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  • Countering An Androgen Deprivation Therapy (ADT) Side Effect: Bone Mineral Density

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    Old 06-09-2021, 02:06 PM   #1
    IADT3since2000
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    Lightbulb Countering An Androgen Deprivation Therapy (ADT) Side Effect: Bone Mineral Density

    Males make a small amount of estrogen from our testosterone, and therefore our estrogen is reduced when our testosterone is reduced. Estrogen protects our bone mineral density (BMD). Therefore, when ADT reduces testosterone, it also reduces our estrogen and puts our bone density, the strength of our bones, at risk.

    The most important countermeasure tactic for me was to use bisphosonate drugs plus supplements to counter the decrease in bone mineral density that is typical of ADT used beyond a few months (specifically that kind of ADT that reduces testosterone, such as Lupron, but not the antiandrogen drugs like Casodex and Xtandi). A DEXA scan for BMD showed that I was in the osteopenia range, meaning more or less a milder version of osteoporosis. However, two of my vertebrae were already in the osteoporosis range. I was on Fosamax for years, and later Boniva, which I only needed to take once a month instead of weekly. For my last round of ADT, I was on transdermal estradiol patches instead of the bisphosphonates to protect BMD. I liked the patches; they also reduce or eliminate hot flashes, and they may help with cognitive (thinking) ability, replacing some of the hormone loss (testosterone) with a different hormone (estrogen). Plus you will be able to learn quilting. (Just kidding – the estrogen is not emasculating, rather just restoring estrogen to the normal level in males when used at a dose to counter loss of bone mineral density.)

    Medications were not the whole story for me. I was also taking calcium and vitamin D3 while on the drugs; the drug label information says it is important to take the supplements. I also did frequent “weight bearing exercise,” mostly walking, which is also know to promote bone density.

    Subsequent DEXA scans showed the therapy was successful: I rebuilt BMD to normal levels.

    Two good references about bone density for men on ADT are “The Key to Prostate Cancer”, 2018, by Dr. Mark Scholz, MD, and twenty nine other experts, particularly Chapter 30, “Reducing the Side Effects of TIP [Dr. Scholz’s term for ADT], especially pages 242-244, and “Androgen Deprivation Therapy, 2nd Edition”, 2018, Richard Wassersug, PhD, Lauren Walker, PhD, and John Robinson, PhD, especially pages 22-24 on “Weaker Bones.”

    For those who want a look at published medical research on the risk of decreased bone strength, you can go to the US government’s PubMed, www.pubmed.gov, and use a search string like - prostate cancer AND ADT AND (bone mineral density OR osteoporosis OR osteopenia) ; I just used that string and got a list of 343 publications. By clicking on the blue hypertext, you can access a brief summary (abstract) of the research paper. You can tweak the string, for example, the string - prostate cancer AND ADT AND (bone mineral density OR osteoporosis OR osteopenia) AND (weight OR resistance exercise) – focuses on just 56 papers that involve exercise.

    ….Jim

    - - - - - - - - - - - - - - - - - - - - - - - -
    21 years as a survivor. Doing well. Diagnosis Dec 1999 PSA 113.6 (first ever), age 56
    Gleason 4+3=7 (J. Epstein, JHU), all cores +, most 100%; "rock hard" prostate with ECE - stage 3, PNI, PSADT determined later 3-4 months; technetium bone scan and CT scan negative; prognosis 5 years.
    Later ProstaScint scan negative except for one suspicious small area in an unlikely location. ADT Lupron as first therapy, in Dec 1999, then + Casodex in March 2000, then + Proscar and Fosamax in Sep 2000. Rejected for surgery January 2000; offered radiation but told success odds were low; switched to ADT only vice radiation in May 2000, betting on holding the fort for improved technology; PSA gradual decline to <0.01 May 2002. Commenced intermittent ADT3 (IADT3) with first vacation from Lupron & Casodex. Negative advanced scans in 2011 (NaF18 PET/CT for bone) and 2012 (Feraheme USPIO for nodes and soft tissue). With improved technology, tried TomoTherapy RT, 39 sessions, in early 2013, plus ADT 3 in support for 18 months (fourth round of IADT3), ended April 2014. Continuing with Avodart as anti-recurrence shield. Current PSA remarkably low and stable at <0.01; apparently cured (Current PSA as of 12/2/2020). (Current T 93 12/2/2020.) Supportive diet/nutrition, exercise, supportive medications during this journey, as well as switches in antiandrogen, 5-ARI, and bone drugs. Barely noticeable side effects from radiation; continuing low T, likely do to long use of ADT, but good energy and adequate strength. I have a lot of School of Hard Knocks knowledge, and have followed research, which has made me an empowered and savvy patient, but I have had no enrolled medical education. What I experienced is not a guarantee for all but shows what is possible.

     
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