Bone Health in Focus Prostate Cancer

7/30/2019 Bone Health in Focus Prostate Cancer

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A RepoRt About

Pos CCsImPC o Bos


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3/28

1

the significAnce ofbone heAlth in pAtients

with pRostAte cAnceR

todAys pAtient with cAnceR fAces A dAunting Amount of

infoRmAtion. soRting thRough it All And deciding whAts

impoRtAnt cAn be An immense chAllenge. And with so mAny

impoRtAnt issues to consideR, boe helthmAy not be At

the top of A pAtients AgendA.

but pRostAte cAnceR-RelAted bone diseAses Resulting fRom

the consequences of cAnceR tReAtment oR fRom metAstAses

to bone cAn Result in significAnt pAin And disAbility. studies

hAve Also shown A coRRelAtion between cAnceR-RelAted bone

diseAses And incReAsed Risk of moRtAlity.1

At the sAme time,

it is An undeR-Recognized issue thAt mAy not Receive enough

Attention fRom pAtients And sometimes even fRom theiR

heAlthcARe pRovideRs.

this RepoRt Aims to fill the educAtionAl gAp by illustRAting

the seRious consequences of pRostAte cAnceR-RelAted bone

diseAses, spuRRing impRoved communicAtion between pAtients

with pRostAte cAnceR And theiR heAlthcARe pRovideRs, And

inspiRing Action to impRove bone heAlth in pAtients with cAnceR.

Bo HLH

in fOcus


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2

pRostAte cAnceR-RelAted bone diseAses include

two pRimARy conditions:

CC m-IduCd Bo Loss (CIBL): b

ra ra ar ra, u a ar ra ray (Adt).

Bo msss: car a ara r rar r a

ra r a r. t r ar

a a r . t aa r a

a r a r r a, a a-

ra (sRe).

skeletal-related event (s) can ccur whencancer ha pread t the bne (etataized)

and weakened it. s include:

Pologil frur

Spil ord omprssio

Surgry o bo

Rdiio o bo

ma a ar a a r

r r ra. Ar a ar, a ar

raa r a xr ar, ar, rra, a

. t a ar r ra r a a xa

a ra, r a r r aar rr

ar. br r a, a a a ar r a r

ar r r, a a ra a

r a a. t a a

r x ra ar, a a a ar

r a .


5/28

3

R ra ar a ar a

r r a, a r a aa a A

r a ar r ar . t

a r arr harr ira a

a a ar a a a a a r -aa r aa ar, a r

aar a r a a a ar. t r r

harr ira sury, a - r a ra

ar, ar u rr. fr r ra au harr ira

sr a , a rr a 21 rr. t

rr a ra aar, r a, a ura a r a-

ya au aru ra u a.

cAnceR tReAtment-induced bone loss (ctibl) inpAtients with non-metAstAtic pRostAte cAnceR

