Bone Health in Focus Prostate Cancer
Content
A RepoRt About
Pos CC’s ImPC o Bos
Bo Bo H L LH
in fOcus the significAnce of bone heAlth in pAtients with wit h pRost pRostA Ate cAn cAnceR ceR todAy’s pAtient with cAnceR fAces A dAunting Amount of infoRmAtion. soRting thRough it All And deciding whAt’s
impoRtAnt cAn be An immense chAllenge. And with so mAny impoRtAnt issues to consideR, boe helth mAy not be At the top of A pAtient’s 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 A n undeR-Recognized issue i ssue thAt thAt mAy mAy not Receive enough Attention fRom pAtients – And An d 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. 1
pRostAte cAnceR-RelAted bone diseAses include two pRimARy conditions: CC m-IduCd m-IduCd B o Loss (CIBL): b
ra ra ar ra, u a ar ra ray (Adt). Bo m ms sss: ss: 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 r a, a ara (sRe).
skeletal-related event event (s) can ccur when cancer 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 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 .
2
R ra ar a ar a r r r a, a r a aa a A ®
r a ar r ar . t a r arr harr ira 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 sury, a - r a ra ra ar, 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 aya ya au aru ra u a.
cAnceR tReAtment-induced bone loss (ctibl) in pAtients 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, ar, a r r.3 Adt a r 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 ra aar (48 r) a r a r r a ar r ira sr a a q Adt.7 R r harr ira a a r (46 r) a a (58 r) ar
r r ry r a rar ctibl a r a -aa ra ar a r..7 d r r, ay
ray ray ua au r a.7
In the haRRIS InteRactIve SRve, eSS than ha O PatIentS Ith nOn-etaSta nOn-etaSt atIc PROSta PROState te canceR (48 PeRcent PeRcent)) eRe e Re aaRe tha that t aDt cOD eaD tO One OSS, anD On 55 PeRcent O thOSe hO eRe aaRe DIScSSeD ctI Ith theIR PhSIcIan. 7 In cOntRaSt cOnt RaSt,, the ajORIt O ROOIStS anD OncOOIStS OncOOIStS SRveeD (90 anD 98 PeRcent,, ReSPectIve) PeRcent ReSPectIve) cOnSIDeReD ctI a SeRIOS ISSe OR theIR PatIentS Ith nOn-etaStatIc PROState canceR.7
3
a One IneRa DenSIt (D) teSt, teSt, hIch DeteRIneS the aOnt O IneRaS (cacI, PhOSPhORS, aneSI) IthIn ceRt ceRtaIn aIn aReaS O One, can PReDIct the RISk O RactRe. thIS teStIn PROceDRe, caeD One DenSItOetR DenSItOetR (DeXa Scan), IS PaIneSS, nOn–InvaSIve nOn–InvaSIve 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 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 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
4
peRcent of uRologists And medicAl oncologists who AgRee thAt the consequences below cAn Result fRom A fRActuRe. 7 pa
91%
93%
la,
ur
i
87%
99%
79%
83%
fa
ma
la,
o
srr
t
79%
82%
r r ra a
91%
97%
dra a a a -
t aa r a
86%
92%
a (a , a,, r, .) a
cr a rr
55%
69%
ra r rar ar ar a
5
cuRRent tReAtment options, unmet needs foR ctibl tr ar rr r ra ar ar u.s. f a dr Ara (fdA) (fdA) a r ctibl. t naa cr car nr (nccn) r ra a r r ra a naa
or or fua.14 t u r ra ra -araa r a x r ra a ra 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
6
It IS IPORtant OR PatIentS tO cOnIcate an One-ReateD SPtOS SPt OS 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 skeletAl-RelA -RelAted ted 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 Pa tIentS Ith et etaSt aSta atIc PROSt PRO Sta ate canceR can ceR – eeR than t han 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 rr aa a aa rr a a a r a ra ar a aa a (71 r) r r iv
a ra. ra. 22 t harr ira sr a a 68 r a aa ra ar 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 ra r r ar ar ar a r r rar.13
7
beRt (patient with prtate cancer, cancer, diagned 1996) 1 996)
The day after my surgery, the doctor said he didn’t 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 recurrenc recurrence e 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 cAnceR pa ar u r, ay ra a y xr a sRe. 23 mrr, a ra ar a aa, sRe ar aa a ra ra. ra.1 crr ra ar
uruz u r a a a ry aa aa aa, a r a a ay r ra a. 10,22 ira ira a a r ar-ra ar-ra
a aa a a r sRe a r r a q a. 21 ira ira a a a aa.9 Rar r ra r 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.
