My husband is 80, diagnosed in May 2024 with PCa with pretty extensive bone mets in pelvis and spine. Had radiation for one particularly risky lesion on his spine at T11-12. He/we have worked out for 14 years with a trainer with lots of strength and resistance training. He’s not using super heavy weights but deadlifts at 90-120 pounds. After radiation he was cleared by the radiation oncologist to workout. We’ve always mentioned it to the MO, but he doesn’t work out himself. Now the oncology PA who does work out quite a bit, expressed a lot of concern over using heavier weights and anything involving bending (primarily deadlifting) with the disease in his spine and pelvis. The PA is saying he should not go over 30 pounds in weight and just increase the reps. My husband loves working out as it helps tremendously with SEs of ADT and morale. This seems like a drastic reduction in weights but we don’t want to risk fractures either. For those of you who work out and have bone mets in spine/pelvis, what do you do and what does your MO say?
Thank you very much in advance for any help/wisdom.
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Prelki
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I workout 5 days a week and lift heavy and to failure in the AM and cardio in the evening . My MO absolutely loves my workout plan and has approved its use. I too have mets in spine and pelvis. Only difference is that I am 61. Been doing my current workout regimen for about 3 years, previously did HIIT for about 2 years before switching to heavy lifting.
This is helpful and we appreciate this input. Interesting about your MO and I think we need to have a more specific discussion with my husband’s MO. In the meantime, he will change things and emphasize lighter weights and more reps for now. Keep up the good fight.
TL;DR - "Biomechanical engineering analysis of skeletal risk, in circumstances of bone metastases, and further, how this translates into safe exercise, isn't available outside a few laboratories. But that's something that a lot of us really need. It's not clear at all that the average fitness coach can provide this. It's an important topic without enough attention. We're kind of on our own."
This is a fantastic question Prelki about resistance training or heavy lifting in circumstances of bone metastases. And I should say super kudos to your husband for all the hard work he has done!
I have researched this because I have high volume metastatic PCa including serious metastases in three vertebrae. My DEXA scan for bone density has been good, but my doctors have warned against heavy lifting and the risk of fracture (which may increase as time goes by).
But their advice was rather weak and was basically "don't twist" and "no more deadlifts".
Men with metastatic prostate cancer die from cancerous progression of course, and we'd like to put that off as long as possible, but we can also get tripped up by therapy-related heart disease - or via skeletal failures which cascade to widespread system failure.
Concerning bone and skeletal health, many of us have read quite a bit about calcium supplements along with D3 and maybe K2. (Care has to be taken with calcium supplements because of a possible relationship with atherosclerosis risk.)
But the most important thing we can do to keep skeletal risk at bay is is exactly what your husband has been doing in terms of weight lifting or resistance exercise. Stressing the bones keeps them strong against osteoporosis!
So what's really important here is to understand what specific exercises are good. And I have read one paper on this topic published within the last couple of years which basically said that "biomechanical engineering analysis in the context of metastatic prostate cancer skeletal risk" is what is needed, but that such a service is basically non-existent! And the paper implied that this was very unsatisfactory given the increasing number of men afflicted with metastatic prostate cancer.
Here's an example: three of my vertebrae are apparently 30 to 40% "lucent". My understanding is that this means that a significant portion of the bone structure of several vertebrae have been compromised with poor quality rebuilt bone after metastasis. Fortunately all my bone mets seem to be quiescent right now. But apparently such bones even with quiescent mets are nevertheless significantly weaker than before cancer.
What is the comparative strength of a vertebrae that has 30% weaker bone structure? I suspect it's much weaker than a mere arithmetic 30%, especially under a dynamic load. But I have not met a doctor that's able to analyze this. Or even thinks to mention it.
And I don't have much faith in any exercise coach to understand dynamic engineering stresses in circumstances of unknown bone weaknesses.
To my recollection the article I referred to above seemed to be suggesting that such a body of knowledge of biomechanical skeletal engineering analysis could be developed.
In the meantime, my own sense is that my doctors really don't think much beyond the question of cancer. One is left on one's own with one's physician to worry about cardiovascular risks. But for skeletal risks, one is really on one's own.
We do know that resistance exercise is essential to maintaining bone density. And even beyond that we are also learning that resistance exercise generates a whole category of endocrine substances such as myokines which actually fight against cancer! For success when dealing with metastatic prostate cancer, exercise is essential! And can make a real difference in both quality of life and years.
In my case I'm fatigued but I'm trying to exercise, including aerobic exercise and resistance exercise. I don't do deadlifts anymore. Especially, I have found it challenging to come up with a regime built around well-designed set of resistance exercises: a good recipe of motions and reps and recovery etc. etc. I'm still in my 60s and your husband is actually now an inspiration!
P. S. Added Later - It's worth recalling that skeletal risk in circumstances of prostate cancer arises both from specific skeletal metastases, and because of hormone therapy-related osteoporosis processes. My note above focuses mostly just on the fracture risk related to skeletal metastases.
