Mark Moyad on Denosumab for bone protection

[Nev Black]

At yesterday's phone-in meeting, the topic of bone protection with Denosumab came up.

That reminded me of what Mark Moyad told us when we met with him a few months ago.

 

The clicking on the YouTube video should take you directly to the start of his Denosumab remarks (at 28:40).

 

 

 

Transcript of the Denosumab section

Next on the line is essentially the bone drugs. What's new and exciting with the bone drugs out there in other words the osteoporosis prevention drugs. I think what continues to excite people is the idea of using a Denosumab or it's called here Xgeva x g e v a as the potential go-to drug in the future to reduce skeletal related events. So, I still think the fact that getting an injection every once in a while versus an IV not only does it seem to be this drug seems to be working better for a lot of men but I think the real excitement will be these drugs sit in the body for so long that I think in the future oncologists are going to space them out even further in some men. 
I mean, there are women around the world and men around the world that get these injections for osteoporosis right now just one time of year and it is able to maintain their bones capacity. 
In the United States many women just get it twice a year. They don't need to get it every three weeks or four weeks and the drugs sit in their bodies so long they their done after one or two injections for an entire year. I hope that model moves towards prostate cancer that would be extremely exciting.

[Charles (Chuck) Maack]

When I began ADT way back in 1996, I also began Fosamax as an early protection from osteopenia and osteoporosis and that worked just fine for the many years before denosumab as Prolia became available.  I have continued since with Prolia as a medication that has caused me no discomfort, but admittedly, I have not had a osteopenia/osteoporosis check performed recently, and jawbone showing no discomfort but have no idea if that "bone" has been protected from osteonecrosis.  Thankfully not having to move to Xgeva as the more powerful denosumab for those issues, but should the need come to pass, might still opt for Zometa since though an infusion, can be effective for 12 weeks rather than the subcutaneous injection of Xgeva required monthly.

[Patrick Turner]

13 hours ago, Nev Black said:

drugs sit in their bodies so long they their done after one or two injections for an entire year

Yes Nev, and here in Dear Old Nashional Capitole, Canberra Hospital (public) has got be on Xgeva with 1 inject every 2 months because I'm on Zytiga plus Lucrin for last 4 months, and have had ADT now for nearly 7 years. I'm also taking a daily Caltrate pill, Bone&Muscle and so far, so good.

Its a wonder all the chemicals that are now in me don't react together to orchestrate some Difficult & Hideous side effects. 

But one effect took me me by surprize last Tuesday, when I had a chat with my oncologist about how tings were goin and he say my Psa looks like it will "plateau at about 2.0" for "quite awhile" I began Zytiga with Psa 7.2, then has gone to 2.8 at 4 months later. I asked him about 5A4 dutersteride and Avodart and he said he was well aware of its good effects for his patients with BPH. But I now don't quite have BPH, but have a Queer PG, its now become Puff the fried up Prostate Grenade which may just have stopped slowly exploding while the mets all over the joint are now rather inconvenienced by the Zytiga, we might assume. 

But the Psa graph looks promising, but with slowed "halving rate" and I hope it is beginning of a Keating J curve. My onco said he would not prescribe the dutersteride , but my GP was quite free to prescribe it for me; he had no objections, but he didn't know if it would lower Psa more than what is going on now. I also take Tamulosin pill daily to get a good flow, and if I miss a day, I'm real slow flow guy next day, but  with duter I might be able to give up Tamul. GP was OK about duter when I mentioned it to him last month.

The nurses and doc were happy to see me in lycra after riding 20km to get to them. Oxygen number was perfect 100, blood pressure like a 25yo, BMI 24.1, Waist < 100cm, and resting HR 50, steady.

