If you are newly diagnosed with prostate cancer — or progressing from early/localized prostate cancer to more advanced stages of the disease — there are many things to consider. You may wonder and worry about how aggressive your disease is. You want to know how far and how fast it may spread, what the treatment options are, how effective the treatment may be, and what the side effects are. These are all obviously very important. But if you have more advanced prostate cancer, one other important consideration is bone health. This is particularly important if you have metastatic disease (where cancer has spread to lymph nodes, bone, or other organs).
Many men may take bone health and bone strength for granted. However, for men with advanced prostate cancer, it is important to think about and take action to enhance bone health. Prostate cancer can spread to the bones — in fact, it is one of the common locations for prostate cancer to spread. When it does so, it can weaken the bone and increase the risk of breaks, or fractures.
Additionally, androgen deprivation therapy (ADT), which is the mainstay of systemic therapy for patients with locally advanced and metastatic prostate cancer, can also weaken the bones. Other advanced prostate cancer treatments including steroids, novel hormonal therapies, and chemotherapy may also cause bone health problems.
Depending on how long you are expected to need ADT, your doctor may give you a bone mineral density test to check your bone strength. Your doctor may also use other tools to check your risk for broken bones.
How to Make Your Bones Stronger
There are actions you can take to strengthen your bones and decrease your risk of fractures. While some of these involve medication, most of them do not.
First, all men who are taking ADT should take supplemental calcium and vitamin D. These are critical building blocks for the body to build and maintain bones. You can get these without a prescription from your local pharmacy, and you should take them daily. Most patients should try to take 800-2000 international units of vitamin D and 1200 mg of calcium each day as a supplement to a healthy diet.
Second, weight-bearing exercise is important. When men lose muscle, the risk of falls increases and this increases the risk of bone fractures. This means an activity that improves strength and puts a (manageable) stress on the bones helps to keep them strong. Walking is a great start. Talk with your doctors first to see if more intense exercise may be helpful too.
Third, smoking and drinking alcohol can both weaken the bones, so avoiding smoking and large amounts of alcohol are also important.
Finally, there are medications that can be used to protect the bones. There are two categories of medications that may be used.
The first category is called “bisphosphonates” and includes:
- risedronate (Actonel)
- alendronate (Fosamax)
- ibandronate (Boniva)
- zoledronic acid (Reclast)
- pamidronate (Aredia)
These medications are also used for patients with osteoporosis who do not have prostate cancer. They work by blocking cells in the bones that break down the mineral-based strength of the bone.
The second category is called a “RANK-ligand inhibitor,” such as denosumab (Prolia). It affects the signaling pathways that cells in the bone use to build up their structure.
These medications have been shown to decrease the chance of fractures in men with advanced prostate cancer. But they have side effects, so you should talk with your doctor to see if they are right for you.