PSA Rising Prostate Cancer News
Evidence-Based, Patient-Centered
For men diagnosed with low-risk prostate cancer, active surveillance can be a sensible first step in managing the disease.
Mark Solloway and a team of urologists at University of Miami Miller School of Medicine have reported on outcomes for a group of their patients.
In all, 157 men with localized prostate cancer were followed on AS.
...continue reading Most Low-Risk Prostate Cancer Patients Stay Treatment-Free for Five Years
For patients with small, low-grade prostate cancer, delaying surgery -- even for years -- does not appear to increase the risk of the disease progressing to an incurable form.So finds a 10-year Johns Hopkins Medicine study. This discovery could prevent over-treatment, the authors say.
...continue reading For Slow Growing Prostate Cancer Delay May be Reasonable, Hopkins Study Finds
Posted April 16, 2005. Adding androgen-suppressing drugs to radiation therapy improves chances or long-term survival for men with high-risk prostate cancer
PSA Rising, December 13, 2004. Men who are in treatment for prostate cancer using hormone therapy are not receiving the protection they need to prevent crippling osteoporosis.
Currently, a study has found, just 1 out of 7 prostate cancer patients who need protection against osteoporosis to prevent serious fractures actually gets it. Primary care physicians were the most aggressive at managing osteoporosis while cancer specialists were the least.
Researchers writing in the January 15, 2005 issue of CANCER, a peer-reviewed journal of the American Cancer Society, say few prostate cancer patients are ever tested for osteoporosis during hormonal therapy treatment. This widely used type of treatment deprives the man's body of the male hormone testosterone. One effect of this is to cause osteoporosis, which in some men happens within the first six months of therapy.
Even men with other known risk factors for osteoporosis, such as smoking or receiving the hormone treatment for a long time, are unlikely to receive prevention or treatment.
Osteoporosis is a disease characterized by brittle, easily fractured bones. It is associated with major ill-effects including hip fracture, which can cause lasting disability or death. Private health insurers and Medicare have an interest in preventing osteoporosis because it adds significantly to healthcare costs.
Osteoporosis occurs when disregulation of the hormone-regulated bone remodeling system leads to a loss of bone mineral density. Risk factors for male osteoporosis include age-associated hormone changes, alcoholism, smoking, and.or some medications, including those used in the treatment of prostate cancer.
Screening tests such as Dual-energy X-ray absorptiometry (DXA) scan are available. But so far there is no established national consensus guiding doctors on when and what to prescribe.
Osteoporosis can be prevented and even treated using a wide range of therapies. Common prevention measures include calcium and vitamin D supplements and regular exercise.
Treatment strategies include bisphosphonates, which have been shown to prevent further bone loss.
[Update: bisphosphonatres have since been shown to carry risks of avascular necrosis including to the jaw after tooth extraction].
To find out how clinicians were managing osteoporosis risk in the U.S. in year 2003 and identify factors that might predict who gets treated, Tawee Tanvetyanon, M.D. from Loyola University Chicago Stritch School of Medicine reviewed the sampled records of 184 prostate cancer patients who received androgen deprivation therapy (ADT), which is known to raise the risk of osteoporosis.
Dr. Tanvetyanon found that "the majority of patients undergoing ADT did not receive osteoporosis prevention or treatment," even when they reported other risk factors, as well.
Only about one in seven (14.7 percent) eligible patients received any sort of osteoporosis management.
Only one in ten (8.7 percent) received at least one DXA scan within three years.
Only one in twenty (4.9 percent) was prescribed a bisphosphonate.
The one factor that predicted clinical management of osteoporosis risk and disease was the presence of bony metastases (prostate cancers that had spread to the bones). Analysis also showed that primary care physicians were the most aggressive at managing osteoporosis while cancer specialists were the least.
Article: "Physician Practices of Bone Density Testing and Drug Prescribing to Prevent or Treat Osteoporosis during Androgen Deprivation Therapy," Tawee Tanvetyanon, CANCER; Published Online: December 13, 2004 Print Issue Date: January 15, 2005.
This article edited by J. Strax, updated December 13, 2004 and May 2015.
NEW HYDE PARK, NY -- May 30, 2004. Doctors at Long Island Jewish (LIJ) Medical Center recently discovered a link between a common chemotherapy drug and a serious bone disease called osteonecrosis of the jaw (ONJ).
The discovery, published in the Journal of Oral and Maxillofacial Surgeons, prompted both the US Food and Drug Administration (FDA) and Novartis, the manufacturer of bisphosphonates used in cancer chemotherapy, to issue warnings earlier this fall to physicians and dentists about the risk for this potential adverse effect.