I left them feeling elated, ( this the effect I said above ) but then things changed. Off I go down a short street to T intersection in hospital grounds and a car at intersection looked like it would plough into me so I stopped real fast, and the driver went past unfazed, but I just fell over, and as I went, put out hands to slow the "personal height adjustment" and that was OK, and I felt no pain longer than 20 seconds, got back up, got back on, rode another 68km, had a 250M swim, went shopping, and I noticed slight ache in L hand and then by 6pm, it got quite angry and became super painful, so I had an panadiene  extra and drove to Calvary, the other public hospital on my side of town. I don't like driving with one hand, but I am usually very patient, no need to rush anywhere after dinner on a Tuesday nite. I didn't have long to wait for an Xray and a 1/2 plaster cast + bandage. 3 other ppl had hand troubles, two ladies with wrists, and a bloke with dislocated thumb. Who said S--t does not happen? Anyway, pain got worse and next morning I had a second damn pain-killer, and GP said I could have cracked a bone, but a CT scan proved I had not, and now I have removed the 1/2 cast and hand is now nearly as good as new, so I'll be back on bike within daze.

I may have thus given this Denosumab stuff a bit of an irregular test. Please do not repeat this test on your concrete patio. Do not whack patio with hand. And do take care driving around on hospital roads; there are some "challenged" old drivers getting about, plus the odd challenged cyclist.

 

And at present, there's SFA going on in the Parly 'Ouse atop tha hill, but, they look like there gonna get the marriage bill done for a gay Chrissy present. Well, that's all OK afaiac, yeah, really, but I had thoughts I might apply to marry me bicycle. But just after this tiny "fallett" I heard this dour female voice come from my front wheel "Listen 'ere mate, yousa gonna afta look after me a bit better if ya want me to marry ya..."

OK, I got her point.  

Life goes on, until it don't, but I can't fault the doctoring I get.....

Patrick Turner. 

[Charles (Chuck) Maack]

Dear Patrick - you do have a humorous wit about you!  And, I enjoyed the read.  Just listen to that front wheel of your bike and all should go better in the future, and she may approve of marrying you yet! :-) 

[Patrick Turner]

2 hours ago, Charles (Chuck) Maack said:

Just listen to that front wheel of your bike

A man only has a short life, compared to Mr Eternity, let alone Miss Infinity who, like all women, remains a baffling puzzle to whom us men become addicted to. Pca is a thing of gloom which makes some fellas move into serious victim mode, and the doctors get all po-faced and can't explain why what they did didn't work this time, so its a job to jolly up the doctors to get them into a cheery mode so they listen a bit more, and don't treat you like just another tiresome  moron. Really, I wouldn't like to have my onco doc's job, doling out chemicals every day, and watching most of them going down anyway, and there's so many to talk to, so they have little time to be conversational.  

 

I got both knee joints replaced with titanium and plastic last Feb, during a lull in Psa rise, when a glimmer of hope arrived for a week or three, and the onco said I could have the knees done and it wouldn't be a waste of Govt funded health care. With our system here, all the surgery and 2 weeks re-hab didn't cost me a cent, and was probably better because our public hospital doctors don't swan about with nose in the air wondering if they get a morning's work to pay for the front half of a new Mercedes Benz.

Anyway, the operation went well, and as usual, I really hated my knee doc for awhile, ppl warned me, "you will hate him" But he knew ppl did, and after a 5 weeks being still far worse than when I went into hospital, he said, "One day you'll be laughing about all this" and I had to stop myself saying he deserved a prize for bullshitting. But then magic seemed to happen, and knee bend increased and by May I could cycle a bit again on a bike I built up with short cranks.

 

Well, the winter brought its leaves and in many of our suburbs we have American oaks and even a few Elm trees, to offset the drabness of Australian gum trees which look fine in the bush, but look awkwardly sad in the suburbs. One street 5 km away has mature oaks, and leaves in July can pile up deep over footpaths and kerbs, and I went to cycle down a laneway one cold afternoon, making the stupid assumption all would be well because I could see the lane way, and I turned left into it, but quite slow, 6kph, an old man's bicycle speed.

