How Would You Know if Your ADT Was Doing More Harm than Good?

[alanbarlee]

Thanks for the background, Guihan. 

 

My understanding from the PCa experts in the USA is that GS 6 prostate cancer tumours can grow in situ or locally, but are almost always non-metastatic distally (i.e. to bones, nodes and organs). Of course, the prognosis and outcome for an individual man with a GS 6 report will depend a lot on how well the biopsy sampled the prostate, and how carefully the post-RP samples were examined. These days, you would have been an ideal candidate for active surveillance. 

 

You seem to have fallen on your feet on all counts!

 

Alan

 

 

[Guihan]

My instincts were telling me that my ADT was now doing me more harm than good. I had not realised just how much harm was being done.

 

A blood test recently confirmed that my testosterone level was 'too low to record', so my GP sent me to see an endocrinologist. He has started me on testosterone capsules, but the T level is going to take a long time to approach normal.

 

My GP also sent me for a bone density scan. I had a naïve feeling that my bone density would be OK because I was only having the Zoladex implants every six months, instead of every three months. Thus, it came as a big shock when I was told that I had severe osteoporosis. My hips recorded an SD of -3.5, and my lower spine was nearly as bad. Apparently, I am in serious danger of breaking a hip and damaging my spine. They have put me on a drug called Prolia to start trying to strengthen my Swiss-cheese bones.

 

I am not complaining about the Zoladex, but it would have been handy is my medical mentors had done a bit of monitoring of my T levels and bone density. Not happy, Ralph!

[alanbarlee]

G'day again Guihan,

 

Unfortunately, loss of mineral bone density (MBD) goes with the territory with androgen deprivation - and ALL oncologists (and GPs) should warn their PCa patients about this and provide an order for a baseline DEXA scan prior to starting ADT and at least a 12 monthly scan thereafter (unless cessation of ADT or testosterone supplementation allows recovery of T - age-dependent, and unlikely after extended suppression).

 

The slow-release 3 and 6-monthly ADT implants  have precisely the same impact on androgen suppression as each other and as the monthly option: monitoring MBD remains equally important in all cases. 

 

Some physically active patients with a young person's BMD to start with can do quite well with extended ADT (I'm lucky to be one of those). Others however are not so fortunate.

 

You might consider consulting an exercise physiologist trained in helping prostate cancer men, with a view to starting a tailored, gym-based resistance exercise program (e.g.1 hour/session 3 times/week). This can strengthen your bones, as well as your mind. A side benefit is preservation of muscle mass - another side effect of extended ADT. In addition, calcium and vitamin D supplementation are important when progressive bone loss is happening. With a t-score of -3.5 you are at significant risk of fracturing a hip or another bone if you should happen to fall, so you need to be always alert to this possibility when you're on the move. 

 

Prolia is a reduced dose denosumab - a RANKL inhibitor that is an effective bone-strengthening agent, usually administered 6-monthly. The full-strength version is used when bone metastases are involved.  You might want to review the dose choice with your medonc or an endocrinologist. (An alternative is Zometa - a bisphosphonate - again worth discussing with your MO). In any case be sure to let your dentist know that you're using a bone strengthening agent. Greatcare needs to be taken with deeper dental work 0 which may need to be postponed until after cessation and washout of the drug - longer with denosumab but possibly 6 months for both.

 

Best wishes,

 

Alan 

[Guihan]

Thanks Alan. I guess the important thing is never to assume that your doctors and specialists will keep you safe from the drugs they are prescribing for you. It appears that patients must try to research the medications they are taking, and seek full disclosure of side effects and available protective measures. Many patients must struggle to understand it all, and may have to rely entirely on the professionalism of their doctors. Those medical professionals must surely bear the principal duty of care in accordance with their mantra 'do no harm'.