Decision on bone strengthening meds

[Proflac]

Husband has rising PSA (.8, 1.2 1.6 over 6 months) suggesting start of castrate resistance. Details in bio. Currently on abi/pred plus decapeptyl. Regular Bone and CT scan recently show no overt mets still but something is going on. ALP risen too but that could be related to fall and small compression fracture of lower spine a few months back which has now healed. Onc wants to add a bone strengthening agent. We have had dental check up in preparation and also I organised a Dexa scan. This was normal. Good scores. So do we still accept the additional medication given potential side effects.? He is pretty frail and suffering very much from fatigue.

[Atdabeach]

I was on ADT (Eligard and abiraterone + prednisone) for two years until this summer. Last ear I developed sacral insufficiency fractures, which in turn brought on severe sciatica, as a result of ADT combined with radiation damage. My DEXA scan showed osteopenia, so I was prescribed Reclast, which I will have as annual infusions for 3-5 years. I've now had two of these, and the only side effect I had (after the first) was a day of general malaise. My fractures apparently healed (the sciatica went away within a month), and I've been back to weight training for a year. Based only on my experience, I'd say go for it!

[Proflac in reply to Atdabeach]

Thanks for replying. Sounds like a great choice for you. Long may it last! I'll look up Reclast.

[Ian99]

From my experience (mCRPC) the regular bone and CT scans have not shown radiographic progression, as they are not granular enough. But it is a baseline. Other (micro?) cancerous activity is likely influencing the PSA. If your DEXA is clean, good news. I continue to take ADcal-3 for the bones, plus Alendronic Acid due to a Dexa showing osteopenia. Just my experience, hope it’s useful. Good luck.

[Proflac in reply to Ian99]

Thank you for your reply. Yes to the likelihood of micro mets. Have you still not shown any progression on your regular scans? What's your PSA these days? Hope the parp helps. Husband does not have BRCA mutation but don't think they tested for much else genetics wise (basic NHS testing). Given TAs reply will see about BTT being useful despite good Dexa results. Thanks and good luck

[Tall_Allen]

There is a trial that showed that Zometa+Celebrex (but neither alone) increases survival.

ascopubs.org/doi/10.1200/JC...

E-mail and discuss with his doctor.

[Proflac in reply to Tall_Allen]

Thanks for this. Will try and discuss with onco. Sadly we don't get to email our NHS consultant. I was concerned about possible side effects of a BTT given that he's pretty frail already and when this was suggested we had a Dexa scan privately as there was a long wait. Would zometa be a wise addition to abi/pred and ADT even though bone density is currently normal and no bone mets yet showing?

[gsun]

I am on Prolia for osteopenia. My bone strength has increased by seven percent over two years. I have another scan in a few months and expect another 3-4 percent improvement. No side effects.

[Proflac in reply to gsun]

Thanks. Good progress. X