What now?

T-11 vertebral compression fracture ( osteoporotic/insufficiency fracture ) should I be concerned? Is this the result of 3-1/2 years of ADT + Zytiga??

[Derf4223]

Did you get a bone density scan at the start of ADT? In my case, it was done after 5 ADT (and one with radiation) months. At age 68, some bone loss is not necessarily a surprise but I don't have a pre-ADT bone test to tell if losses are likely due to PC treatments. I was taking 600 mg Calcium / day up until a month ago when a funny side effect prompted bone health concerns. It took a month to get the bone density test and it confirmed some bone loss but not osteoporesis level. Anyhow from that point circa Oct 1 through now I am taking 1200 mg Calcium, 200 mcg vitamin K2, 4000 IU vitamin D3, vitamin B12, and magnesium. Vitamin C is also said to be important for immuno and bone health. I suggest you take firm control of what you can control now. Eat right, take bone health supplements, and exercise (high impact cardio, vigorous walking.)

[Hidden in reply to Derf4223]

I've NEVER had a dexa, I've been on the calcium, d3, multi vitamin regimen since the very beginning 3-1/2 years ago. Also worth noting, (as I did in an earlier post) Oncologist reduced denosumab (XGEVA) from monthly to every 3 months that was just about 6 month's ago

[Hidden]

was never told where ALL the mets were....only "Widespread Bony Metastesis" I know the hip and lungs were the only specific mentions

[Abcsoup73]

Hi Tommy,

Is the compression fracture the result of a fall/injury/lifting something heavy?

My father has been on Lupron for many years, and in 2018 had his first compression fracture in L3, then in 2020 another one in L2. He fell two weeks ago and the MRI yesterday showed a compression deformity/fracture now in L4. The first fracture was due to a fall, the second due to lifting something heavy. L2 and L3 were repaired with vertebroplasty, filling in the fracture with cement. This afternoon we will see our doctor and figure out what we are going to do with L4. ADT is known to thin the bones and make them more brittle.

Are you currently having pain from your fracture? What did your doctor say?

[Tall_Allen]

They usually start you on monthly Xgeva or Zometa every 3 weeks. Assuming you did not have a spinal bone met at T11, ADT takes a toll on bone mineral density.

[Benkaymel in reply to Tall_Allen]

Allen, I've been on ADT now for nearly 4 months and started on Xtandi 2 weeks ago. My last blood test showed my calcium was in the middle of the expected range. Anyway, my CO prescribed me calcium+D3 but I remember you writing that we should not take a calcium supplement unless we have a deficiency. For that reason, I haven't started taking the prescribed calcium yet but I'm worried that over time the ADT/AR will reduce my BMD so should I start taking it even though I'm currently within range?

[Tall_Allen in reply to Benkaymel]

There is no evidence that supplemental calcium or vitamin D improves bone mineral density in men without a deficiency. In fact, there is now conclusive evidence that they don't.

Read the section in this article subtitled "No Effect or Negative Effect on Bone Mineral Density" and send it to your CO:

prostatecancer.news/2018/07...

Exercise is your best strategy for maintaining your BMD while on ADT. You can discuss estrogen patches too.

[DD50 in reply to Tall_Allen]

What does estrogen patch provide?

[Tall_Allen in reply to DD50]

Estrogen maintains BMD.

[Kenn2017]

My MO recommended that I undergo Zoledronic Acid infusion to protect my bones from any breakdown caused by lesions. I was diagnosed as getting close to having osteopenia. No side effects except I have to brush with high flouride toothpaste and put on flouride gel every night. this is done to avoid any dental issues and osteonecrosis of the jaw.

[Hidden in reply to Kenn2017]

I've been getting XGEVA injections for 2 years for the same reason

[Hidden]

Are you in pain? I think it is years of adt..It’s simply having no T that depletes the muscle teeth and bones . Tommy I’ve had no t for 7 yrs. I can relate ..Hang tuff young man . ✌️

[Hidden in reply to Hidden]

Yeah, there's pain but I push through it. If I don't, the pain is greater. I do ask myself this question though, "what's worse, having my life destroyed by cancer, or having it destroyed by the side effects of treatment"? I'd give almost anything to trade this disgusting, fat belly for my former physique. I've gained 55 pounds since I began therapy 3-1/2 years ago, I'm in pain and always tired, and lack motivation. If I were to stop the ADT right now, How long before the cancer returns to where it was at diagnosis? Is it years or months? I'm going tomorrow for a dexa scan, hopefully the rest of my bones aren't as F'kd up as my spine, hips, and ribs. I've been taking the d3, calcium, multi vitamin, and Xgeva, hoping to prevent this from happening,.........so wtf? If I was told initially "you're going to have high cholesterol, coronary artery disease, obesity, risk of ONJ, and a fragile skeleton " I may have passed on this ADT crap.

