Prostate Cancer and the Engineer (Part 3)

What are the side effects of blocking testosterone? Do male cancer patients who take antiandrogens experience the loss of muscle mass? If so, that could lead to osteoporosis.

Hi:

I have concentrated on survival, not on side effects. I've found them to be mostly at nuisance level. Osteoporosis is one exception because I had it forcefully brought to my attention by one oncologist. He started me on Zometa in 2004 without advising me of the risk of predisposition for osteonecrosis, a particularly nasty side effect that includes non-healing (ever) lesions on the jawbone. When I learned of that, as mentioned previously, I dropped biophosphonates and looked for alternatives.

I found that strontium supplements had been successfully tested, mostly in Europe and mostly as strontium ranelate, for many years. It did an excellent job of building bone mass and strength. In this country, I didn't find the ranelate, but started 680 mg per day of strontium as citrate. It may be placebo effect (if so, I don't care) but, over several months, many of the minor pains, in my spine and elsewhere, slowly faded to zero.

If you wish to try it, be sure to continue calcium supplements, but at a different time of day. It's available on the internet at reasonable cost. That may be why there is little interest in the medical community. I have been very satisfied with my experience. Good luck.

Dick Leahy

Hi DickL,

please post here or send direct to me the links and articles on strontium.

I suppose that humans do best if all ingredients that exist in seawater are part of our diet. That is resulting from the time of first "homo" 6 to 1 million years ago when - may be in 2 different phases- our ancestors lived at the seaside. (No other place in very hot Africa at that time and sealevels down despite big global warming so we don't find the fossils that may remain as these are 100m down below todays sealevel)

Strontium as selenium, chromium and other trace elements are not existing in sufficient levels in many soils but in seawater and seafood. And we do not know how much is a sufficient level.

The problem with bisphosphonates as Zometa - which is proven to be powerful to prevent bone metastasis not only in prostate cancer : some % of the patients suffer from severe and non healing bone and gum necrosis especially in the jaws.

But one of the leading experts on prostate cancer, Stephen B. Strum, - see for his book - it is a treasure of information - claims that none of his many patients that are regularly on bisphosphonates suffered from bone necrosis because supporting medication to ensure bone health is preventing this problem.

Any person who is interested in prolonged health should consider additional calcium and Vitamin D3. But be cautious not to take too much of calcium there are vast differences how much a person can tolerate without damage to the kidneys. The D3 is giving protection from many other internal cancers!

The debate on the dosing of vitamine D3 is not yet settled, there are different opinions ranging from 100 to 8000 IU per day, so I estimate that a dosing of 500 to 2000IU will be the best.

Regarding hormone blocking treatments the combined treatments (three medications for a minimum time after reaching undetectable PSA) has proven the best outcome.

In Strums book data are published.

Combine the engineers tendency to be and stay informed with some joy and happiness of life and some luck: this will result in the best possible results.

RR

Hi RR:

I'll try the links:[STRONTIUM-1]

,

[STRONTIUM-2]

,

[STRONTIUM-3]

If I find that they didn't work, I'll send the information to you separately. The third has some practical user advice. The role of strontium is structural, not trace mineral.

I'd be interested in any data that show that combined therapy provides better survival benefit than intermittent use and rotation of antiandrogens, with androgen suppression reserved for after failure of all the antiandrogens. That's what I've been doing for some time now and I've managed to remain among the living, even with my discouraging Gleason = 8 and 10 day doubling time.

I am taking an extra 2000 IU of Vitamin D, in addition to that included with my Calcium supplement and Multivitamin/mineral.

Thanks for the advice. I've enjoyed volunteer classroom work since retirement, but I find little interest in science demonstrations in New York state.

Best regards,

Dick Leahy

Dear Dr. Strum:

Thank you for your thoughtful response to my message. I learned of osteonecrosis and strontium through the old Don Cooley network, which I believe you contributed to occasionally ..... at least indirectly. At the time, I resented having been started on Zometa without being told of the potential predisposition for osteonecrosis but perhaps it was just a timing problem. In 2004, it was just being reported.

I was recently advised to cut back my calcium to 600 mg/day because of my blood levels. I also increased total vitamin D to 2600 IU/day and I'm awaiting my lab report on 25-OH levels as recommended by Dr. Trump at Roswell. I'll probably be increasing it further. I'm getting traces of the other elements in my multivitamin, but I'll have to check further on the dosages.

My cancer has recently become hormone refractory so I'm always looking for ideas. I received 103 mCi of samarium 153 a couple of weeks ago and was told that it may not effect PSA. I'm trying to determine how that can be when bone scans from other patients clearly show a reduction in metastatic bone lesions.

Thank you for the information about Quosa. That was the first I'd heard of it. I'll try to find if it'll work on my Mac.

Thank you again for the information Dr. Strum and I hope you'll be a permanent participant in CR-4.

Best regards.

Dick Leahy

Dear Dr. Strum:

Thank you for your reply and information. I share your concern about radioactive isotopes but, in my position, the risk balance looks a little different from that of an unbiased observer. Certainly the risk of marrow damage with strontium 89, with its high energy and long half-life did seem high. That's why I decided very quickly to go with the samarium 153 when I learned of it. One series of bone scan images of a patient who had received 4 infusions of samarium at 16 week intervals, showed an impressive reduction in bone metastasis and platelets seem to recover at 8 weeks with the samarium ...... and my list of options is getting pretty short.

