Men with advanced prostate cancer are at risk for the brittle-bone disease, osteoporosis.
This can be because the disease has spread to the bone, or because they are taking a type of prostate cancer treatment called androgen deprivation therapy (ADT). This medication lowers the amount of estrogen, a hormone that keeps bones strong. The bones of men who take ADT may become thinner, more brittle and at increased risk for breaking.
Fortunately, men with advanced prostate cancer can take medications and make lifestyle changes to protect their bones and help prevent fractures.
In addition to estrogen, ADT also lowers the body’s supply of the hormone testosterone. This hormone serves as the main fuel for growth of prostate cancer cells. Studies suggest that men live longer if they start ADT after prostate cancer has spread to lymph nodes, the bones, or other tissues. ADT may be given to men with prostate cancer that has spread beyond the prostate or for prostate cancer that is in an advanced stage. Some doctors may even prescribe ADT for men in an earlier stage of prostate cancer because it can shrink the tumor and make radiation treatment more effective.
Patrick “Flash” Ludwick, a 72-year-old singer and songwriter, was diagnosed with prostate cancer in 2007. He has been taking ADT since his cancer spread to his bones. He says the disease is not slowing him down. He and his wife regularly walk three miles indoors and do an exercise video together. Men with prostate cancer should get regular exercise to keep their bones strong, says his doctor, Neal Shore, MD, Director for the Carolina Urologic Research Center in Myrtle Beach, South Carolina.
Ludwick also takes calcium and vitamin D daily to protect his bones—another key recommendation for men taking ADT. “I’m still out performing a couple of nights a week—I don’t have pain in my bones,” he says. He has had some side effects from previous prostate cancer treatment, including some numbness in his hands and feet. But he continues to enjoy a busy schedule. “My lifestyle hasn’t really changed a whole lot,” he says.
If you are receiving ADT, there are a number of things you can do to reduce your risk of bone loss, Dr. Shore explains. “Make sure you are not leading a sedentary lifestyle—exercise regularly and keep fit with weight-bearing activities like walking,” he says. “Avoid smoking and excessive amounts of alcohol. Supplement your diet with vitamin D and calcium to keep bones strong.” Your doctor may recommend a yearly bone density scan to see if your bones are thinning.
In addition to Flash’s prostate cancer treatment, he receives an injection every month called denosumab. This medication is given monthly to some men whose prostate cancer has spread to the bone to help prevent or delay fractures as well as pain. Denosumab is also given to some men on ADT to prevent osteoporosis-induced fractures. This form of the drug is given every six months.
Your doctor may also prescribe another kind of drug to strengthen bones when on ADT or when cancer has spread to bones. Called bisphosphonates, these drugs can prevent a decrease in bone strength. These drugs may also delay or prevent fractures and development of bone cancer pain.
The most commonly used drug of this type is called zolendronic acid. It is given as an intravenous injection, usually once every three to four weeks. This drug can affect the kidneys. So if you take this drug, your doctor will regularly check your kidney function. Your doctor will also want you to have any needed dental work done before you start this treatment.
Other treatments for men with prostate cancer that has spread to the bone include:
- Corticosteroid drugs. These drugs can help relieve bone pain.
- Radiation therapy. This treatment can help reduce bone pain and shrink tumors on the spine or other parts of the body.
- Radiopharmaceuticals. These drugs contain radioactive elements. They are injected into a vein. They settle into areas of the bone with cancer, where they kill cancer cells. These drugs are known as strontium-89, samarium-153 and radium-223. These drugs can help relieve pain caused by prostate cancer that has spread to the bone.
- Radium-223 has been shown to help prostate cancer patients whose cancer has spread only to their bones to live longer.
In addition to ADT, other risk factors for osteoporosis include:
- Being thin or having a small frame
- Having a family history of the disease
- Using certain medications, such as steroids
- Not getting enough calcium
- Not getting enough exercise
- Drinking too much alcohol
If you have or are at risk for osteoporosis, it’s important to prevent falls. Here are some tips for keeping yourself safe in your home:
- Place items you use most often within easy reach so you don’t have to bend and stoop.
- Put skid-proof backing on carpets and area rugs, or tack them to the floor.
- Remove loose cords and wires from the floor.
- Place a non-skid rubber mat in the shower or tub.
- Keep a flashlight by your bed so you don’t trip if the power goes out.
- Mark the bottom and top steps of your stairway with brightly colored tape.