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a SStantIa PeRcentae O PhSIcIanS hO tReat etaStatIc One DISeaSe aRe nOt SatISIeD 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 De a Skeeta Ske eta cOPIcatIOnS cOPIcatIOnS De tO One One etaSt etaStaSeS. aSeS.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 aaa 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 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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pAtients with pRostAte cAnceR 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 li s i . or r of txs, s ry ggrssi form of pros r, wi ws origilly
digosd i 1992. e fr pros surgry, 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. 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.” pryr.”
10
Jim* jim’s 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 jim’s plis, ri bs d spi, bu Olympi, sigo i i s d o bo pi d is r s sbilizd, s o ggrssi ggrssi ormol rm. “Sbl” ms sill s bo msss bu y ’ grow i siz or umbr i ll is im. his oologis sys, “wr you’r doig, p doig i.” il jim s d som bo loss du o is ormo rm, is bo dsiy ss r ow wii orml rg. h ribus is o is bo rm d o igorous xris, 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. S’s “ 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 Sury d r o flid wi hrris Iri.
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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 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
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the suppoRt of fAmily And fRiends – A netwoRk of suppoRt ha r a r a a r ra. fr xa, r a a a r
a 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 PROSta PROSt ate canceR ReIeD On theIR SPOSe SP OSe OR SInIIcant SIn IIcant OtheR On theIR Path tO RecOveR. 7
beRt (patient with prtate cancer, cancer, diagned 1996) 1 996)
I’m 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. We’ve 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…. I’ve been at it for 14 years,
and I spend maybe two or three hours a day just reading up on what’s happening or what the latest is. I try to keep ahead of the game.
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keep RecoRd RecoRds s t r a aa a, a rar a ra a r r r r aar rr r 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 a a , r r a a, a’ .
Jim* (patient with prtate cancer, cancer, diagned 1989) 1 989)
My oncologist communicates clearly, without medical jargon. To me, that’s critical. I also bring a tape recorder to my appointments, because I can’t remember all of the information we discuss, and having it recorded helps a great deal.
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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 r a a, b a,
“i’ a r a aa aqa ra, i a a a a a r r.”
phillip (patient with prtate cancer, cancer, diagned 2001) 2001 )
I’ve read quite a bit about it, the effects of ADT, and I’m 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 I’ve read. These are the opportunities to talk about things like side effects and so forth.
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teAR-out foR youR neXt visit
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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? know?
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RecommendAtio RecommendA tions ns foR effective effecti ve communicA communicAtion tion between cliniciAns And pAtients mAnAging communicA communi cAtions tions s a r ar arra a a r, a raa r ra . A a r, a r r ra a r 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 a aa r r. w r a ara, r r a a ra ar rr.
pAtients need to be theiR t heiR own best Adv AdvocA ocAte te 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 a r 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.
19
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 r ra ra . t r 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 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 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.
20
some ResouRces cAn pRovide A helpful stARt: u too (. ( ..) .) cuRe (.ra (.ra.)
self-RepoRted pAtient suRvey methodology t r a ra ar a u sa harr ira frar 17 a mar 8, 2010, 2 010, 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 methodology A ya r r y harr ira fruary 19 a Ar 16, 2010, a A a arr u too. R R 113 r a 63 a . A r r rr rr a a Ara ma Aa 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 ury ara 10 u . pya aa a rra rra a r a a.
21
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 hr,, raa , ra rr ar ara. overall rvival rate: 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: 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 r ra, a r r ra.35
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nøraar m, J AØ, Ja Ja Jb, c k, fr Jp, Jp, sør sør ht. ht. sa ra , áa a ra ra ar: a a a r dar (1999 2007). J Urol . 2010;184:162-167.
2
Acs ga fa & fr 2007. 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, p, sra sm, n Jb, tr tr dl, R nm. b ar a ar ra ra a ra ar. J Clin Cli n ndocrinol ndo crinol 2005;12:6410-6417. Metab. 2005;12:6410-6417.
6
saa vb, k k yf, yf, fra Jl, g Js. R rar rar ar ar ra ra r ra ar. ar. ngl J Med . 2005;352:154-164.
7
harr ira b ha sr. sr. daa . A i. J 27, 27, 2010. 2010.
8
bmd . . naa or fa . . :// :// ..r/r/ ..r/r/ .. A A 31, 2010.