pra ar, a ar

r (ar -aau ar)2, a ra y a ur r a

, r . car ra- (ctibl) a r a a

ar ra, a ar ra ra (Adt) a

ar-a ra ar, a r r.3

Adt a r a-r a ra ra ar a

.4 hr, Adt a a a a ra a a a ra

r rar.5,6

d a ctibl, a a -aa ra

ar a ra aar (48 r) a r

a r r a ar r

a q Adt.7R r harr ira sr a

a a r (46 r) a a (58 r) ar

r r ry r a rar ctibl a r

a -aa ra ar.7 d r r, ay

ray ua au r a.7

In the haRRIS InteRactIve SRve, eSS than ha O PatIentS Ith

nOn-etaStatIc PROState canceR (48 PeRcent) eRe aaRe that

aDt cOD eaD tO One OSS,anD On 55 PeRcent O thOSe hO

eRe aaRe DIScSSeD ctI Ith theIR PhSIcIan.7 In cOntRaSt,

the ajORIt O ROOIStS anD OncOOIStS SRveeD (90 anD 98

PeRcent, ReSPectIve) cOnSIDeReD ctI a SeRIOS ISSe OR theIR

PatIentS Ith nOn-etaStatIc PROState canceR.7


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4

a One IneRa DenSIt (D) teSt, hIch DeteRIneS the aOnt O

IneRaS (cacI, PhOSPhORS, aneSI) IthIn ceRtaIn aReaS

O One, can PReDIct the RISk O RactRe. thIS teStIn PROceDRe,

caeD One DenSItOetR (DeXa Scan), IS PaIneSS, nOnInvaSIve

anD InvOveS InIa RaDIatIOn eXPOSRe. eaSReentS aRe OSt

cOOn aDe OveR the aR (OeR PORtIOn O SPIne) anD OveR

the PPeR PaRt O the hIP.8

the impAct of pRostAte cAnceR tReAtment on bones

Adt a a ra ra , ra r

rar.5,6 i a, a r a ar (19 r)

r Adt xr a rar ar ra a

ar 13 r ra Adt.6

frar a ra ar a a a a a a

a ar qa .9,10 pa a a r a rra rar

a a r ra ar.11 frar a a aa, r

a, a ar r r.12 frr, ra ar

ar ra Adt a xr a rar ar a a

a ar Adt ra.6

frar ra r ra ar a aa a

39- ra ra ar a r rar.13

t harr ira sr r r a r q

rar. ur a a , r, ra ra ar

a rar q ctibl:

t r aa a r (76 a 91 r)7

irr ar ra (43 a 61 r)7

ca ra r (42 a 55 r)7

t ajr r a rr a a a - (91 r)

a a a (91 r) a a (87 r) a a a

q rar ctibl.7 o rr. A ajr

a (99 r) a a (93 r) a a

a a a - (97 r) a q.7

t ar ar a, rr, a a

r r raa a.7


7/28

5

peRcent of uRologists And medicAl

oncologists who AgRee thAt the consequences

below cAn Result fRom A fRActuRe.7

ur

pa

la,

i91% 93%

ma

o

dra a

a a -91% 97%

fa

la,87% 99%

srr83%79%

cr a rr

ra r rar ar

ar a

69%55%

t

r r

ra a

82%79%

t aa r a

a (a ,

a, r, .)

86% 92%


8/28

6

cuRRent tReAtment options, unmet needs foR ctibl

tr ar rr r ra ar u.s. f a dr

Ara (fdA) a r ctibl.

t naa cr car nr (nccn) r ra a r r ra a naa

or fua.14 t u r ra -araa

r a x r ra a ra (iv)

a. ty u aqua a au a a d, ruar

-ar a u-r xr, ra r r a a

aa a u a x a a.15

bone metAstAses: bone is the most

common site of metAstAses in pAtients

with pRostAte cAnceR

sx 75 r a aa ra ar a a

aa r r r a.16 i r,

ar ra r rary ur u, r y a r.

t r ar a a r ar r a a

r a r r a a a-ra (sRe),

ar aa ra a, a a.

1,9,17,18

the ajORIt O OncOOIStS aRe cOnceRneD aOt theIR PatIentS

DeveOPIn One etaStaSeS (87 PeRcent) anD SReS (94 PeRcent).

aOn ROOIStS, 76 PeRcent aRe cOnceRneD the DeveOPent

O One etaStaSeS anD 77 PeRcent aRe cOnceRneD aOt SReS.7

hOeveR, cOnveRSatIOnS aOt the tReatent O One etaStaSeS

aRe nOt Reqent. On One-thIRD (32 PeRcent) O PatIentS Ith

PROState canceR RePORteD DIScSSIn One etaStaSeS tReatent

Ith theIR PhSIcIan.7

b a r a aa ar a ra ,19 a

a -r a ar a ra .20 b a a

a a a aa a a arar

a a r.20


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7

It IS IPORtant OR PatIentS tO cOnIcate an One-ReateD

SPtOS tO theIR DOctOR aS SOOn aS POSSIe SO a One Scan can

e PeROReD tO DeteRIne I One etaStaSeS aRe PReSent.

