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.
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- 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
