Prostate Cancer Treatment and Bone Health

Issues to consider in prostate cancer treatment and bone health.

Prostate Cancer Treatment and Bone HealthProstate cancer treatment and bone health are closely linked. The most effective treatment of advanced prostate cancer is to reduce the serum testosterone. Traditionally, this has been done by surgical castration and more recently with chemical castration. Outside of the United States, 90% of men undergo surgical castration, which is very effective in controlling their prostate cancer upfront. In the United States chemical castration is more common but the effects are the same in prostate cancer treatment and bone health.

One of the major side effects of reducing serum testosterone is increasing the rate of osteoporosis. This increases the rate of fractures in these patients and there is an overall decrease in bone mass. This is a major side effect in prostate cancer treatment and bone health.  This has been shown in many trials over the past decade. On the same token, there is a lot of research into the prevention of osteoporosis associated with androgen deprivation (the lowering of serum testosterone.)

Farshid Dayyani:  Bone health is a major concern for the patients who are about to start treatment for their prostate cancer.

The most effective treatment of advanced prostate cancer initially is to reduce the serum testosterone.  Traditionally, this has been done by surgical castration and more recently with chemical castration.  As a matter of fact outside of the United States, 90% of men undergo surgical castration which is very effective in controlling their prostate cancer upfront.  Here in the US for various reasons, we use much more chemical castration, but the effects are the same.

One of the major side effects of reducing serum testosterone is increasing the rate of osteoporosis, increasing the rate of fractures in these patients, and overall a decrease in bone mass.  This has been shown in many trials over the past decades and is well established, but on the same token, there has been a lot of research into how to prevent the osteoporosis associated with androgen deprivation meaning lowering serum testosterone.

Originally, we used to use so called bisphosphonates that initially were supplied as tablets.  Now, we have more potent form of bisphosphonates.  They are given in IV form every four weeks and they have been shown to stop or even improve the bone density in men who receive hormone therapy.  The most effective possibly is called zoledronic acid and although not FDA approved for this indication, has been used and shown to be effective in reducing bone loss in men with hormone deprivation.

More recently, a more biologic drug was approved with the name of Denosumab and what this drug does it is actually a monoclonal antibody, so it’s immune therapy that affects the bone resorbing cells in the patients.  It is highly effective in slowing down and sometime possibly also reversing the bone loss in men who receive hormone deprivation therapy and was recently approved by the FDA for this indication.  It is given once every six months as a subcutaneous injection and men who are being treated for two to three years with hormone deprivation therapy should strongly discuss this option with their physicians.

More straightforward measures to prevent bone loss, is to make sure there is a sufficient dietary intake of calcium and daily vitamin D.  I do always recommend my patients moderate exercise four to five times a week to maintain their bone health and these are things that everybody can do in addition to the other drugs I mentioned.

Farshid Dayyani
Dr. Dayyani earned his medical degree in Munich, Germany at Ludwig-Maximilians Universitaet before completing his internal medicine internship and residency at Beth Israel Deaconess Medical Center in Boston, Mass.
Farshid Dayyani

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