9
ca l, baa X, c e, l A, war war A. ia a a a a’ qa , , a a . Support Care Cancer . 2008;16:879-889.
10 saa f, f, ga dm , mrra R, a. l-r l-r a r a r r a a a a r-rrar ra ar. J atl Cancer Inst . 2004;96( 11):879-882. 11
R pd, pd, da Jw, Jw, e Rs, wa wa Rd. pa a a aa rra rar a r a . J Clin pidemiol . 1994;47:231-239.
12
br R, da-h da-h b, s dh, w w Jb, k A, t t A. i a r r-ra rar u sa, 2002-2005. 2007;22:465-475. J one Miner Res . 2007;22:465-475.
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o mg, R v, v, cra w, R m. sa rar a a rra ra ra ra ar. J Urol . 2002;68:1005-1007. 2002;68:1005-1007.
14 t nccn nccn ca pra pra g o. o. naa cr car nr . ://..r/ra/a_/a.a. A A 31, 2010.
23
15
ca u r r a ra ra r. naa or fua . :// ://..r ..r/r /ra//nof_cagu2009_7.. a//nof_cagu2009_7.. A sr 19, 2010.
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ca Re. sa a aa. Cancer . 1997;80():1588-1594.
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wr a. Aa o 16: 579–584, 2005.
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wr a. Aa o 17: 986–989, 2006.
19
Ra c, far far f. f. maa a: a a ra. Curr Rev Pain. 2000;4:187-196.
20 gra J, tra, tra, d. d. maa aa a: r a. 2007;33:462-472. J Pain Pai n Symptom Sympt om Manage Man age. 2007;33:462-472. 2 1 saa f. f. ia aa a’ a’ qa a ra ra. 5):547-550. ur Urol . 2006;5( 5):547-550. 22 mrr Je, sa k, k k Jd. par a u sa ra aa a. Clin reast Cancer . 2007;7:682-689. 23 paa p, p, sa og, gaa ec, a. Aa a a a a aa a aa. rthopedics. 2006;29:609-622. 24 l A, u R, Aa RJ, a. t t a ra a . . J atl Compr Canc Ca nc etw e tw . 2009;7:s1-s29.
25 za ® (r a) rr ra, nar. 26 Ara® (ara ) rr ra, nar. 27 cr rar rar a. naa lrar lrar m . ://...///ar/000443.. A A 31, 2010. 28 dar car tr—raa. tr—raa. naa car i . . ://.ar./ar. A A 31, 2010. 29 dary car tr—ra tr—ra y raa ray ray. naa car iu . ://.ar./ary. A Auu 31, 2010. 30 d t t t b. curtay . :// ://.uray.. .uray.. A Auu 31, 2010.
3 1 dr ca w ta? car car . . :// ://.arar.r//a_ .arar.r//a_ / _r_a_.. A Auu 31, 2010. 32 dar car tr—a tr—a r r. naa car i . ://.ar./ar. A A 31, 2010. 33 Jaja nA. Raa r aa. Cancer . 2000;80:1628–1645. 34 dar car tr—ra tr—ra ra ra. naa car i . ://.ar./ar. A A 31, 2010. 35 dar car tr—a tr—a r. naa car i . ://.ar./ar. A A 31, 2010.
24
25
26
c47358--7 P24371
Pos CC’s ImPC o Bos
Bo Bo H L LH
in fOcus the significAnce of bone heAlth in pAtients with wit h pRost pRostA Ate cAn cAnceR ceR todAy’s pAtient with cAnceR fAces A dAunting Amount of infoRmAtion. soRting thRough it All And deciding whAt’s
impoRtAnt cAn be An immense chAllenge. And with so mAny impoRtAnt issues to consideR, boe helth mAy not be At the top of A pAtient’s 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 A n undeR-Recognized issue i ssue thAt thAt mAy mAy not Receive enough Attention fRom pAtients – And An d 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. 1
pRostAte cAnceR-RelAted bone diseAses include two pRimARy conditions: CC m-IduCd m-IduCd B o Loss (CIBL): b
ra ra ar ra, u a ar ra ray (Adt). Bo m ms sss: ss: 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 r a, a ara (sRe).
skeletal-related event event (s) can ccur when cancer 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 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 .
