Bone treatment
Overview
Bisphosphonates
Bone-targeting therapy is a systemic prostate cancer treatment that reinforces the bones. Bisphosphonates are able to relieve bone pain and strengthen bones weakened by prostate cancer. They can reduce the breakdown of bone thereby lowering the risk of fracture.
Bisphosphonate therapy can be used:
- to relieve bone pain or prevent fractures in advanced hormone‑refractory prostate cancer (palliative therapy)
- to prevent osteoporosis in men receiving hormone therapy
Drugs are administered by mouth, intravenously or injected subcutaneously (under the skin).
Reasons for choosing bisphosphonates
Prostate cancer metastasizes (spreads) to the bone more often than any other part of the body. Cancer cells can spread to the spine, pelvis, ribs, arms, and thigh bones in particular. This is called bone metastasis.
If prostate cancer spreads to the bone, it can:
- make your bones more fragile. Ask your doctor what you can do to help keep your bones strong and what medication can help.
- cause considerable pain. Medication and radiation therapy can help relieve some of the pain caused by cancer that has spread to the bone.
Types of bone-targeting treatments
Zoledronic acid (Zometa)
Zometa is a bisphosphonate that:
- lowers high levels of calcium in the blood (hypercalcemia caused by the tumour).
- relieves pain by preventing or slowing bone complications during surgery or radiation therapy to relieve pain, and prevent bone damage and uncontrolled bone growth associated with bone metastases.
Denosumab (Xgeva)
Denosumab (Xgeva) is the first in a new class of drugs that helps to strengthen the bone and prevent fractures.
- Proven to be effective in preventing complications caused by metastases in the bone.
- Reduces the risk of developing cancer-related complications such as fractures and/or bone pain requiring surgery or radiation therapy.
- Proven to also be effective in reducing bone loss and preventing osteoporosis caused by medical castration, as well as reducing the risk of fractures associated with weak bones.
Risks and complications
Bisphosphonate-associated osteonecrosis of the jaw (BONJ)
Using these drugs can cause serious bone complications. It is recommended that you consult a dentist to perform any necessary dental procedures prior to starting your treatment.
Bisphosphonate-associated osteonecrosis of the jaw includes numbness or heaviness in the jaw; poor gum healing particularly after dental procedures; mobility of teeth; exposed bone in the mouth; mouth, teeth, or jaw pain; dry mouth; swelling or infection of the gum; bad breath.
Kidney damage
Kidney damage can be sudden (acute) or develop gradually.
Contraindications
Individuals with serious kidney problems or low calcium levels in the blood should not take these drugs.
Treatment procedure
Zoledronic acid (Zometa)
- Zometa is given through an intravenous drip over a 15 minute period. Doses are normally 4mg. If you suffer from kidney problems, depending on the state of your kidney function, your doctor may prescribe a lower dose.
- Intravenous drips are given every 3–4 weeks. If you are undergoing antineoplastic therapy—a treatment that stops the growth of cancer cells— Zometa may be given before of after your treatment.
- You will also need to take both a 500-mg oral calcium supplement and a multivitamin containing at least 400 IU of vitamin D each day.
- If you have a history of high blood calcium levels or your blood calcium levels rise too high because of calcium and vitamin D supplements during treatment, your doctor may advise you to stop taking supplements.
Denosumab (Xgeva)
- Xgeva is given as a single 120‑mg injection under the skin (subcutaneous) once every four weeks.
- The injection can be administered in upper arm, upper thigh, or abdomen.
- An individual trained in subcutaneous injections will administer the injection.
Side effects
Possible side effects of Zometa
- Bone, joint, and/or muscle pain
- Flu-like symptoms
- Loss of appetite
- Redness and swelling of the skin around the injection site
Possible side effects of Xgeva
- Diarrhea
- Nausea/vomiting
- Fatigue
- Weakness
- Redness and swelling of the skin around the injection site
When to call or consult
Your doctor or pharmacist
If you experience any of the following severe side effects, contact your doctor immediately:
- A decrease in blood calcium levels (hypocalcemia) sometimes causing muscle cramps, dry skin, tremors, cramps, and numbness or tingling in the fingers, toes, or around the mouth.
- Skin infections are sometimes accompanied by fever (cellulitis). The infected area of the skin will be swollen and red and can be hot and tender to the touch.
