Cases of osteoporosis correlated with Brachytherapy?

Posted by dk68 @dk68, Mar 21 5:56pm

My PCP assigned a DEXA for on the basis of weigh and "having been treated for Prostate Cancer." Androgen ablation (HT) is causally associated with OP. But I had no HT. I was treated with brachytherapy 11 years ago. I have femoral neck OP and severe OP in lumbar.

I've read papers that stress the need to do baseline testing before brachytherapy for breast, cervical, and rectal cancer, before drawing any firm conclusions regarding correlations.

No mention of prostate brachy, but it is certainly in the same areas of cervical/rectal cancers. Curious

Interested in more discussions like this? Go to the Osteoporosis & Bone Health Support Group.

Every OA/OP sites list the two male-specific causes of secondary BMD loss: low testosterone and Prostate Cancer.

Can anyone verify if early stage or non-metastatic Prostate Cancer causes bone loss?

Obviously, any man treated with hormone-ablution is at risk, because low-testosterone is a risk-factor. However, I have found only one article (abstract) which claims that a high PSA and/or prostatic adenocarcinoma itself is correlated with OA/OP. (DOI: 10.1016/j.urology.2004.03.036) I don't have access to the article, but only 34 men were tested and prostate cancer is not often diagnosed in younger men, so I am skeptical that age-related factors are not more implicated than high PSA.

If high PSA score/PC (at any stage) is a risk factor–what is the association? What the prostate gland contribute but ejaculate-payload?

If I am correct, the sites should specify that PC Treatment with hormone production is a cause and not PC alone!

The abstract concludes by recommending that men over 70 with a high PSA and slight frame should be tested for BMD. Duh?

Help-there's enough mind-f with this issue!

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@dk68

Every OA/OP sites list the two male-specific causes of secondary BMD loss: low testosterone and Prostate Cancer.

Can anyone verify if early stage or non-metastatic Prostate Cancer causes bone loss?

Obviously, any man treated with hormone-ablution is at risk, because low-testosterone is a risk-factor. However, I have found only one article (abstract) which claims that a high PSA and/or prostatic adenocarcinoma itself is correlated with OA/OP. (DOI: 10.1016/j.urology.2004.03.036) I don't have access to the article, but only 34 men were tested and prostate cancer is not often diagnosed in younger men, so I am skeptical that age-related factors are not more implicated than high PSA.

If high PSA score/PC (at any stage) is a risk factor–what is the association? What the prostate gland contribute but ejaculate-payload?

If I am correct, the sites should specify that PC Treatment with hormone production is a cause and not PC alone!

The abstract concludes by recommending that men over 70 with a high PSA and slight frame should be tested for BMD. Duh?

Help-there's enough mind-f with this issue!

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Obviously, ablution was a typo! They don't wash the hormones. It should have been reduction. Ugh.

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@dk68, I added your question to the Prostate Cancer group as well. You're right that osteoporosis is more commonly associated with men receiving androgen-deprivation therapy (ADT) for prostate cancer.

What were the results of your DEXA scan? Will you need treatment for osteoporosis?

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@colleenyoung

@dk68, I added your question to the Prostate Cancer group as well. You're right that osteoporosis is more commonly associated with men receiving androgen-deprivation therapy (ADT) for prostate cancer.

What were the results of your DEXA scan? Will you need treatment for osteoporosis?

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Thanks Colleen. I had brachytherapy in 2012. Full remision (nearly undetectable PSA). I have -2.7 in my Left Femoral Neck. >2.2 OA in my femurs and right femoral neck. The spine: OP: L1-4 T-4.4. L3-4 = T-4.9 and L4 = T-4.8. No breaks, no pain, just a lot of anxiety. No idea what the other bones were. My GP said they would be about the same. Same as WHICH Score? She prescribed Fosamax. This is not appropriate–I have an endo appt. scheduled for mid-August. I'm anxious and angry.

Whatever the cause turns out to be (it's not drugs or low testosterone), I am sure I will need something restore my vertebrae.

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My GP rebuked me for asking for more tests, beyond the DEXA and routine blood work! Diagnosed with worse than L t ≤-4.4, she gave me a Rx for fosamax, said we'd screen in 3 years! When I couldn't get an Endo for 5 months, I asked her to do the tests. She wrote, "stop self diagnosing. Suspend treatment and wait for the follow-up… [sic]". I wrote telling her that was what I was asking her to do. Can any one explain why MDs are so miserly about ordering tests?!

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@dk68

My GP rebuked me for asking for more tests, beyond the DEXA and routine blood work! Diagnosed with worse than L t ≤-4.4, she gave me a Rx for fosamax, said we'd screen in 3 years! When I couldn't get an Endo for 5 months, I asked her to do the tests. She wrote, "stop self diagnosing. Suspend treatment and wait for the follow-up… [sic]". I wrote telling her that was what I was asking her to do. Can any one explain why MDs are so miserly about ordering tests?!

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I had numbers similar to yours and my endo said fosamax wouldn’t do anything for me. Sometimes doctors don’t make as much money if they order too many tests. Each month they are limited as to how many they order from what I have heard. That applies to hmo type plans. Used to be that way anyways. I would find an endo that specializes in osteo. Dr. Kevin McCormick is a chiropractor who had severe osteo at 45 and know so much about it. He does televisits and just came out with a book on bones.
Best wishes to you.

