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    Advanced Prostate Cancer and Side Effects

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    Prostate Cancer Pain and Weakening Bones continued...

    Bisphosphonates to Strengthen Bones

    These drugs help reduce or delay problems such as fractures caused by bone metastases in prostate cancer. The drug zoledronate is the most effective bisphosphonate in reducing fractures caused by prostate cancer and endocrine therapy.

    A new class of drugs, the rank ligand antagonists, specifically denosumab, has been found to be superior to zoledronate in reducing fractures in castrate independent prostate cancer. It is administered subcutaneously.  Denosumab is also used to prevent osteoporosis caused by endocrine therapy for non-metastatic prostate cancer,

    The drug toremifene, a serum estrogen receptor modifier used primarily for metastatic breast cancer, is also useful in the treatment of osteoporosis related to prostate cancer.

    Both zoledronate and denosumab have the unique side effect of destroying the jaw bone. Therefore, before beginning either therapy dental disease should be addressed.

    Radiation Therapy for Bone Pain

    Radiation is given to reduce bone pain in advanced prostate cancer.

    • External beam radiation therapy: Radiation using a high-energy X-ray machine that directs radiation to the painful bones
    • Radioisotopes: Radiation therapy delivered through an injection that targets and attacks the area of bone containing cancer. Strontium 89 is a commonly used radioisotope. Radium 223 (alphadrin) is a new radioisotope used to treat metastatic prostate cancer, which improves pain and prolongs survival.

    Surgery to Stabilize Bones

    Doctors may recommend surgery to stabilize a weakened bone or bones. A surgeon may insert rods, plates, screws, wires, or other devices to provide support to bones damaged by metastasis. Surgery is usually performed only if there is an impending, or an actual, fracture.

    Other, Less Invasive Treatments to Relieve Bone Pain

    A newer noninvasive procedure uses MRI scanning to enable the surgeon to apply heat from ultrasound energy to destroy nerve endings in the bone around the tumor. This can provide relief from bone pain with a low risk of complications. It is indicated for men who are not candidates for external radiation or have failed that therapy. Other, minimally invasive treatments include the use of extreme cold or electrical current to reduce the size of or to destroy the tumor.

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