If prostate cancer spreads to the bones…

• It can make your bones more fragile. Ask your doctor what you can do to help keep your bones strong and which medications can assist you.
• It can cause considerable pain. Medications and radiotherapy sessions can help alleviate the pain caused by cancer that has spread to the bones.

Zoledronic acid (Zometa)

Zometa is a medication belonging to the bisphosphonate family. It is used to:

• Reduce the excessive amount of calcium in the blood (tumor-related hypercalcemia).
• Prevent or delay bone complications during surgery or radiotherapy aimed at relieving pain, preventing bone destruction, and uncontrolled bone growth associated with cancer spreading to the bones.

Denosumab (Xgeva)

Xgeva is the first agent of a new class of drugs that prevents the stimulation of cells that weaken bones, leading to bone fractures.

• It has been effective in preventing bone complications associated with metastases.
• It reduces the risk of developing cancer-related complications such as fractures and/or bone pain requiring surgery or radiotherapy.
• It has also been highly effective in reducing bone loss (i.e., preventing osteoporosis) caused by medical castration, as well as reducing the risk of fractures associated with this bone weakness.

Risks and Complications

Osteonecrosis of the jaw (ONJ)

Serious complications affecting the jawbone can occur with the use of these medications. It is recommended to consult a dentist and undergo necessary dental interventions before starting treatment.

Osteonecrosis of the jaw includes numbness or heaviness of the jaw, poor healing of the gums especially after dental interventions, tooth mobility, bone exposure in the mouth, mouth pain, tooth or jaw pain, dry mouth, swollen or infected gums, bad breath.

Kidney Damage

Kidney damage can occur suddenly (acute side effect) or develop gradually.

Contraindications

Zoledronic acid (Zometa)

• Zometa is administered by infusion into a vein over a period of at least 15 minutes. The dose is usually 4 mg. If you have kidney problems, your doctor may prescribe a lower dose based on your kidney function.
• It will be administered to you every 3 or 4 weeks. If you need to undergo antineoplastic treatment (therapy that blocks the growth of cancer cells), Zometa will be administered to you before or after this treatment.
• You will also need to take a daily oral calcium supplement of 500 mg and a multivitamin containing at least 400 IU of vitamin D.
• If you have a history of high blood calcium levels or if your blood calcium level increases too much during treatment with calcium and vitamin D supplements, your doctor may advise you to stop taking these supplements.

Denosumab (Xgeva)

• Xgeva is administered as a single 120 mg injection under the skin (subcutaneously) once every four weeks.
• The injection can be given in the upper arm, upper thigh, or abdomen.
• It can be administered by a person trained to give subcutaneous injections.

Side Effects

Each patient reacts differently to treatments for bone metastases: some have many side effects, while others have very few. Here are some examples of side effects experienced by patients who have received zoledronic acid or denosumab. These reactions, usually mild, will likely disappear quickly. Talk to your healthcare team about the effects you are experiencing so they can best help you manage them.

Possible effects of zoledronic acid

• Bone/joint pain
• Flu-like symptoms
• Fatigue, fever, headaches
• Loss of appetite, weight loss
• Skin reactions (redness and swelling) at the injection site

Possible effects of denosumab

• Diarrhea, nausea/vomiting
• Fatigue
• Weakness
• Skin reactions (redness and swelling) at the injection site

Don’t delay

If you experience any of the following serious side effects, talk to your doctor immediately:

• Denosumab sometimes causes hypocalcemia, which is a decrease in blood calcium levels. This can manifest as tetany, tingling, muscle stiffness, contractions, spasms, or muscle cramps.
• If you notice any dental abnormalities, such as a loose tooth or gum problems (pain, swelling).
• If you notice a skin infection with a swollen, red, warm, and tender area of skin, sometimes accompanied by fever (cellulitis).
• If you have eye problems (redness and/or pain and inflammation in the eyes, excessive tearing).
• Intense bone, joint, or muscle pain, sometimes debilitating, as well as drowsiness, irregular heartbeats (atrial fibrillation), difficulty breathing with wheezing or coughing, lung disease, severe allergic reaction, and rash accompanied by itching.