2
R ra ar a ar a r r r a, a r a aa a A ®
r a ar r ar . t a r arr harr ira 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 sury, a - r a ra ra ar, 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 aya ya au aru ra u a.
cAnceR tReAtment-induced bone loss (ctibl) in pAtients 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, ar, a r r.3 Adt a r 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 ra aar (48 r) a r a r r a ar r ira sr a a q Adt.7 R r harr ira a a r (46 r) a a (58 r) ar
r r ry r a rar ctibl a r a -aa ra ar a r..7 d r r, ay
ray ray ua au r a.7
In the haRRIS InteRactIve SRve, eSS than ha O PatIentS Ith nOn-etaSta nOn-etaSt atIc PROSta PROState te canceR (48 PeRcent PeRcent)) eRe e Re aaRe tha that t aDt cOD eaD tO One OSS, anD On 55 PeRcent O thOSe hO eRe aaRe DIScSSeD ctI Ith theIR PhSIcIan. 7 In cOntRaSt cOnt RaSt,, the ajORIt O ROOIStS anD OncOOIStS OncOOIStS SRveeD (90 anD 98 PeRcent,, ReSPectIve) PeRcent ReSPectIve) cOnSIDeReD ctI a SeRIOS ISSe OR theIR PatIentS Ith nOn-etaStatIc PROState canceR.7
3
a One IneRa DenSIt (D) teSt, teSt, hIch DeteRIneS the aOnt O IneRaS (cacI, PhOSPhORS, aneSI) IthIn ceRt ceRtaIn aIn aReaS O One, can PReDIct the RISk O RactRe. thIS teStIn PROceDRe, caeD One DenSItOetR DenSItOetR (DeXa Scan), IS PaIneSS, nOn–InvaSIve nOn–InvaSIve 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 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 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
4
peRcent of uRologists And medicAl oncologists who AgRee thAt the consequences below cAn Result fRom A fRActuRe. 7 pa
91%
93%
la,
ur
i
87%
99%
79%
83%
fa
ma
la,
o
srr
t
79%
82%
r r ra a
91%
97%
dra a a a -
t aa r a
86%
92%
a (a , a,, r, .) a
cr a rr
55%
69%
ra r rar ar ar a
5
cuRRent tReAtment options, unmet needs foR ctibl tr ar rr r ra ar ar u.s. f a dr Ara (fdA) (fdA) a r ctibl. t naa cr car nr (nccn) r ra a r r ra a naa
or or fua.14 t u r ra ra -araa r a x r ra a ra 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
6
It IS IPORtant OR PatIentS tO cOnIcate an One-ReateD SPtOS SPt OS 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 skeletAl-RelA -RelAted ted 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 Pa tIentS Ith et etaSt aSta atIc PROSt PRO Sta ate canceR can ceR – eeR than t han 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 rr aa a aa rr a a a r a ra ar a aa a (71 r) r r iv
a ra. ra. 22 t harr ira sr a a 68 r a aa ra ar 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 ra r r ar ar ar a r r rar.13
7
beRt (patient with prtate cancer, cancer, diagned 1996) 1 996)
The day after my surgery, the doctor said he didn’t 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 recurrenc recurrence e 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 cAnceR pa ar u r, ay ra a y xr a sRe. 23 mrr, a ra ar a aa, sRe ar aa a ra ra. ra.1 crr ra ar
uruz u r a a a ry aa aa aa, a r a a ay r ra a. 10,22 ira ira a a r ar-ra ar-ra
a aa a a r sRe a r r a q a. 21 ira ira a a a aa.9 Rar r ra r 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.
8
a SStantIa PeRcentae O PhSIcIanS hO tReat etaStatIc One DISeaSe aRe nOt SatISIeD 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 De a Skeeta Ske eta cOPIcatIOnS cOPIcatIOnS De tO One One etaSt etaStaSeS. aSeS.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 aaa 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 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
9
pAtients with pRostAte cAnceR 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 li s i . or r of txs, s ry ggrssi form of pros r, wi ws origilly
digosd i 1992. e fr pros surgry, 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. 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.” pryr.”
10
Jim* jim’s 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 jim’s plis, ri bs d spi, bu Olympi, sigo i i s d o bo pi d is r s sbilizd, s o ggrssi ggrssi ormol rm. “Sbl” ms sill s bo msss bu y ’ grow i siz or umbr i ll is im. his oologis sys, “wr you’r doig, p doig i.” il jim s d som bo loss du o is ormo rm, is bo dsiy ss r ow wii orml rg. h ribus is o is bo rm d o igorous xris, 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. S’s “ 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 Sury d r o flid wi hrris Iri.
