They are basically discussing denosumab and zoledronic acid in PCa with bone metastasis
New guidelines to prevent skeletal ev... - Advanced Prostate...
New guidelines to prevent skeletal events in metastatic prostate cancer
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Maxone73
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Here are the key points from the page:
- **Bone Health Guidelines**: The NCCN guidelines emphasize the importance of bone health in prostate cancer patients, particularly those with bone metastasis, recommending agents like **denosumab** and **zoledronic acid**.
- **Efficacy and Safety**: Denosumab has shown superior efficacy in delaying skeletal-related events compared to zoledronic acid but has higher risks of **hypocalcemia** and **osteonecrosis of the jaw**.
- **Dosing Frequency**: Studies suggest that **every 12-week dosing** of zoledronic acid is as effective as every 4-week dosing, with fewer adverse events.
- **Combination Therapy**: Combining bone protective agents with treatments like **radium-223** and **abiraterone** can reduce fracture risk, but careful consideration is needed to avoid increased fracture rates.
Here are some questions you might consider asking about this page:
1. **Efficacy Comparison**: How do denosumab and zoledronic acid compare in terms of preventing skeletal-related events in bone metastatic CRPC patients?[^1^][1]
2. **Adverse Events**: What are the key adverse events associated with denosumab and zoledronic acid, and how do they differ?[^2^][2]
3. **Dosing Frequency**: What evidence supports the recommended dosing frequencies for denosumab and zoledronic acid?[^3^][3]
4. **Bone Health Guidelines**: How have the NCCN guidelines for bone health in prostate cancer patients evolved, and what are the key recommendations?[^4^][4]
Here are the key points from the page:
- **Bone Health Guidelines**: The NCCN guidelines now include sections on bone health for prostate cancer patients, focusing on preventing symptomatic skeletal-related events in bone metastatic CRPC patients.
- **Denosumab vs. Zoledronic Acid**: Both agents are effective in preventing skeletal complications, with denosumab showing a slightly better efficacy but higher risks of hypocalcemia and osteonecrosis of the jaw.
- **Dosing Frequency**: Studies suggest that zoledronic acid can be administered every 12 weeks instead of every 4 weeks without losing efficacy, potentially reducing adverse events.
- **Combination Treatments**: Combining bone protective agents with other treatments like radium-223 and abiraterone can reduce fracture risk, but careful consideration is needed to avoid increased fracture rates.
I wish to say that denosumab (prolia) is what I was offered and the advantage of the denosumab is that it is kind on the kidney and because it is a protein it will interfere less with the future possible lutetium PSMA treatment etc. the problem could be that you can't stop denosumab. You can just convert to zoledronic acide infusions or tablets. Therefore better if you tolerate zoledronic acide otherwise you are in trouble.
Why can't you stop denosumab? I did over 2 years ago.
Were you weaned off of it? Why did you decide to stop it?
After 4.5 years of <0.01 I decided to stop lupron, abiraterone and xgeva. I did not "wean". I simply did not take my next 6 month shot. I did wean off the prednisone. Following this trial: dana-farber.org/clinical-tr...
If you stop denosumab you should transfer yourself to the zoledronic acide otherwise you could brake a bone. Therefore you could see that if you are forced to stop denosumab because of the necrosis of the jaw you are in trouble.
It is especially crazy to start zoledronic acide infusions or denosumab in a hormone sensitive prostate cancer treatment phase of your metastatic prostate cancer setting. Doctors don't understand this very well.
Well I stopped everything. Not only was I undetectable, my dexascan showed improvement in my osteopenia. I know I'm very lucky.
Good luck for you. How intensive was your denosumab treatment?
Memory says a 6 month shot for about 4 years. Alternated every 3 months with 6 month lupron shot.
Therefore you received Prolia (60 mg of denosumab) every six months. Ok that was reasonable but still you should star only if you have osteoporosis or if you are osteoporotic in a castrate resistant phase or if you start abiraterone with prednisolone or if you plan to receive xofigo infusions after developed bone pain. Ol of these stuff should be considered carefully. In a hormone sensitive prostate cancer treatment phase you are much better of to avoid falls make your home fall proof and don't carry heavy stuff around like myself.
my oncologist wants to put me on zoledronic acid, After reading possible SE's I am holding off. Wonder how many here with bone mets are taking it . I think she said every 12 weeks.