- Mouth, tooth, or jaw pain.
- Eye problems: redness and/or pain and swelling, excessive tearing
- In very rare cases: bone, joint, or intense and debilitating muscle pain; drowsiness; irregular heartbeat (atrial fibrillation); difficulty breathing with wheezing or coughing; lung disease; severe allergic reaction; and itchy rashes
We are here for you
You have questions or concerns? Don’t hesitate. Contact us at 1-855-899-2873 to discuss with one of our nurses specialized in uro-oncology. They are there to listen, support and answer your questions, and those of your family or your loved ones. It’s simple and free, like all of our other services.
Also take the time to visit each of our pages on this website, as well as our YouTube channel, in order to get familiar with the disease, our expert lectures, our section on available resources, the support that is offered to you, our events and ways to get involved to advance the cause.
Staying Informed
Pages that might interest you
Want to know more? Just click on one of the links below.
The latest PROCURE news that might interest you
Every week we publish a blog article. Here are some we have chosen for you.
- Why does PSA play such an important role during and after your treatment?
- You no longer respond to your hormone therapy?
- Prostate cancer: The right drug to the right patient at the right time.
The medical content and editorial team at PROCURE
Our team is composed of urologists, and nurses certified in uro-oncology with a deep knowledge of prostate cancer and other diseases related to the genitourinary system. Meet our staff by clicking here.
Sources and references
- Prostate Cancer – Understand the disease and its treatments; Fred Saad, MD, FRCSC and Michael McCormack, MD, FRCSC, 4th et 5th editions
- Canadian Cancer Society
- Prostate Cancer Foundation-PCF.org
- National Cancer Institute-USA
- American Cancer Society
- Memorial Sloan Kettering Cancer Center
- Prostate Cancer UK
Last medical and editorial review: September 2023
Written by PROCURE. © All rights reserved
Bone treatment
Bone treatment
Bone treatment
Bones are the part of the body where prostate cancer spreads (or metastasizes) most often. More specifically, cancer cells can spread to the spine, pelvis, ribs, arms, and thigh bones. These are then referred to as bone metastases.
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
These medications should not be used in individuals with severe kidney disorders or low blood calcium concentration.
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.
Additional Information - Advanced cancer
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Prostate cancer: Tests, imaging and biomarkers
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Understanding the hereditary and genetic aspects of this disease can provide valuable information to both individuals affected and their families.
Symptoms, risk and screening
Are you over 50 or experiencing urinary problems? Discover why early screening for prostate diseases is important.
Diagnosis and treatment
Recently diagnosed with cancer? Educate yourself to fully understand your situation.
The role of hormone therapy
Has your doctor recommended hormone therapy? This video is for you!
States of prostate cancer following treatment
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External radiation or Brachytherapy?
Explore the benefits and considerations of each treatment option for prostate cancer to determine which might be right for you.
Q-A – New therapies for advance prostate cancer
In this interview, we answer patients’ questions about new therapies for advanced prostate cancer.
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All about hormone therapy
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Active surveillance in 5 points
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Me a guinea pig?
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Sources and references
Last medical and editorial review: April 2024. See our web page validation committee and our collaborators by clicking here.
Discover our animated video!
Symptoms, risk and screening
Are you over 50 years old, or have you been having urinary problems for some time now? This video is for you! Several diseases can affect your prostate, and it’s important to detect them early. Let’s take a closer look.
Anatomy
What is the prostate
The prostate is a gland:
- Located between the bladder and the penis, just in front of the rectum;
- Formed of 2 lobes which surround the urethra, a canal that runs through the center of the prostate, from the bladder to the penis, letting urine and sperm flow out of the body;
- The size of a walnut, which grows larger in size in your forties;
- That has a soft, spongy texture to the touch like a small, ripe plum.
The prostate is made of:
- Gland cells that secrete liquids for ejaculation;
- Muscle cells that participate in the evacuation of your sperm during ejaculation;
- Fiber cells that maintain the structure of the gland.
Around the prostate, we find:
- The seminal vesicles, glands that produce sperm and that are located on either side of the prostate;
- The vas deferens, the tube that carries sperm from the testicle to the seminal vesicles;
- The nerve bundles that control your bladder and erectile function and that are located on either side of your prostate.