seRious consequences RequiRe

pRoActive communicAtion: bone metAstAses

And skeletAl-RelAted events

b aa r ra ar a ra r sRe ra a

ra a r. i , ar 50 r a

aa r ra ar r ra r-aa ra

( a Adt) and r ra r aa xr a sRe

yar. t sRe ru raa a a ua ar. 21

i a, a ra ar a rra () aa a

xr y r ar a a, u a ura a.21

aIIaRIt Ith Skeeta-ReateD eventS IS veR O aOn

PatIentS Ith etaStatIc PROState canceR eeR than 1 In

10 (7 PeRcent) StateD the eRe aIIaR Ith theSe cInIca

cOnSeqenceS O One etaStaSeS.7

t ajr r a xr r a rr

rar ar ra a q sRe.7 hr,

r ra ra ra aa a

a ra a a a. fr xa, a

rr aa a aa rr a a a r a

ra ar a aa a (71 r) r iv

a ra.22 t harr ira sr a a 68 r a aa ra ar a aa

ra r a.7 tra aa r sRe a

ra ar aa aa a a a r a

q ra.

i a ra ar, a r r rar a aa

a r ra ra r r ar ar ar

a r rar.13


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8

beRt(patient with prtate cancer, diagned 1996)

The day after my surgery, the doctor said he didnt think he got it all, which meant

that it probably would metastasize. Now I had a very high Gleason [score], this is

another indicator of the aggressiveness of the cancer and when my pathology

report came in with a Gleason 9, the doctors knew that I would get recurrence and

metastases. They knew that. I became very alert about it from day one.

tReAting bone metAstAses And skeletAl-RelAted

events in pAtients with pRostAte cAnceRpa ar u r, ay ra a y

xr a sRe.23 mrr, a ra ar a aa,

sRe ar aa a ra ra.1 crr ra ar

uruz u r a a a ry aa

aa, a r a a ay r ra a.10,22

ira a a r ar-ra

a aa a a r sRe a r

r a q a.21

ira aa a aa.9 Rar r ra

r iv a ar r a aa

a ra rra.24,25,26

w ra a r a a, a a

a r a, iv a a arra r a a.

trr, a a ra, ra a r r sRe.


11/28

9

a SStantIa PeRcentae O PhSIcIanS hO tReat etaStatIc One

DISeaSe aRe nOt SatISIeD Ith cRRent tReatent OPtIOnS. aOn

PhSIcIanS hO tReat PROState canceR, 27 PeRcent O ROOIStS anD

25 PeRcent O OncOOIStS eRe DISSatISIeD Ith OPtIOnS tO tReat

OR Dea Skeeta cOPIcatIOnS De tO One etaStaSeS.7

suRgicAl And RAdiAtion tReAtment options

foR AdvAnced pAtients with cAnceR

i a a r rar r a ara rar, rr

rr aa r r rr a. fr a aa-

a ar, rr a ajr ra, a rr a

a a rqr aa.

w r ra ar , r ra a

aa j a a , a q a

vrra, rra. ka, ar r ar

a a ra , rar raur a rr rra rr

u a a a ra a r .27

t rr r raa ra r a ar raa,

ar r arr raa rar a a ar 28,a ra raa ra, a

r r r , r ra a.29,30


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10

pAtients with pRostAtecAnceR speAk out About

bone heAlth

he etinal cnequence f cancer can be difcult t anage and are nly

agnied when cancer ha etataized t bne.

JAck*j, wo is 78 yrs old d lis i . or r of txs,

s ry ggrssi form of pros r, wi ws origilly

digosd i 1992. e fr pros surgry, w is PSa sould

b zro, is umbrs wr ld, wi idid poil

msss, oug msss r sowd up i is bos.