Monthly for me
Here is a private message from our member who was on zoledronic acide for six years about bone medication:
"lol ….. bone treatment/s stuff like zoledronic acid and densosumap are off the table for me now. That and my medical team is holding their breath on that one.
I had zoledronic acid drips “ every month “ for nearly 6 years. Prolly nearly 60 of them. This before anyone noticed I was being waaaaaaaay overdosed with it and stopped it. I had around 5 oncologist changes in 5 years ( big oncologist turnover at Kaiser Hospitals. ) They won’t be giving me any additional treatments unless they see something on a bone density scan. They are holding their breaths that I don’t have leg bone or esp pelvic bone fractures or splitting from too much zoledronic acid. Every Zometa infusion I received was intensely painful and debilitating for days after the infusion.'
Not debilitating for me, not a bit, not for a second.
Lots of people have side effects from the zoledronic acide infusions. I booked the infusion in our infusions centre and I asked the nurses and they said to me that some people have side effects. I was thinking to get a yearly infusion but I cancelled it and I believe that in a hormone sensitive prostate cancer treatment setting it is only recommended if you are osteoporotic.
I am happy for you. For how long do they want to keep you on zoledronic acide infusions? Did you have a bone mineral density scan performed as a baseline scan and when was it?
I had to take a full scan of my teeth before starting and of course I am seeing the dentist every 4-6 months. For some reason I think they are keeping denosumab for a later stage as from what the MO told me, zometa will be used for 24 months only.
That sound reasonable.
Therefore you will see if you could tolerate zoledronic acide infusions (lots of people can't tolerate zoledronic acide infusions.) and later if you will need to switch to prolia (six monthly denosumab 60 mg) you could continue for up to 10 years and after ten years you could just safely switch again to zoledronic acide with the knowledge that you will most probably tolerate it again. (I am not a doctor but it was told to me when I asked the endocrinologist what will I do after ten years on prolia knowing that when you stop denosumab the bone mineral density will go down.)
Everything looks complex and you really need a good team of doctors. I am wondering for how long could you live with CRPC?
You are still hormone sensitive therefore I don't understand why you are on zoledronic acide infusions if your bone mineral density is probably still ok? I just know that I have Mets even in my neck and spine but because they are hopefully still not visible on scans I refused to get prolia or zoledronic acide until I experience the first fracture.
For prevention and also because there is some evidence (I don't know how strong) that those bone density medicine not only help with the current damage but also contrast new bone metastasis formation.
I understand what you are saying because years ago some young registrars said to me the same in my Kinghorn cancer centre in Sydney but than I read the research study of Coleman (he is based in UK) and he said that this bone agents will not prevent bone metastasis formation.
If you have any recent study which supports giving bone agents in a metastatic hormone sensitive prostate cancer treatment setting I would like to know about this study.
TA said that they had some hope years ago that denosumab could prevent a formation of new metastasis but unfortunately it didn't substantiated.
I can understand that in a CRPC it is important to prepare a patient to Abiraterone plus prednisolone and to the later treatment with Xofigo (alpha radiation) in order to avoid the alpha radiation to brake your bones.
But you are actually shooting yourself into the foot of you use zoledronic acide or denosumab in a hormone sensitive prostate cancer treatment setting because per definition you are in a stable honeymoon phase of your prostate cancer and you are not developing new metastasis.
I personally believe that me it is better to save that drugs for a later stage (CRPC) of my prostate cancer treatment.
If I understand properly you are still in a hormone sensitive prostate cancer phase.
TA said that dr Fred Saad has a special recommendation how to proceed.
I could even ask ChatGPT but again he is not a doctor but still could give us interesting perspective.
For your would be the easiest to ask TA or just go through his replies in a last 3 years.
For me (I am not on bone medication) is enough to know that Coleman concluded that it will not prevent the formation of new metastasis in his paper about metastasis prevention with bone strengthening agents.
You have to understand that it will not extend your life if you start zoledronic acide infusions now in a hormone sensitive prostate cancer treatment setting and it was proven in clinical trials.
it is given also to non metastatic patients to prevent future skeletals events. See, you say you want to wait for a fracture, but a lot depends on where the fracture happens....one finger is not a problem but in other places it can be painful and force you in bed, hence muscle mass loss and more bone mass loss, hence indirectly shortening your OS and decreasing QOL...I think it's a personal choice.
