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  1. Click here to read "A Brief Update of the Current Landscape of Bone Targeted Therapies for Prostate Cancer" by Joel Nowak of Malecare. Radium 223 (Xofigo) has been approved for use in Australia. However it is not publicly subsidised. This means that its cost effectively puts it out of reach of most Australian men with advanced prostate cancer. Your committee is lobbying to try to get Radium 223 (Xofigo) publicly subsidised. However it's unlikely to be publicly subsidised in the near future.
  2. The Malecare Advanced Prostate Cancer Blog reported on research data presented at the 7th European Multidisciplinary Meeting on Urological Cancers held in Barcelona from 12-15 November 2015. Patients who were treated with abiraterone acetate (Zytiga) or denosumab at the same time as they were treated with Ra-223 had better Overall Survival. Patients who had a good ECOG performance status*, no pain and low alkaline phosphatase (ALP)# had significantly longer Overall Survival. * ECOG performance status Clinical trials require the use of standard criteria for measuring how the disease impacts a patient’s daily living abilities (known to physicians and researchers as a patient’s performance status). The ECOG Scale of Performance Status is one such measurement. It describes a patient’s level of functioning in terms of their ability to care for themself, daily activity, and physical ability (walking, working, etc.). The scale was developed by the Eastern Cooperative Oncology Group (ECOG). # Alkaline phosphatase (ALP) This is a protein that the body produces mainly in the liver and in bones. With prostate cancer, elevated levels of ALP are associated with the formation of metastases in the bones.
  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."
  4. Patients with castration-resistant prostate cancer and bone metastases may experience debilitating pain that impacts daily functioning and diminishes the quality of life. Previous results from a phase III trial demonstrated superiority of Denosumab (brand name Xgeva) to Zoledronic Acid (brand name Zometa) in delaying or preventing skeletal-related events (pathological fracture, radiation or surgery to the bone, spinal cord compression) in castration-resistant prostate cancer patients with bone metastases. Participants in this trial regularly completed Pain Inventory and Quality of Life questionaiires. Researchers did an ad hoc analysis of this trial which focused on the subgroup of men with no or mild pain at the start of the trial. This analysis showed that that Denosumab therapy significantly delayed the time to worsening of pain interference and maintained a higher overall cancer specific quality of life compared to Zoledronic Acid in castration-resistant prostate cancer patients with bone metastases. Should you be having Denosumab instead of Zoledronic Acid? I agree with Joel Nowak that you should "Speak with your doctor about this question.” Previous posts about Denosumab v Zoledronic Acid are at http://forums.jimjimjimjim.com/index.php?/topic/534-denosumab-or-zometa-for-protection-of-bones-in-prostate-cancer/ http://forums.jimjimjimjim.com/index.php?/topic/535-denosumab-or-zometa-for-protection-of-bones-in-breast-cancer/?hl=zometa
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