Structure
Three main zones of the prostate
Peripheral zone
- The peripheral zone is the largest area of the prostate. It can easily be felt by the doctor during a digital rectal exam (DRE).
- Most prostate cancers start in the peripheral zone.
Transition zone
- This is the area located in the middle of the prostate, between the peripheral and central areas. It surrounds your urethra that runs through the prostate.
- With age, the transitional area increases in size until it becomes the largest portion of your prostate. This is called benign prostatic hyperplasia (BPH) or enlarged prostate.
Central zone
- It is the part of the prostate that is farthest from the rectum. This is why prostate tumors located in this area can not be felt by the doctor during a digital rectal examination.
- If the doctor is in doubt, the following information will help decide if additional investigation is necessary:
- Your PSA level
- Your age and family history
- Your ethnic origin
Fonction
In short
Your fertility and natural fertilization
- It produces … a prostatic fluid rich in enzymes, proteins and minerals that nourishes and protects your spermatozoa.
- It makes … a protein (APS) that is used to liquefy your sperm to facilitate the mobility of your spermatozoa.
- It allows … ejaculation by contracting.
- It promotes … fertility through its enzymes facilitating the penetration of sperm through the cervix.
- It is not related to the mechanism of erection. Therefore, the origin of erectile dysfunction lies elsewhere.
Additional details
Exocrine Function
The prostate is made up of thousands of tiny fluid-producing glands. Specifically, the prostate is an exocrine gland. Exocrine glands are so-called because they secrete through ducts to the outside of the body (or into a cavity that communicates with the outside). Sweat glands are another example of an exocrine gland.
The fluid that the prostate gland produces forms part of semen, the fluid that carries sperm during orgasm. This fluid, produced in the prostate, is stored with sperm in the seminal vesicles. When the male climaxes, muscular contractions cause the prostate to secrete this fluid into the urethra, where it is expelled from the body through the penis.
Urine Flow
The prostate wraps itself around the urethra as it passes from the bladder to the penis. Prostatic changes can affect urine flow. Increasing the size of the prostate or muscle tone may impede the flow of urine due to the close anatomical relationship between the urethra and the prostate.
Prostate Specific Antigen (PSA)
The prostate also produces a protein called prostate-specific antigen (PSA). PSA is released with the ejaculatory fluid and can also be traced in the bloodstream. The testing of PSA levels in the blood is used to detect prostate cancer. The level of PSA in the blood is usually measured in nanograms of PSA per milliliter of blood (ng/mL).
A raised PSA level
Usually, a PSA rate of less than 4 nanograms per milliliter of blood is normal, but age should also be taken into consideration as PSA levels gradually increase with age. A rise in PSA concentration may indicate the presence of:
- An enlarged prostate (benign prostatic hyperplasia)
- An inflammation or infection of the prostate (prostatitis)
- A prostate cancer
Your doctor will have you undergo other tests to determine the exact cause of the increase in your PSA.
We are here for you
You have questions or concerns? Don’t hesitate. Contact us at 1-855-899-2873 to discuss with one of our nurses specialized in uro-oncology. They are there to listen, support and answer your questions, and those of your family or your loved ones. It’s simple and free, like all of our other services.
Also take the time to visit each of our pages on this website, as well as our YouTube channel, in order to get familiar with the disease, our expert lectures, our section on available resources, the support that is offered to you, our events and ways to get involved to advance the cause..
Staying Informed
Pages that might interest you
Want to know more? Just click on one of the links below.
The latest PROCURE news that might interest you
Every week we publish a blog article. Here are some for you.
The medical content and editorial team at PROCURE
Our team is composed of urologists, and nurses certified in uro-oncology with a deep knowledge of prostate cancer and other diseases related to the genitourinary system. Meet our staff by clicking here.
Sources and references
- Prostate Cancer – Understand the disease and its treatments; Fred Saad, MD, FRCSC and Michael McCormack, MD, FRCSC, 4th et 5th editions
- Canadian Cancer Society
- Prostate Cancer Foundation-PCF.org
- National Cancer Institute-USA
- American Cancer Society
- Memorial Sloan Kettering Cancer Center
- Prostate Cancer UK
Last medical and editorial review: September 2023
Written by PROCURE. © All rights reserved