Plus they are giving it to me monthly to be able to intervene in case.
On an end note, and I don't know how reliable as it's a retrospective study:
link.springer.com/article/1...
bisphosphonates improve OS in the castration sensitive subgroup according to these guys
I am six years into polimetastatic prostate cancer now and I am still alive without bone strengthening agents.
I am not a doctor but I personally made a decision for myself after reading about the side effects of either zoledronic acide infusions or denosumab injections that I don't want to take a risk to interfere with my immune system by introducing this new medications known to interfere with the immunity even if they prevent the formation of new bone metastasis.
For my immunity I am taking hot showers and exposing my bone metastasis to warm water for Les than 30 seconds. I am not doing this for all metastasis. I am only exposing my neck because I have bone Mets in my neck.
I was reading about fracture of the spine and it happens often and people don't even realise it just carry on with their life and if you are not on bone strengthening medication it will heel eventually. If you are on bone strengthening medication you could maybe reduce the accurance of the spinal fracture for let day 5 % but if it happens than you will great problem with the healing of any fracture. I took a time to inform myself on the osteoporosis forums.
For me Colemans opinion is enough to believe that it will not prevent the formation of new bone metastasis in a hormone sensitive prostate cancer treatment setting.
You are welcome to follow your doctor's guidelines. I refused and doing it at my own risk.
As I said, personal choice
ChatGPT said:"When I say that zoledronic acid does not **significantly prevent** the formation of new bone metastases in a hormone-sensitive prostate cancer (HSPC) treatment setting, I mean that clinical studies have not demonstrated a clear or substantial effect of zoledronic acid in stopping the cancer from spreading to bones in patients who are still sensitive to hormone therapy.
Specifically:
1. **Lack of Preventive Effect:** While zoledronic acid is effective in managing complications from existing bone metastases (like reducing fractures or bone pain), studies have not shown that it significantly reduces the risk of new metastases forming in the bone for patients with hormone-sensitive prostate cancer. The STAMPEDE trial, for example, showed that adding zoledronic acid to standard hormone therapy did not significantly prevent the development of new bone metastases [[❞]](urotoday.com/conference-hig....
2. **No Survival Benefit:** The same studies that evaluated the use of zoledronic acid in this context did not find an improvement in overall survival or a significant delay in the time it takes for the cancer to spread to the bones in patients who are still responsive to hormone therapy [[❞]](link.springer.com/article/1....
In summary, while zoledronic acid is useful for managing bone complications in advanced prostate cancer, it has not been proven to effectively prevent new bone metastases in patients with hormone-sensitive prostate cancer."
ChatGPT is not a doctor but if there are no good clinical trials to convince me to use zoledronic acide and Coleman also don't know anything what would support the use of the zoledronic acide in order to prevent the formation of new bone metastasis in a hormone sensitive prostate cancer treatment setting than I will rather myself not take it. By the way my teeth are really not in a best condition and that also contribute to my decision not to start yet with zoledronic acide infusions. But as you said it will negatively impact your kidneys and down the road it may disqualify you to get PSMA treatment.
As I said,personal choice and of course (goes without sayin) related to the individual health conditions), I am not trying to convince you I have just published the new official guidelines, so please do not try to convince others and complain with the authors of the guidelines. Enough of this conversation.
Q. What is Robert Coleman's (from UK) opinion on metastasis prevention using bone strengthening medication like zoledronic acide?
A. Robert Coleman, a prominent oncologist from the UK specializing in bone metastases in cancer, has contributed significantly to the understanding of bone-targeted therapies, including the use of zoledronic acid (Zometa). His opinion on metastasis prevention using bone-strengthening medications like zoledronic acid has been shaped by his extensive research in this field.
Coleman has emphasized that while zoledronic acid and other bisphosphonates (like denosumab) are effective in reducing skeletal-related events (SREs) in patients with bone metastases, their role in preventing metastasis formation is less clear. His research and reviews suggest that zoledronic acid is beneficial in managing bone metastases by:
1. **Reducing the risk of skeletal complications** such as fractures, spinal cord compression, and the need for radiation or surgery to bone.
2. **Potentially prolonging time to first skeletal-related event** in patients with existing bone metastases.
However, Coleman has been cautious about claiming that zoledronic acid can prevent the development of metastases in patients without bone involvement at the start of treatment. The primary use of zoledronic acid is to manage and reduce complications in patients who already have bone metastases, rather than as a preventative measure against the spread of cancer to bones.
