dad time right now.
I don’t understand anything. This is all so confusing.
You are confusing the drugs he takes to treat his cancer, with the drugs he takes to manage/prevent symptoms.
One does become resistant to the meds he takes to treat his cancer.
One does NOT become resistant to bone strengthening meds. But side effects accumulate over time, so it is best not to keep taking them, if possible.
I see what you’re saying. Thank you.
another viewpoint: Prolia, and possibly also Zometa, alter the bone micro-environment and appear to make it less hospitable for forming new metastasis. So that is a possible significant benefit even in non metastatic PC and even while hormone sensitive. Also protects bone from effects of ongoing ADT even if not yet osteopenic.
90% (ish) of men with APC will ultimately have Bone Mets with pain and fractures at the end of the road. The risk of osteonecrosis from Prolia is around 2-4% in men whose dental care is kept in good shape. That is why I have happily chosen to be on Prolia. I want it on my side to protect my bones.
Possibly Zometa? Hey now I have been counting on Zometa to have a bit of that bone microenvironment effect since I am not on Prolia lol.
I also add the Celebrex to Zometa for the possible OS benefit found (in chaarter?,Stampede?) with my high bone met load.
yes I agree. Probably similar with both Zometa and denosumab. I also add celecoxib daily at 400mg. Excellent idea.
Yep. 200mg BID.
In my experience and opinion only, there's no point to using a medication like Zometa unless you know bone strength is affected. I understand from someone who took it that Zometa has nasty side effects as well.
I think you have never known anyone with bone mets from skull to shins. Zometa is another tool in the tool box to help strengthen the weakened bones weakened by mets and to possibly reduce the bone microenvironment that metastases form in. With widespread bone mets treating the cancer comes first for me. Risk of side effects comes second. No choice.
You hit on a subject that always elicits many differing opinions. I think most importantly we might not have the full story of your dad's condition/extent of bone metastases and his Dr. does. So those here with no bone metastasis will say only use if dexa bone scan shows decreased density.
His bone metastasis situation alone may dictate the Zometa. Many here without widespread or any bone metastases get on Prolia because a dexa scan shows low bone density or because it is felt that the hormone treatment will be indefinite and effects bone density so Prolia is started even before low bone density is confirmed.
Appears you dad does have extensive bone mets. In that case Zometa (for the reasons Mateo Beach mentioned) plus Celebrex can be beneficial not only to maintain bone strength in light of widespread bone metastases but the combo was found inadvertently in a trial to increase overall survival.
I was prescribed Zometa for widespread bone metastases not for low bone density. I take Celebrex as well.
I see what you’re saying but our confusion is why would they switch it if it’s working? He has extensive bone Mets and the current regiment has kept his PSA undetectable so we can’t figure out why they’d change it to Prolia out of the blue when Zometa has been working. Hope that makes sense!
Ah yea. That's confusing indeed. I can really only say try to press the Dr. for an answer to that. I can only widely speculate.
It’s very frustrating. It’s a new doctor. His old one retired.
An MO correct?
If you find out from him why he wants to change to Prolia and if you don't like the reasoning you could tell him you want to stay on Zometa and add Celebrex as the Stampede trial showed survival benefit with the combination.
Maybe Prolia does show less tendency of the side effect rarely seen but rightfully feared with Zometa (necrosis of jaw) so maybe that is why he is pushing Prolia.
IMHO with the bone mets he has I feel the Zometa plus Celebrex is a more common and studied treatment for those with extensive bone mets.
possibly it is for less frequent dosing in that Prolia is once every 6 months. The higher intensity dosing of same drug is Xgeva, every month or many use intermediate dosing at every three months as I do. Both seem to provide similar benefits.
that’s the only thing one of the physician assistants said… “wouldn’t you rather receive less shots?” We don’t care how many shots he gets as long as he’s alive and his quality of life is good which it is right now.
I should have mentioned my dad is metastatic stage IV
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