I rode through a few leaves, and suddenly, and the bike stopped dead, hitting a curb buried under leaves. A voice from front wheel announce "Patrick, I ain't goin any further, but youse are.." The voice wasn't kidding and I found my arse rotated up to overtake my head, and I had both hands stoically gripping the bars, and the ground rushed to meet my face, and we had an unfortunate meeting. The bars hit first, and arms absorbed energy, but they are spindly 70yo arms spared the agony of ever training as a gymnast. So I got a fast lesson in how to eat Earth, and then I rolled sideways, and all things became a motionless silent equilibrium, and I though I'd smashed all my teeth because there were bits or stone in my mouth, but no, luckily, it was just result eating some gravel. I laughed for awhile, and thought I deserved "Dickhead of the Year" award but nobody got it on a mobile phone video, so I couldn't claim the prize. I cut a lip, but was OK, nothing broken, and looked like I'd just won a bar brawl, but that's OK, and I proceeded home, thanking Lady Luck, who can otherwise be a right bitch when she wants to.

 

So the moral of the outing was "Be careful under the old oak tree in winter" maybe it was treeful revenge against humans wanting to tie yellow ribbons around old oak trees. But it wasn't long before I was able to ride the better Cannondale with 20 speeds again and then re-join a cycle group I hadn't ridden with for 5 years. Last month I rode 1,200km, and I genuinely do not hate my knee surgeon any more.

I even like my onco doc better, Psa going down, and Hoo Noze, it might go down more than they predict with 5AR inhibitors my onco said I could have if I wanted to. 

 

So I have found it a surprize to be able to proove that a man can be completely castrated for years, then ride faster than most in a group of 20 over 80km routes on country roads, while riddled with castration resistant metastasised Pca.  I don't know how long for, but really, for me, its Wonderment that propels me, I don't have to know the meaning of life, it just is, until it isn't, and if it had any meaning, it may be that it hasn't any meaning, because we have little idea of figuring out why Eternity and Infinity exist, let alone figuring out ourselves, or a missus, if we have one. But I have got to understand two bicycles better.

Patrick T.

   

[Charles (Chuck) Maack]

I could read your interesting posts always!  You have a great way with "words," my Aussie friend! I'm sure others who may be reading this are experiencing the same enjoyment.  You are "living" your life the way your want, and that is a huge plus for you.

 

Chuck

[Patrick Turner]

10 hours ago, Charles (Chuck) Maack said:

You are "living" your life the way your want

I wish I was sure about that, Unkel Fate seems to have mixed ideas about my destiny. IMHO, it is a philosophical trap to try to figure out who's in charge of our destiny, ie, the real history of us, and those who surround us as it happens, which is often very different to how we want it, or how TWSU want it. Life's in charge of me, rather than me in charge of life.

 

Let's face it, say I go buy a bright red Lamborghini. Why would I not? I sure could if I wanted to. Well, I hear the depreciation is $50 per 20 minutes, and the service agents have strange ideas about costs, and really, I'd be scared some idiot in a Toyota SUV will drive into it, or over the darn thing. But I do know this Lamborgic  measure of happiness, ie, owning a car of the rich, is fantasy; and the reality is that the Lambo would own me, and its me who gets taken for a ride and if the car attracted a nice young ting of 50 to sit beside me to endorse my ego and masculinity, or to make her look better than she really is, I can bet that the one sentence I will never hear from Ms Oldah Companion is "jus lie down 'ere luvvy, it won't cost yer anyfink".  

If I really valued old fashioned style, and perhaps class, and speed, then maybe a Vincent Black Lightning or an AJS 7R would be far more exciting but then one little step off at 100kph would reduce me to a bag of rattling bits of bone, its the old KE = M x Vsquared  thingie, old guys need to know a few laws of fizziks and know their fragility, and declining reflexes, so, as a cyclist, I really don't mind be sneered at by young male motorists "Git orf tha F------n road ya B-----d" they yell, often on a Sunday morning, after their drunken Satdee nite. I am more than happy I am not dependant on costly toys - because I know its unlikely the crappy bicycle and far crappier car I own will ever be stolen or vandalised. If the car gets stolen, its OK, its worth less than a tow-away fee. Woohoo!

Getting closer to Lucrin+Denosumab day next Friday, plus I should get scrip for Dutersteride 5AR stuff. 

Regards to all.