In summary, while Robert Coleman acknowledges the critical role of zoledronic acid in managing bone metastases, he does not advocate its use primarily for metastasis prevention. The focus is more on reducing skeletal complications in patients with existing bone metastases.
Q. Ok, but their are a group of people who could still benefit from zoledronic acide infusions in reducing the formation of bone metastasis? Who they are? Hint: older ladies with breast cancer. Could you please say something about this group of cancer patients and what is the rational behind a metastasis prevention using zoledronic acide?
A. You're correct that there is a specific group of patients who may benefit from zoledronic acid in reducing the formation of bone metastases: postmenopausal women with early-stage breast cancer.
### The Group:
- **Postmenopausal Women with Early-Stage Breast Cancer**: This group of patients has been the focus of research to determine whether zoledronic acid can help reduce the risk of bone metastases and potentially improve overall outcomes.
### Rationale Behind Metastasis Prevention:
1. **Bone Microenvironment Alteration**: Zoledronic acid is a bisphosphonate that inhibits osteoclast-mediated bone resorption, which plays a critical role in the development of bone metastases. In postmenopausal women, the bone microenvironment is more susceptible to cancer cell colonization due to increased bone turnover. By reducing bone resorption, zoledronic acid may make the bone environment less favorable for cancer cells to establish metastases.
2. **Anti-Tumor Effects**: Beyond its effects on bone, zoledronic acid may exert direct anti-tumor activity. Some studies suggest it can induce cancer cell apoptosis (programmed cell death) and inhibit angiogenesis (the formation of new blood vessels that tumors need to grow).
3. **Clinical Evidence**:
- **AZURE Trial**: The AZURE (BIG 01/04) trial, led by Robert Coleman, was one of the key studies investigating this approach. It found that in postmenopausal women with early breast cancer, adjuvant zoledronic acid significantly improved disease-free survival compared to standard therapy alone. The benefits were most pronounced in women who were fully postmenopausal at the start of treatment.
- **Other Studies**: Subsequent studies and meta-analyses have supported these findings, showing that zoledronic acid can reduce the risk of distant recurrences, particularly in bone, and improve overall survival in this subgroup of patients.
### Why Postmenopausal Women?
- **Menopausal Status**: The menopausal status of a woman plays a crucial role in the efficacy of zoledronic acid for metastasis prevention. The hormone changes after menopause, particularly the drop in estrogen, create a bone microenvironment that is more prone to resorption and, consequently, more susceptible to metastasis. Zoledronic acid helps to mitigate this risk by stabilizing the bone environment.
In summary, postmenopausal women with early-stage breast cancer may benefit from zoledronic acid infusions to reduce the risk of bone metastases and improve overall survival. This approach leverages both the drug's ability to modify the bone microenvironment and its potential anti-tumor effects, particularly in a hormonal context where bone turnover is high.
Further information about zoledronic acide infusions prevent bone metastasis in postmenopausal women. :Zoledronic acid infusions are particularly effective in early-stage breast cancer for several key reasons related to the biology of cancer progression, the bone microenvironment, and the timing of intervention. Here's a deeper look into why this is the case:
### 1. **Timing of Intervention and Cancer Biology**:
- **Early vs. Late-Stage Disease**: In early-stage breast cancer, the tumor burden is generally lower, and cancer cells may not have yet established robust metastatic sites. Zoledronic acid, when administered early, can alter the bone microenvironment before cancer cells can successfully seed and grow in the bones. By the time breast cancer reaches an advanced stage, metastatic cells may have already established themselves in the bones and other organs, making it harder to disrupt these established sites.
- **Dormant Cancer Cells**: In early breast cancer, micrometastases or dormant cancer cells may reside in the bone marrow. Zoledronic acid may help prevent these cells from becoming active and forming clinically detectable metastases by reducing bone turnover and altering the bone microenvironment, making it less conducive to cancer cell growth.
### 2. **Bone Microenvironment in Early-Stage Breast Cancer**:
- **Bone Turnover and Resorption**: Postmenopausal women experience increased bone resorption due to decreased estrogen levels, which makes the bone microenvironment more hospitable to cancer cells. Zoledronic acid inhibits osteoclasts, the cells responsible for bone resorption, thereby reducing this favorable environment for metastasis formation.
