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  1. A retrospective study, which looked at the medical data from 1999 to 2012 of 16,535 US Military Veterans diagnosed with prostate cancer, found a positive association between higher vitamin D levels and prostate cancer survival. The researchers stated: "To the best of our knowledge, this is the first published report indicating that vitamin D status and monitoring are associated with significantly better outcomes in veteran prostate cancer patients. The exact mechanisms by which vitamin D may influence prostate cancer are still a subject of continuing investigation. Vitamin D may affect the natural history of prostate cancer and its progression via effects on cellular invasion, angio-genesis, and metastases............ There are several compelling reasons for testing and treating prostate cancer patients with vitamin D, pending large-scale prospective studies. Indeed, another study found that treating patients with both metastatic prostate cancer and vitamin D deficiency with 2,000 IU/day of vitamin D improved bone pain and muscle strength........... We recommend that all prostate cancer patients be prescribed 2,000 IU vitamin D3 daily, with this dose appropriately adjusted based on sequential monitoring”. Reference: “Vitamin D and Prostate Cancer Survival in Veterans” Military Medicine, Vol. 179, January 2014
  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
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