11
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 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
12
the suppoRt of fAmily And fRiends – A netwoRk of suppoRt ha r a r a a r ra. fr xa, r a a a r
a 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 PROSta PROSt ate canceR ReIeD On theIR SPOSe SP OSe OR SInIIcant SIn IIcant OtheR On theIR Path tO RecOveR. 7
beRt (patient with prtate cancer, cancer, diagned 1996) 1 996)
I’m 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. We’ve 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…. I’ve been at it for 14 years,
and I spend maybe two or three hours a day just reading up on what’s happening or what the latest is. I try to keep ahead of the game.
13
keep RecoRd RecoRds s t r a aa a, a rar a ra a r r r r aar rr r 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 a a , r r a a, a’ .
Jim* (patient with prtate cancer, cancer, diagned 1989) 1 989)
My oncologist communicates clearly, without medical jargon. To me, that’s critical. I also bring a tape recorder to my appointments, because I can’t remember all of the information we discuss, and having it recorded helps a great deal.
14
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 r a a, b a,
“i’ a r a aa aqa ra, i a a a a a r r.”
phillip (patient with prtate cancer, cancer, diagned 2001) 2001 )
I’ve read quite a bit about it, the effects of ADT, and I’m 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 I’ve read. These are the opportunities to talk about things like side effects and so forth.
15
teAR-out foR youR neXt visit
16
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? know?
17
18
RecommendAtio RecommendA tions ns foR effective effecti ve communicA communicAtion tion between cliniciAns And pAtients mAnAging communicA communi cAtions tions s a r ar arra a a r, a raa r ra . A a r, a r r ra a r 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 a aa r r. w r a ara, r r a a ra ar rr.
pAtients need to be theiR t heiR own best Adv AdvocA ocAte te 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 a r 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.
19
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 r ra ra . t r 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 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 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.
20
some ResouRces cAn pRovide A helpful stARt: u too (. ( ..) .) cuRe (.ra (.ra.)
self-RepoRted pAtient suRvey methodology t r a ra ar a u sa harr ira frar 17 a mar 8, 2010, 2 010, 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 methodology A ya r r y harr ira fruary 19 a Ar 16, 2010, a A a arr u too. R R 113 r a 63 a . A r r rr rr a a Ara ma Aa 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 ury ara 10 u . pya aa a rra rra a r a a.
21
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 hr,, raa , ra rr ar ara. overall rvival rate: 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: 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 r ra, a r r ra.35
22
RefeRences 1
nøraar m, J AØ, Ja Ja Jb, c k, fr Jp, Jp, sør sør ht. ht. sa ra , áa a ra ra ar: a a a r dar (1999 2007). J Urol . 2010;184:162-167.
2
Acs ga fa & fr 2007. 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, p, sra sm, n Jb, tr tr dl, R nm. b ar a ar ra ra a ra ar. J Clin Cli n ndocrinol ndo crinol 2005;12:6410-6417. Metab. 2005;12:6410-6417.
6
saa vb, k k yf, yf, fra Jl, g Js. R rar rar ar ar ra ra r ra ar. ar. ngl J Med . 2005;352:154-164.
7
harr ira b ha sr. sr. daa . A i. J 27, 27, 2010. 2010.
8
bmd . . naa or fa . . :// :// ..r/r/ ..r/r/ .. A A 31, 2010.
9
ca l, baa X, c e, l A, war war A. ia a a a a’ qa , , a a . Support Care Cancer . 2008;16:879-889.
10 saa f, f, ga dm , mrra R, a. l-r l-r a r a r r a a a a r-rrar ra ar. J atl Cancer Inst . 2004;96( 11):879-882. 11
R pd, pd, da Jw, Jw, e Rs, wa wa Rd. pa a a aa rra rar a r a . J Clin pidemiol . 1994;47:231-239.
12
br R, da-h da-h b, s dh, w w Jb, k A, t t A. i a r r-ra rar u sa, 2002-2005. 2007;22:465-475. J one Miner Res . 2007;22:465-475.
13
o mg, R v, v, cra w, R m. sa rar a a rra ra ra ra ar. J Urol . 2002;68:1005-1007. 2002;68:1005-1007.
14 t nccn nccn ca pra pra g o. o. naa cr car nr . ://..r/ra/a_/a.a. A A 31, 2010.
23
15
ca u r r a ra ra r. naa or fua . :// ://..r ..r/r /ra//nof_cagu2009_7.. a//nof_cagu2009_7.. A sr 19, 2010.
16
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