ONJ is a condition in which the bone tissue in the jaw fails to heal after minor trauma such as a tooth extraction, causing the bone to be exposed. The exposure can eventually lead to infection and fracture and may require long-term antibiotic therapy or surgery to remove the dying bone tissue.
The chief of the Division of Oral and Maxillofacial Surgery at LIJ, Salvatore Ruggiero, DMD, MD, and his staff reported that they were struck by a cluster of cancer patients with necrotic lesions in the jaw -- a condition they rarely saw, in only about one to two patients a year. When they launched a study of patients' charts, they found that 63 patients diagnosed with this condition over a three-year period shared only one common clinical feature: they had all received long-term bisphosphonate therapy.
In post-menopausal women, bisphosphonates to prevent osteoporosis are commonly used in the form of pills (tablets). Stronger forms are used for patients with advanced cancers that have metastasized to the bone. Cancer often causes bone pain and possibly even fractures. Several cancers can involve or metastasize to the bone, including lung, breast, prostate, multiple myeloma. In cancer chemotherapy, the drugs are given intravenously, for months or years.
In their study, Dr. Ruggiero teamed up with Bhoomi Mehrotra, MD, in the Division of Hematology-Oncology at LIJ, and dental specialists at the University of Maryland Medical Center. Of the 63 patients diagnosed with ONJ between February 2001 and November 2003 at their centers, 56 were cancer patients who had received infusions of bisphosphonates for at least a year and 7 were non-cancer patients who had been receiving long-term oral therapy for osteoporosis.
The patients developed ONJ after normal bone trauma, such as a tooth extraction, while receiving bisphosphonate therapy. Rather than healing, the bone began to die, and the majority of patients required surgery to remove the diseased bone.
In the FDA MedWatch and Novartis alerts issued in late September, oncologists and dentists were advised that osteonecrosis of the jaw thad been added to "Precautions" and "Adverse Reactions" sections on the labeling of injectable bisphosphonates. Referring to spontaneous reports of the condition as found mostly in cancer patients, the alerts recommend a dental examination with appropriate preventive dentistry in patients with risk factors such as cancer, chemotherapy, corticosteroids and poor oral hygiene prior to initiating treatment with the bisphosphonates.
"Monitoring the dental health of patients on bisphosphonates is key because an early diagnosis may reduce the complications resulting from advanced destruction of the jaw bone," said Dr. Ruggiero. "Since our paper was published and dentists became aware of the connection, many more patients with the condition have been identified, even in our own center. Prevention and early detection are so important to preserving the jaw bone in these individuals." Individuals should attempt to avoid tooth extractions and other major dental work while on the drugs.
Bisphosphonates block the work of bone cells called osteoclasts, one of two important types of bone cells that are involved in the continuous process of bone remodeling in a delicate balancing act. During this process, osteoblasts -- "the good guys"-- put calcium in the matrix of the bone and make bone stronger, and osteoclasts -- "the bad guys" -- take calcium away, diminishing the internal strength of the bone. Bone remodeling is like a necessary game of tug-of-war between the goods guys and the bad. Bone mass and mineral content constantly adjust throughout the life cycle to support the places on the skeleton where the most outside force occurs.
Novartis's Aredia® (pamidronate disodium) and Zometa® (zoledronic acid) injections are the two intravenous bisphophosphonates used in chemotherapy regimens. Novartis changed their labeling in August. Merck's Fosamax® (alendronate) and Procter and Gamble Pharmaceuticals's Actonel® (risedronate sodium) are the most commonly used oral bisphosphonates, which are only indicated for osteoporosis. Labeling for the oral forms has not been changed.
Bisphosphonate-Related Osteonecrosis of the Jaw: Diagnosis, Prevention, and Treatment. Ruggiero SL, Mehrotra B. Annu Rev Med. 2008 Oct 17. [Epub ahead of print, Expected final online publication date for the Annual Review of Medicine Volume 60, January 07, 2009.]
Osteonecrosis of the jaws associated with the use of bisphosphonates: a review of 63 cases. Ruggiero SL, Mehrotra B, Rosenberg TJ, Engroff SL.
Division of Oral and Maxillofacial Surgery, Long Island Jewish Medical Center, New Hyde Park, NY. J Oral Maxillofac Surg. 2004 May;62(5):527-34.
Ten Years' Experience with Alendronate for Osteoporosis in Postmenopausal Women. Henry G. Bone, M.D. et al. New England Journal of Medicine March 18 2004