Srig o ormo rpy i 1994, j suffrd from bo loss d ig ris of

spil frur, bu dos rll big old bou poil sid ffs. ts

o bo rgd rm d lium supplms, is ss sow is bo

dsiy is ow wii orml rg.

j srd wi urologis w ws digosd, bu swid o

oologis yrs lr. h sys did o mu wrss of bo ompliios

uil ws rs sd d rd wll fr is iiil digosis. h lrd bou

bo rms from door prsig s tOO mig. h sd

door o bom is oologis d primry r pysii.

j is ry i i s tOO o sy up o d o mos urr iformio, d

ds migs o mo. h lso sys amri cr Soiy s

-o- groups ds. h lso rlis o di, xris d pryr.


13/28

11

Jim*

jims pros r ws origilly digosd i 1989 mor

20 yrs go w ws 50. h ws o of rly usrs of

PSa s, wi, blis, sd is lif. S yrs go,

r rurrd d mssizd i jims plis, ribs d spi,

bu Olympi, sigo i s d o bo pi d is

r s sbilizd, s o ggrssi ormol rm.

Sbl ms sill s bo msss bu y grow

i siz or umbr i ll is im. his oologis sys, wr

your doig, p doig i.

il jim s d som bo loss du o is ormo rm, is bo dsiyss r ow wii orml rg. h ribus is o is bo rm d o

igorous xris, wi blis ourgs bo ll rgrio. ery im

gs ifusio is door lso sduls rl d lir ss o m sur r r

o poil problms.

jim sys is door gis im s mu im s ds. Ss qurrb,

dds, bu osuls wi rious rsr rs d progrms o is ow bus

of is wor s suppor group ldr. I osul wi bs d brigs

so I wol piur, bu ryig gos roug my oologis.

ai i s tOO s suppor group ldr s wll s pi do for Da,

jim blis srogly i xris d uss imi d rbl supplms, bsd o

is prsol rsr.

*Pi simoils wr olld sprly from hrris Iri Suryd r o flid wi hrris Iri.


14/28

12

ReaIn actIve In OR caRe. Seek Ot InORatIOn RO PatIent

aDvOcac ORanIatIOnS anD aSk qeStIOnS O OR heathcaRe tea.

Role of effective communicAtion

A a a , a, ara a a

a a a ar ra . pa

ra ar a ar a r a rarr a , r

. t ra a rar r

r a a ra. nr a a a a r

a, a a ra a

a a ra, a ra a .

infoRmAtion is AvAilAble

k r. t ay ru r a ra ar. s, a

a r aar, a a a a

r ra a. ira aaa a

ra r a a ra . i a, a a

ra ar r harr ira, r a a (54 r)

a ar r a r a arr r ar

ra, a a (27 r) a ar ra

r r a.7

pra rr aar r , ar a

a ra ar q (46 r) a

a ra a a a ar.7 b r r a,

r a a ir rar a r rr (46 r)

r ra ra a.7


15/28

13

the suppoRt of fAmily And fRiends

A netwoRk of suppoRt

ha r a r a a r ra.

fr xa, r a a a ra r, a a a ra a- a

ar r, a, a rr a

a a a r.

w a, o a a , r a aa,

r aa r a?, da, a a

ra ar, a aa, Aa. f.

In the haRRIS InteRactIve SRve, 69 PeRcent O PatIentS Ith

PROState canceR ReIeD On theIR SPOSe OR SInIIcant OtheR On

theIR Path tO RecOveR.7

beRt(patient with prtate cancer, diagned 1996)

Im a member of the US TOO prostate cancer support group, and I facilitated that

for 10 years. We have brought in several speakers on bone mineral health. Weve

had several talks on it and the importance of trying to take care of bone mineral

density and also attack prostate cancer of the bone. All of those are still under

constant discussions in our support group meetings. Ive been at it for 14 years,

and I spend maybe two or three hours a day just reading up on whats happening

or what the latest is. I try to keep ahead of the game.


16/28

14

keep RecoRds

t r a aa a, a rar a

ra a r r r r aar

rr r ra r r r r a

a.31 ta a a r ra ar

r r ra r rar. i a a r a

a-rr r , r .7 (ma a ar

a a rr .) pa rr r a

ra aa r ar a r r r.

Ar a r a rr ra a r a a

ra a a jra r . i a a ra

j a, , a a , r a

a, a .