As for the osteoporosis risk, this is driven by typical hormone therapies designed to drive testosterone to zero. And here's the fun part - estrogen is made from testosterone. So everyone in our situation is living with not only zero testosterone but zero estrogen as well. And thus we are at risk for bone density depletion, not unlike women after menopause.
Why? Because both men and women need estrogen (men not so much of course): bone management processes are managed via the estrogen axis. It's a whole separate discussion regarding the maintenance of bone strength with the help of drugs, including the possible prescription of bone strengthening agents, and/or supplemental estrogen, most recently transdermally.
In terms of keeping our bones strong and avoiding fracture, there's a lot to be said just for what we can do ourselves via exercise!
Thank you, John, this is very helpful. I think you are right that doctors are more focused on what they know and leave it to us to try to interpret and apply as best we can what they tell us and what we learn elsewhere to help ourselves. It does seem that resistance exercises are critical though we did not know about the endocrine substances including the myokines so thanks for sharing that. What you say makes sense - he will stop the deadlifts and focus on more reps and alternative exercises. He can still do many other types of things and it should continue to help with the quality of life and survival. Fingers crossed and let’s hope for no fractures for him, you and everyone else on this site.
You all who have been fighting this disease for longer than us are inspiring and provide such wonderful caring support and incredible amounts of information. We feel lucky to have found you all and check in every day. Many thanks for your entire response. So glad if my husband can be a bit of inspiration too! 😁
I was lucky and found a trainer that is in medical school. Knowing my limitations she designed a program for me so as to lessen chance of skeletal injury. I was told not to exceed 120 lbs on my deadlift which I can easily do. I do a "bro" workout which consists of targeting a single body part per workout. I am only allowed to do 4 different sets per workout with 40 reps per set of increasing weight. She no longer lives in my town but comes to visit and always makes time to workout with me and check my form.
That was extremely lucky to find her. Wish I knew one. But interesting about letting you still do deadlifts with a bit less weight (still pretty heavy though). Since my husband is 20 years older than you, maybe even lower weight for him makes sense. We both still want to stay strong so want to keep at it to the fullest extent possible. Thanks!
I have compression fractures in several vertebrae, and have been warned not to lift more than 20 pounds. (It's difficult to follow this advice and actually do much of anything around the house, shopping, etc.) But I think the advice is generally sound: there is a risk of further compression, possible cord compression, etc. I have also been warned off of accelerated twisting of my torso, for the same reason.
Does your husband have a neurologist or neurosurgeon? It may be helpful to consult with one about this specific question. I have a neurosurgeon, who has explained the risks well. In the meantime, he should consider structuring his workout routine to avoid vertical and rotational stress on his vertebrae. I have found TRX to be helpful, since using one's own body weight for resistance rarely imposes those loads.
Good comments PA, you are highlighting the difference between static and dynamic loads on the spine or other bones. And as you say just doing things around the house makes following the "don't lift more than 20 lb" difficult to follow. In part because the dynamic load for some milliseconds will be much higher. My suspicion is that the 20 lb suggestion is casual and not really based on serious review. It's even counter-productive if doctors are frightening patients into doing less exercise than they could be.
As for your comments concerning working with a neurologist or a neurosurgeon, it's not clear to me that they would necessarily have deep biomechanical engineering knowledge about skeletal static and dynamic loads under different motions and situations.
Both interesting points. He does not have a neurologist or neurosurgeon. I think we will be careful and reduce weight but increase reps in the hopes of maintaining strength and avoiding fractures until we can get some kind of reassurance that somewhat heavier weight is okay (we may never get that, I know). Thanks again to you both. Every bit of input and perspective helps!
At age 81, I was advised to take bone agent Prolia when I started ADT a year ago. I declined the Prolia, hoping almost daily use of weight bearing exercise machines would maintain the bones. I grew quite strong and enjoyed lifting heavy objects.
After a year, a DEXA scan showed the beginning of osteopenia only in one hip, and an MRI showed an insufficiently fracture in the sacrum bone.
So I am now taking the Prolia, have cut the weight in half on the back extension machine, and don't do heavy lifting any more.
Thanks, vintage42. This makes sense especially since you and my husband are close in age. He does have Zometa infusions for his bones and will have a scan in July. There are certainly other options to deadlifting and sandbag lifting so I think he will focus on that now.
Doctors don’t know much about this and thankfully don’t pretend to. Much has been learned about the assumed risk of heavy weight on ADT and older people in general.
However, a great place to start is to just do high rep (15-20) and/or high volume sets (many sets with very little rest between them). Super intense, safer than heavy weight and a really good alternative to it.
Somewhat off topic............ In my mid 70s my cardiologist advised me to stop lifting weights and to not shovel snow. I miss the lifting but not the snow. (like anyone shives a git)....
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