- **Disruption of the "Vicious Cycle"**: Cancer cells in the bone can create a vicious cycle by stimulating osteoclast activity, leading to bone destruction and the release of growth factors from the bone matrix that further promote tumor growth. In early-stage breast cancer, zoledronic acid can disrupt this cycle before it becomes established, helping to prevent metastasis.
### 3. **Potential Anti-Tumor Effects**:
- **Direct Anti-Tumor Activity**: Zoledronic acid has been shown in preclinical studies to have anti-tumor effects, such as inducing apoptosis (cell death) in cancer cells and inhibiting angiogenesis (the growth of new blood vessels needed for tumor survival). These effects may be more pronounced when the tumor burden is lower, as in early-stage disease.
- **Immune Modulation**: Some studies suggest that zoledronic acid may modulate the immune system, enhancing the body's ability to target and destroy cancer cells. This immune modulation might be more effective when the number of circulating tumor cells and micrometastases is still relatively small, as seen in early-stage breast cancer.
### 4. **Clinical Evidence Supporting Early Intervention**:
- **Clinical Trials**: The benefits of zoledronic acid in reducing recurrence and improving survival have primarily been observed in postmenopausal women with early-stage breast cancer, particularly in those with hormone receptor-positive disease. The AZURE trial, for example, showed that zoledronic acid had a significant impact on disease-free survival in this population when given as an adjuvant therapy soon after initial treatment.
- **Metastatic Setting**: In contrast, in the setting of advanced or metastatic breast cancer, zoledronic acid is primarily used to manage skeletal-related events (such as fractures, bone pain, and spinal cord compression) rather than to prevent the formation of new metastases. By this stage, the cancer has often spread beyond the bone, and the therapeutic focus shifts to managing symptoms and complications rather than preventing metastasis.
### 5. **Hormonal Influence**:
- **Estrogen and Bone Health**: The reduction of estrogen levels in postmenopausal women leads to increased bone turnover, which creates a fertile ground for cancer cells to colonize. In early-stage breast cancer, zoledronic acid helps counteract this process by preserving bone density and altering the bone microenvironment before metastasis can occur.
### Summary:
Zoledronic acid is effective in early-stage breast cancer because it intervenes at a critical point when cancer cells may be attempting to establish new sites in the bone. By altering the bone microenvironment, reducing bone resorption, and possibly exerting direct anti-tumor effects, zoledronic acid helps to prevent the progression from micrometastatic disease to overt bone metastasis. In contrast, once metastases are established, the focus of treatment with zoledronic acid shifts from prevention to the management of bone-related complications.
The idea of using zoledronic acid for the prevention of bone metastasis in prostate cancer is indeed compelling, given the drug's effectiveness in managing bone metastases in various cancers, including breast cancer. However, there are several reasons why zoledronic acid hasn't been as effective in preventing bone metastasis in prostate cancer as it has been in breast cancer:
### 1. **Differences in Tumor Biology**:
- **Prostate Cancer vs. Breast Cancer**: The biological behavior of prostate cancer differs significantly from that of breast cancer. Prostate cancer tends to be slower growing, and the mechanisms by which it metastasizes to bone may not be as effectively disrupted by zoledronic acid. Prostate cancer cells have a high affinity for the bone environment and can promote new bone formation (osteoblastic activity) in addition to bone resorption. This osteoblastic nature of prostate cancer metastasis is different from the predominantly osteolytic (bone-destructive) nature of breast cancer metastasis, which is where zoledronic acid's bone resorption inhibition is most beneficial.
### 2. **Timing and Efficacy of Intervention**:
- **Established vs. Early Intervention**: In prostate cancer, by the time bone metastases are detectable, the disease often has already established a strong foothold in the bone. Zoledronic acid is effective in reducing skeletal-related events (SREs) in these patients but may not be as effective in preventing the initial formation of metastases. Unlike in early-stage breast cancer, where zoledronic acid is used in the adjuvant setting to prevent metastasis, prostate cancer's metastatic process may already be well underway before diagnosis or the start of zoledronic acid therapy.