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@candy209

I had numbers similar to yours and my endo said fosamax wouldn’t do anything for me. Sometimes doctors don’t make as much money if they order too many tests. Each month they are limited as to how many they order from what I have heard. That applies to hmo type plans. Used to be that way anyways. I would find an endo that specializes in osteo. Dr. Kevin McCormick is a chiropractor who had severe osteo at 45 and know so much about it. He does televisits and just came out with a book on bones.
Best wishes to you.

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Thanks. You might be right about the tests. Worst of all she joined a practice (corporation?) about 8 years ago. They may be strangling the doctors.

I've reviewed KM's work–have his new book (a tome). I need the tests to even take to a functional doctor. [KM lists thousands of dollars worth of tests in his book, by my estimate. The blood work, that I had for my annual charged my HC around $700.]

I'm working to find an endo that will see me before August. My PCP is not taking patients anymore. I am figuring that she is winding down her practice and is creating a pretext to dump me.

What I resent most of all is the condescension. My life has been about research (Ph.D). It is not in medicine, but I'm not an idiot.] Clinical education/practice/experience understandably triumphs research papers, etc. I don't know why she will not take seriously a L in the high -4s. She has one more opportunity to adjust her thinking to a non-PMOP! [Not that her behavior should be appropriate for a female with the same numbers either!]

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@dk68

Thanks. You might be right about the tests. Worst of all she joined a practice (corporation?) about 8 years ago. They may be strangling the doctors.

I've reviewed KM's work–have his new book (a tome). I need the tests to even take to a functional doctor. [KM lists thousands of dollars worth of tests in his book, by my estimate. The blood work, that I had for my annual charged my HC around $700.]

I'm working to find an endo that will see me before August. My PCP is not taking patients anymore. I am figuring that she is winding down her practice and is creating a pretext to dump me.

What I resent most of all is the condescension. My life has been about research (Ph.D). It is not in medicine, but I'm not an idiot.] Clinical education/practice/experience understandably triumphs research papers, etc. I don't know why she will not take seriously a L in the high -4s. She has one more opportunity to adjust her thinking to a non-PMOP! [Not that her behavior should be appropriate for a female with the same numbers either!]

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I just started reading his book this weekend. My numbers are in the 5’s and I am 64 and scared. I called his office and the they can offer discounts for labs. I booked a consult with him and mailed him the labs I do have. Endos are hard to find and especially ones that specialize in bones. Do you have a teaching hospital near by? That really is where you should be seen. I am fortunate to have San Fran and Stanford close by. It still took me five months to get into one. She prescribed tymlos for me but there is a hitch. My follow up with her is in six months. She is so busy and I worry about starting a med like that and not having a doc that is accessible.
Keep searching for an endo. I am sorry your doc isn’t helping you.
Please keep us updated.
All the best,
Candy

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@candy209

I just started reading his book this weekend. My numbers are in the 5’s and I am 64 and scared. I called his office and the they can offer discounts for labs. I booked a consult with him and mailed him the labs I do have. Endos are hard to find and especially ones that specialize in bones. Do you have a teaching hospital near by? That really is where you should be seen. I am fortunate to have San Fran and Stanford close by. It still took me five months to get into one. She prescribed tymlos for me but there is a hitch. My follow up with her is in six months. She is so busy and I worry about starting a med like that and not having a doc that is accessible.
Keep searching for an endo. I am sorry your doc isn’t helping you.
Please keep us updated.
All the best,
Candy

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Thanks so much. I didn't know about discounts with KM.

I live in the lap of Med School excellence: Boston and Providence (Brown Med School). I am still trying to get cleared for Harvard / Mass Gen. Brown Endo cannot see me until August.

My god, -5s. I have been trying to find out what the highest numbers are and they are no where to be found! Lucky to get in. I think if things went south with the meds, you'd at least get a response regarding ameliorating the symptoms.

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@candy209

I just started reading his book this weekend. My numbers are in the 5’s and I am 64 and scared. I called his office and the they can offer discounts for labs. I booked a consult with him and mailed him the labs I do have. Endos are hard to find and especially ones that specialize in bones. Do you have a teaching hospital near by? That really is where you should be seen. I am fortunate to have San Fran and Stanford close by. It still took me five months to get into one. She prescribed tymlos for me but there is a hitch. My follow up with her is in six months. She is so busy and I worry about starting a med like that and not having a doc that is accessible.
Keep searching for an endo. I am sorry your doc isn’t helping you.
Please keep us updated.
All the best,
Candy

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Candy, what did the MDs say when they discovered you are in the -5s? Which area was it in? How was it discovered–the standard schedule for front line MDs is >65 for women (way too late for informed decision making!).

My GP has approached my OP as simply OP and still refuses to further tests. Most charitable explanation, she wants to leave it in the hands of more advanced specialists. I've secured a soon appt. in July (4 months out) at another endo. I'll try one more group.

At least, GP agreed that I shouldn't start Fosamax without getting the information that will "satisfy" (pacify) my anxiety.

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