There are large gaps in my knowledge of the strontium/biophosphonate tradeoff, but I rely largely on the results of studies such as the one reported in the following abstract:

"Strontium Ranelate: Dose-Dependent Effects in Established Postmenopausal Vertebral Osteoporosis—A 2-Year Randomized Placebo Controlled Trial P. J. Meunier, D. O. Slosman, P. D. Delmas, J. L. Sebert2, M. L. Brandi, C. Albanese, R. Lorenc, S. Pors-Nielsen, M. C. De Vernejoul, A. Roces and J. Y. Reginster Hôpital Edouard Herriot (P.J.M., P.D.D.), 69437 Lyon, France; Cantonal Hospital (D.O.S.), 1211 Geneva 14, Switzerland; Centre Hospitalo-Universitaire (J.L.S.), 80030 Amiens, France; University of Florence (M.L.B.), 50139 Florence, Italy; University of Rome (C.A.), 00161 Rome, Italy; Health Center (R.L.), 04-736 Warsaw, Poland; Hillerød Hospital (S.P.-N.), 3400 Hillerød, Denmark; Hôpital Lariboisière (M.C.d.V.), 75475 Paris, France; Hospital Candelaria (A.R.), 38010 Santa Cruz de Tenerife, Spain; and Centre Hospitalo-Universitaire (J.Y.R.), 4020 Liège, Belgium Address all correspondence and requests for reprints to: Pierre J. Meunier, M.D., Hôpital Edouard Herriot, 69437 Lyon Cedex 03, France. E-mail: . Meunier@lyon151.inserm.fr Abstract The aim of the strontium ranelate (SR) for treatment of osteoporosis (STRATOS) trial was to investigate the efficacy and safety of different doses of SR, a novel agent in the treatment of postmenopausal osteoporosis. A randomized, multicenter, double-blind, placebo-controlled trial was undertaken in 353 osteoporotic women with at least one previous vertebral fracture and a lumbar T-score <-2.4. Patients were randomized to receive placebo, 0.5 g, 1 g, or 2 g SR/d for 2 yr. The primary efficacy endpoint was lumbar bone mineral density (BMD), assessed by dual-energy x-ray absorptiometry. Secondary outcome measures included femoral BMD, incidence of new vertebral deformities, and biochemical markers of bone metabolism. Lumbar BMD, adjusted for bone strontium content, increased in a dose-dependent manner in the intention-to-treat population: mean annual slope increased from 1.4% with 0.5 g/d SR to 3.0% with 2 g/d SR, which was significantly higher than placebo (P < 0.01). There was a significant reduction in the number of patients experiencing new vertebral deformities in the second year of treatment with 2 g/d SR [relative risk 0.56; 95% confidence interval (0.35; 0.89)]. In the 2 g/d group, there was a significant increase in serum levels of bone alkaline phosphatase, whereas urinary excretion of cross-linked N-telopeptide, a marker of bone resorption, was lower with SR than with placebo. All tested doses were well tolerated; the 2 g/d dose was considered to offer the best combination of efficacy and safety. In conclusion, SR therapy increased vertebral BMD and reduced the incidence of vertebral fractures."

That, to me, looks like a very effective agent for improving BMD and reducing fractures. I have not seen comparable data for biophosphonates. I would also be curious to know the overall size of the patient group in which the 13 cases of ONJ occurred and to know how many of that cadre were exposed to a triggering event, such as a tooth extraction, after 14 months of zoledronic acid treatment."

As you can tell, I'm way over my head in this sort of discussion, but I still have to work things out the best I can and make the decisions I need to keep my guinea pig alive. I really appreciate you taking the time to carry on this discussion and I hope that others can benefit. Thanks again for your participation in this discussion.

Best regards.

Dick Leahy

Dear Dr Strum,

I see your name continues to come up in Internet searches regarding the intersection of prostate cancer and osteoporosis. Typically, the concern is the possibility of osteoporosis in men already diagnosed with prostate cancer. My case is just the opposite. I am almost 59 and was diagnosed with osteopeonia/osteoporosis over five years ago. Just three months ago, I was also diagnosed with "indolent" prostate cancer. My concern is the relationship between calcium and the two diseases. I have been taking Actonel in conjunction with calcium for more than five years now. My bone density is improved (although I now understand that the "quality" of new bone growth may be in question). I have scheduled an appointment with my general practitioner and am scheduled back with the urologist in September for another series of PSA tests/another biopsy. In the meantime I am really unsure whether to continue on with daily calcium supplements or not. Comments? Insights?

Thanks,

Jim Moldovan

Hi Moose, I am Dick Leahy's son. I am sorry to report that my dad passed away on Nov 20 at approx. 6:00 AM. I had seen him the week before and we got to spend some time together. He did not die of cancer, it was apparently a massive coronary. He was not necessarily afraid of dying, he just didn't want to succumb to cancer. So in that regard at least he died successfully staying one step ahead of his cancer, for which I am proud of him. His determination was inspiring. I know he really enjoyed the CR4 site and the sense of community that he had with you and so many of your members. His insight on so many different topics will be missed by me and I'm sure many of the people on CR4 with which he corresponded.Hopefully this reaches you. Thank you for recognizing my dad in your blog.

Sincerely, Mark Leahy