### 3. **Clinical Trial Results**:
- **Studies in Prostate Cancer**: Clinical trials investigating zoledronic acid in the adjuvant setting for prostate cancer have not shown the same level of benefit as seen in breast cancer. For example, studies like the Zometa European Study (ZEUS) trial found that zoledronic acid did not significantly reduce the incidence of bone metastases in high-risk prostate cancer patients who were free of bone metastases at the time of treatment initiation. This suggests that while zoledronic acid is effective in managing established bone metastases, it is less effective in preventing their initial occurrence in prostate cancer.
### 4. **Differences in Hormonal Influence**:
- **Androgen Deprivation Therapy (ADT)**: In prostate cancer, androgen deprivation therapy (ADT) is a common treatment that also affects bone health. ADT can lead to increased bone resorption and osteoporosis, which could theoretically make the bone environment more susceptible to metastasis. However, the addition of zoledronic acid has primarily been shown to be effective in managing bone density loss and preventing SREs rather than preventing metastasis in this context. The hormonal environment in prostate cancer, driven by androgen levels, differs from the estrogen-driven environment in breast cancer, which may influence the effectiveness of zoledronic acid in metastasis prevention.
### 5. **Nature of Bone Metastases in Prostate Cancer**:
- **Osteoblastic vs. Osteolytic Lesions**: Prostate cancer typically causes osteoblastic lesions, where abnormal bone formation occurs. Zoledronic acid primarily targets osteoclasts and bone resorption, which is more relevant in the context of osteolytic lesions, as seen in breast cancer. Although zoledronic acid does have some effects on bone formation, its primary mechanism is more aligned with preventing and treating osteolytic bone destruction.
### 6. **Focus on Advanced Disease**:
- **Skeletal-Related Events (SREs)**: In prostate cancer, the use of zoledronic acid is primarily focused on reducing SREs (such as fractures, spinal cord compression, and the need for radiation or surgery to bone) in patients with established bone metastases. While this is crucial for improving quality of life and reducing complications, it reflects a different therapeutic goal than preventing metastasis altogether.
### Summary:
While the logic behind using zoledronic acid to prevent bone metastasis in breast cancer is based on early intervention in a specific hormonal and biological context, the same approach has not shown similar benefits in prostate cancer due to differences in tumor biology, the nature of bone metastases, and clinical outcomes. In prostate cancer, zoledronic acid remains a valuable tool for managing bone-related complications in advanced disease but is not as effective in preventing the initial formation of bone metastases.
I may take it after I brake a bone, but not immediately only after the bone healing because zoledronic acide infusions and denosumab injections interfere negatively with bone healing. If you Mets are under control like my bone Mets are for more than six years I can't see the reason to take it except if you are really osteoporotic. The doctors don't really understand that.
You should start zoledronic acide or even better denosumab ones you are in a castrate resistant phase of your prostate cancer. Otherwise you will simply not be able to continue long enough your bone treatment.
TA is not recommending zoledronic acide because first it is too harsh on the kidneys second not recommended if you plan a future treatment with lutetium PSMA or something similar. Denosumab would be ok because it is a protein.
These bone density scans are not very accurate. They should be performed by the same operator on the same machine otherwise you can't see what is really happening with your bone density. I had two bone density scans until now and was pushed multiple times by registrars, professor of Oncology and finally a professor of endocrinology to take denosumab or whatever I want to take but I refused each time because I believe that I don't need it. Maybe as I said, maybe if New bone Mets start to pop up in a castrate resistant phase of my prostate cancer treatment setting or maybe if I brake a bone and it heals.
That TA recommendation is about kidneys because both zoledronic acid and 177 lutetium can be hard on the kidneys
We know that. But it is not the only reason why TA recommended only denosumab. The biggest concern is that zoledronic acide could interfere with the lutetium PSMA treatment.
I will have to ask him according to which trial because I cannot find anything.
Why don't you just try to get answers from ChatGPT and you may have a better idea what is going on. I am not saying that I believe everything to the AI but I like to ask in order to train the model.
Better if you ask your doctors why did they prescribe you the bone strengthening drugs while you are still hormone sensitive and your bone metastasis are under control. All these drugs have side effects. You are in a healthcare setting where you can't even get a script for Metformin and you are not considering berberine instead. I am not saying that you should but you could get improvement in your bone density with exercise only and you should avoid dangerous life on the edge an fall proofe your home and workspace.