Jim*

(patient with prtate cancer, diagned 1989)

My oncologist communicates clearly, without medical jargon. To me, thats critical.

I also bring a tape recorder to my appointments, because I cant remember all of

the information we discuss, and having it recorded helps a great deal.


17/28

15

speAk up

i a ra a r, a r ar. i a

a a r a r ra r r, a

a r a. pa a a rq a a r - r

r .31

b, a a ra ar, a aa r

a ar a ar ra a ra r ra

. exa ra a, b a,

i a r a aa aqa ra, i a a

a a a r r.

phillip(patient with prtate cancer, diagned 2001)

Ive read quite a bit about it, the effects of ADT, and Im well aware of the impact

on bone loss and bone health. Whenever I go to see my doctor, I have a huge list of

questions. We just talk about the lab reports and anything that Ive read. These are

the opportunities to talk about things like side effects and so forth.


18/28

16

teAR-out foR youR neXt visit


19/28

17

Ask key questions

Here are e quetin patient with prtate cancer ight ak their dctr

r nure abut their treatent and fllw-up:31

whAt ARe my tReAtment options?

whAt is the Recommended tReAtment? why?

how often will i Receive tReAtment?

whAt ARe the possible side effects?

whAt ARe the possible benefits And Risks

of this tReAtment?

if my doctoR is not AvAilAble, who cAn i Ask?

foR eXAmple, is A nuRse, sociAl woRkeR oR otheR

speciAlist AvAilAble?

is theRe Any infoRmAtion thAt i cAn ReAd About

this tReAtment oR pRoceduRe?

is theRe Anything else i should know?


20/28

18


21/28

19

RecommendAtions foReffective communicAtion

between cliniciAnsAnd pAtients

mAnAging communicAtions

s a r ar arra a a r,

a raa r ra . A a r, a r

r ra a r ra,

a a.

prr a ara a r ra a rar

-ar r a r, , ra

a r a a ar r a. w a r ar r

a r (r a a) ra, a ar a r,

r arr ra r a. t a ra ra

ra ar, r a a -aa a.

m r ra r a a, r

aa ara a rrr a a aa r r.

w r a ara, r r a a ra ar

rr.

pAtients need to be theiR own best AdvocAte

ba rar a ra rr, ar a:

car-ra a ar a r a ra r a a

aa a a.

t a aa ra ar, ra, a a ar a a ra r .

pa a a a a , a

a a r ra. e a a ar a

a ra aaa , a rrr r

ra a a arr ar ra r.

mr a r qa a a a r

a, a a a r a a ra r r

ra, a r r ra r.


22/28

20

t aa a a a ra a ra ar a

aar a r a a a ar r ar

a ar ra .

t r aar a ra a a ar-ra

a r a rr r ra . t r

ra a ra ar r a

a r a ar . i a,

a, a, r r a r aa a a ra a r

aa a a r a r a a a

ar-ra a rr a ra .

the eectIve tReatent O canceR ReqIReS a cOnSIDeRae eORt

the PatIent anD PhSIcIan. ORIn a StROn PaRtneRShIP, hIch

ShOD aSO IncDe aI, RIenDS, OncOO nRSeS, SOcIa ORkeRS

anD PatIent SPPORt ROPS, IS nOt On heP t cRcIa tO

eectIve DISeaSe anaeent anD tReatent.

wr r r, a a a :

A aar ar a r r a

a ra a a ar r .

c a ar- ra a. i r r

r , a ra.

ta xa ra ra a aa a

a a r rr a ra r

aar rr.

ma r ar q a r aar rr.

oa r ra a r r r a a

rr.

s a, a a raa r a a r

ar ra.


23/28

21

some ResouRces cAn pRovide A helpful stARt:

u too (..)

cuRe (.ra.)

self-RepoRted pAtient suRvey methodology

t r a ra ar a u

sa harr ira frar 17 a mar 8, 2010, a

A a arr u too. R 186 a

ra ar r rr r harr cr i pa. pra ar

a aa a rra r a a.

