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  1. Paul Edwards

    Not having a sex change just yet

    Dr Snuffy Myers suggests that small doses of oestrogen may minimise some of the side effects of Androgen Deprivation Therapy, including, amongst others, cognitive side effects. There were also a few small clinical trials around 2005-2007 which looked at the effect of oestrogen on memory (well-known researcher Tomasz Beer did a couple of these). For some time I've been trying to find someone willing to prescribe me oestrogen for this purpose. Until now, most doctors have been reluctant because of the increased risk of cardiac side effects, particularly deep vein thrombosis. My new endocrinologist was willing to prescribe it. The drug that he prescribed is normally used for transgender patients undergoing a sex change. This led to a very interesting conversation at the chemist when the pharmacist asked me had I used the drug before.
  2. Severe hypocalcemia associated with denosumab (Xgeva or Prolia) in metastatic castration-resistant prostate cancer has been reported on the European Urology website (25/2/2015) Some practice points for physicians have been recommended here. Bone is the most frequent site of metastatic disease in prostate cancer, which can lead to skeletal-related events (SREs) such as pathologic fracture and cord compression. Denosumab is approved by the US Food and Drug Administration (and the TGA / PBS in Australia) for use in solid tumors with bone metastases to prevent or delay SREs such as new fracture and the need for radiotherapy to bone. The authors' case series suggested that a higher prevalence of severe and often prolonged hypocalcemia requiring hospitalization may occur in patients with metastatic castration-resistant prostate cancer in clinical practice. Hypophosphatemia was also commonly identified in cases of severe hypocalcemia. Increased disease burden and vitamin D deficiency were discernible risk factors. Patients with albumin-corrected calcium levels in the low normal range may also be at risk. Hospitalization for aggressive calcium and vitamin D replacement, calcitriol therapy, and correction of other electrolyte imbalances is encouraged for patients who experience severe hypocalcemia while receiving treatment. Denosumab (Xgeva or Prolia) is a unique monoclonal antibody inhibiting 'RANKL', as distinct from zoledronic acid, which is a second generation bisphosphonate, also widely used for bone protection in the context of extended androgen deprivation (ADT) and/or bone metastases. a clinical comparison of these two drugs can be found in this section of The Forum. Patients about to use or already using denosumab should discuss the issues raised above with their prescribing doctors, and should ensure that serum calcium and phosphate are being adequately monitored. Cheers, Alan B
  3. Denosumab (brand name Xgeva) is associated with a rare but well-known risk for severe hypocalcemia (very low calcium in the blood stream). The "New" Prostate Cancer InfoLink has an article about this risk which includes a very sensible warning: "If your doctor advises you that you would be appropriately treated with denosumab for prevention of skeletal-related events associated with advanced forms of prostate cancer (particularly in men with metastatic disease on long-term androgen deprivation therapy), you need to be sure that your serum calcium and vitamin D levels are monitored prior to initiation of therapy."
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