I am an electrical engineer studying some elective subjects from biomedical engineering therefore I was always interested in health but I am not a doctor. What my health is concerned I am realising that we all should make our informed decisions because there are different ways how to skin the cat. You should make a decision after taking to your doctors and thinking through what you are doing. It is difficult sometimes to make an informed decision because you just don't know enough plus in the so called cattle medicine the doctors just simply don't have enough time for you. You may see your medical oncologist only ones in three months for ten minutes. That is really not enough but that is a standard of care in the USA in a hormone sensitive prostate cancer treatment phase except if you are receiving chemotherapy etc.
I asked the AI and they don't know the reason why is denosumab being a protein a preferred option.
I was only recommended six monthly prolia (60 mg denosumab injections).
My information is, but I didn't check the information, that according to the British government clinical trial STAMPED there is no survivor advantage of getting zoledronic acide in a hormonal sensitive metastatic prostate cancer setting.i don't really know much but what I know is that if you for any reason brake your bone while receiving zoledronic acide or any other bone medication you will face a prolonged and more difficult bone healing.
Life is complex and everybody should make an informed decision. I have a post where everything was clarified about bone medication. Xgeva and Pluvicto
healthunlocked.com/advanced...
One more post about bone medication from TA:
Q. Is there any proven survival benefit taking zoledronic acide in a hormone sensitive metastatic prostate cancer treatment setting?
A. The use of zoledronic acid in hormone-sensitive metastatic prostate cancer has been studied, but its primary benefit is in reducing skeletal-related events (SREs) rather than directly improving overall survival.
Several studies and clinical trials have investigated this. The Zometa European Study (ZEUS) and the STAMPEDE trial are notable examples. These trials generally found that while zoledronic acid is effective in reducing SREs, it does not provide a significant overall survival benefit in the hormone-sensitive setting.
However, the decision to use zoledronic acid should be individualized based on a patient's risk of SREs and overall health status, in consultation with their healthcare provider.
Thanks for the info, Like I said I'm holding off on the Zol. I think My bones are still rattling just fine for now, lol
Could you ask for a bone density scan? It should be in the osteoporotic range to do anything.
I will mention it to my oncologist. Thanks
I myself wanted actually to do the bone density scan again for a third time. Last time it was performed by professor Freud and I was hoping that she could do it again. Unfortunately she was not doing that and I didn't understand if it is only temporary or permanent? What I learnt from the bone health Forum here in health unlocked that it is very important that the scans are performed by the same operator and on the same machine in order to have a result any relevance for you. In the UK it looks to me that the surgeon is performing the bone density scan. Now here where I am it looks that almost every day we have a new operator of the machine. I have no influence to change that therefore I will rather not have a new scan now not even for a baseline scan. If you can try to make sure that the place where you are could guarantee a same operator and the same machine even in two years time. I understand that it is very difficult to find but unfortunately the results of the bone density scan are very machine and operator dependent and we want to make a proper conclusion how our bone density is changing.
Zometa every 3 months for 4 1/2 years (my mets widespread skeletal from day one of diagnosis) and stopped several months ago since Pluvitco has put a sledgehammer on my progression for now so taking a break from Zometa while stable PC. Dental check recently and no necrosis.
Nothing scientific about it just my personal experience.
Q. "Rotflol ….. I’d be lucky if it was that simple. lol. Besides many of my teeth are just bony stubs, shattered and broken off at gum level due to the Zometa treatments that put cracks in all of them and caused them to fall apart."
Could it really be a side effect of the zoledronic acide infusions administration in a hormone sensitive metastatic prostate cancer treatment setting? Could you please clarify.
A. Yes, the dental issues you're describing could indeed be a side effect of zoledronic acid (Zometa) infusions. Zoledronic acid is a bisphosphonate used in the management of bone metastases in cancer, including hormone-sensitive metastatic prostate cancer. One of the well-known side effects of bisphosphonates like zoledronic acid is the development of osteonecrosis of the jaw (ONJ). This condition can lead to serious dental issues, including the exposure of bone, poor healing, and the crumbling or breaking off of teeth.
ONJ is more likely to occur after invasive dental procedures, but it can also develop spontaneously. The symptoms can range from mild discomfort to severe pain and include exposed bone, loose teeth, or teeth breaking off at the gum level, as you’ve described. This can happen because bisphosphonates affect bone turnover and healing, particularly in the jaw.
If you suspect that your dental issues are related to Zometa, it's crucial to inform your oncologist and a dental specialist who has experience with ONJ to manage the condition appropriately.
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