A a r ara 10 .

self-RepoRted physiciAn suRvey methodologyA ya r r y harr ira fruary 19 a

Ar 16, 2010, a A a arr u too. R

113 r a 63 a . A r r rr

a a Ara ma Aa (AmA) ar a a

a ra. ma r rr a a AmA

ar a , a a a r r

harr pya pa. A ya ury ara 10 u . pya

aa a rra a r

a a.


24/28

22

definitions

skeletal-related event (s) a ur ar a ra

(aaz) a a . sRe u:

Pathological fracture: A raur r a a aa ar

a a a rqur urry. i a au ru ar a

ay a a.9

spinal crd cprein: i aa r ar rra

, xa r a rr a r. t a

a r a a ara, a .32

srgery t bne: i a a r rar r a ara rar,

rr rr aa r r rr a.

w a aa ar, rr a ajr ra,

a rr a a a rqr aa.9,17

adiatin t the bne: Raa rr ra

aa a aa a.33 hr, raa

, ra rr ar ara.

overall rvival rate: t r rr ra a

r ra r ar a r a ra r ar r

a r ra r a a. t ra ra ra a a

a -ar ra ra, ra a r ra

r ar a ar ar a r ra.34

Glean cre: Ra r 2 10 a a a a r

ra. A ga r a ar ar ra ra

, a r ra; a ga r a ar

r r r ra, a r r ra.35


25/28

23

RefeRences

1 nraar m, J A, Ja Jb, c k, fr Jp, sr ht. sa ra

, a a ra ra ar: a a a r

dar (1999 2007).J Urol. 2010;184:162-167.

2 Acs ga fa & fr 2007.

3 br Am. car ra- : a a a

r. ncologist. 2008;13:187-195.

4 ba m, c l, ba l, a. l-r r a ar r

a xra rraa a a aa ra ar (a eoRtc

): a a iii ra ra. la 2002;360:103-8.

5 gra sl, ca p, sra sm, n Jb, tr dl, R nm. b ar

a ar ra ra a ra ar.J Clin ndocrinol

Metab. 2005;12:6410-6417.

6 saa vb, k yf, fra Jl, g Js. R rar ar ar ra

r ra ar. ngl J Med. 2005;352:154-164.

7 harr ira b ha sr. daa . A i. J 27, 2010.

8 bmd . naa or fa . ://..r/r/

.. A A 31, 2010.

9 ca l, baa X, c e, l A, war A. ia a a

a qa , , a a . Support Care Cancer.

2008;16:879-889.

10 saa f, ga dm , mrra R, a. l-r a r a r

r a a a a r-rrar ra

ar.J atl Cancer Inst. 2004;96( 11):879-882.

1 1 R pd, da Jw, e Rs, wa Rd. pa a a aa

rra rar a r a . J Clin pidemiol. 1994;47:231-239.

12 br R, da-h b, s dh, w Jb, k A, t A. i a r r-ra rar u sa, 2002-2005.

J one Miner Res. 2007;22:465-475.

13 o mg, R v, cra w, R m. sa rar a rra

ra ra ra ar. J Urol. 2002;68:1005-1007.

14 t nccn ca pra g o. naa cr car

nr . ://..r/ra/a_/a.a. A

A 31, 2010.


26/28

24

15 ca u r a ra r. naa or

fua . ://..r/ra//nof_cagu2009_7..

A sr 19, 2010.

16 ca Re. sa a aa. Cancer. 1997;80():1588-1594.

17 wr a. Aa o 16: 579584, 2005.

18 wr a. Aa o 17: 986989, 2006.

19 Ra c, far f. maa a: a a ra.

Curr Rev Pain. 2000;4:187-196.

20 gra J, tra, d. maa aa a: r a.

J Pain Symptom Manage. 2007;33:462-472.

2 1 saa f. ia aa a qa a ra ra.

ur Urol. 2006;5( 5):547-550.

22 mrr Je, sa k, k Jd. par a u sa ra aa a. Clin reast Cancer. 2007;7:682-689.

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