[Hidden in reply to Hidden]

I’m with ya Tommy! I got wiped out by imrt Lupron and Tak-700 .. My point is that nobody knows the future with APC . We are all with the same beast #4 just at different stages , afte4 treatment. . So the docs can read you their stats, if I had bought into that I don’t think I’d be here today . I was told 50/50 chance to even survive treatment and 36 months max ,no matter what . I’m working my 8 th yr past dx. But i had this PC in me for years to get to where it shut down my urology . Which is worse the treatments or the pc? Imho the APC and end stage is not good . No man wants that . So we fight with the poisons available to us now . I’m a health nut as to diet .. I think you must live clean with a whole food diet . Cut out all sugar and bad stuff . That what s I’ve done . I went from 233 with macho muscle down to 165 and gaunt . I’m 6.3 . Now im back at 200 but skin and bone no muscles . I went into painful osteopenia after four years of dexa s and double adt . . I did prolia for 3 yrs . I tossed it and the Tak-700( similar to zytiga) six months ago . But I chopped my balls off 2015 and dropped Lupron . All of my issues now are from no T and the treatments . Psa<.1 and 3 T no signs of PC .. for over seven years . We are told that there can be 2-3 million of of enemies cells hiding undetectable to any scan . That’s not good .. I got djd ,,degenerative joint disease from it all and an over use of bad antibiotics for mr first two yrs with tubes and a foley. Pure hell buddy . You don’t want to go there . I’ve done a lot of alt med also and nutrition …. I do understand no wanting to fall in line and take on the standard of care pathway . Only the shadow knows how long a guy with APC can hide out under the radar like I have for 7 yrs , I’m a lucky mofo . If getting #4 is lucky at 53? I really feel for those younger than 50 here ,some in their 40’s . That sucks . Do whatever you feel will save you . Take time to love yourself and those around you .😩 Sorry for that pain . Anything to feel better is my thinking .. take care Tommy ..

[Hidden in reply to Hidden]

They never tell us this stuff although they are completely aware of all of the side effects . My docs let me go into osteopenia before saying prolia . 3 yrs on prolia I had a non displaced L -3 rib fracture . I Thought that prolia would prevent that ? . Not true . I feel like the disintegrating man .. this pc takes it all … really , accepting treatments are a trade off for life . Live depleted or What just give in ? I’m not sure what I’ll do when the beast comes back for it’s dinner .? Chemo? Shit! Maybe , jump off a Cliff ? . Surely , I jest! I was in that mind set when I was under the gun myself . Now im in the eye of the storm whistling Dixie ! Im Just waiting for the inevitable pendulum to swing back the other way and chop my head off .I’ve got the high cholesterol too , my veins are gone , I’m thinking that a heart event is better than end stage .. Today is a good day for me . I’m hoping that you can beat this pain and push pc down. 😳⛵️⛵️⛵️⛵️⛵️

[john4803 in reply to Hidden]

My Dietitian wife just stared my MO down & told him you should know that calcium supplements do little & she just had me up my intake of milk products, ie. milk, yogurt, specifically. We get a little from veggies, too.

She agrees that exercise is EXTREMELY important!

[Hidden in reply to john4803]

Good to have a loving informed wife pulling for you . I have the same . Yogurt is the best of dairy . Take care friend! 💪

[john4803 in reply to Hidden]

I am combining yogurt with Flax Seed, also, which will help with my Lipids, hopefully?

My wife, who is retired now, worked previously with my MO, & liked him for his cancer care. He has participated in several clinical trials, also. None for PCa, that I know of, though? However, as she has often told me, typically Docs have almost no nutritional course work & rely on Dietitians.

Yes, my wife is a great asset now, especially after 52 years of marriage. Hopefully, the "until death do us part" will come later than sooner? Totally dependent on God's Will! Best of luck to you & yours!

[Hidden in reply to john4803]

ground up flax seed is good medicine . 👍👏👏👏

[Hidden in reply to john4803]

Thank you! 🙏✌️

[NRH_Beach]

After SBRT to 3 vertebrae and my first year of ADT, I had (2) collapsed vertebrae (August & December). I started Zometa (90 days) and had Kyphoplasty procedure on both veribrae. (Medical cement injected into each vertibrae). It worked like magic.

i can’t get more than a 100 day vacation from ADat.. BUT my back is intact; I can do a full yoga routine; comfortable on the Peloton bike.

[Hidden in reply to NRH_Beach]

I cringe at the pain you suffered . I’m glad you’re in a better place now! 😎🙏