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Hypercalcemia & Prostate Cancer?
Good afternoon everyone,
I posted a few months ago the background of my father's diagnosis of Stage IV, HsMPC (mets to distant lymph nodes & bones). He was diagnosed in May 2023. You can read his full story here, as well as so many wonderful/helpful responses I received from this community regarding his possible prognosis: https://connect.mayoclinic.org/discussion/prognosis-for-stage-4-metastatic-prostate-cancer/
One puzzling anomaly that I wanted to post about here today, is the issue of hypercalcemia, and whether anyone else has experienced the same. When my dad was admitted to hospital last summer with severe backpain and an extreme lack of appetite (resulting in a 50 lb weight loss), his calcium levels were found to be through the roof - just over 4.0 mmol/L. After giving him tons of fluids and an injection to lower his calcium, they did a PSA test and found it to be over 800, leading to his PC diagnosis. At that time, he was referred to oncology, did a biopsy which confirmed PC, and was fortunate enough to undergo triplet therapy shortly after his diagnosis (Zoladex, Docetaxel & Nubeqa). His PSA has dropped to 0.2 (May 2024), and we are told he is responding well as his PC appears to remain hormone sensitive.
One frustrating thing, is that at the same appointment where the oncologist told us his PSA is down to 0.2, they noted his calcium level has ticked back up to 2.61. They did another blood test after giving him a ton of fluids (in case he was just dehydrated), and now his calcium is 2.63... I keep asking the oncologist why this could be and he says "it is likely because of the prostate cancer", and that we should not worry unless it goes over 2.75. Based on my research, and searching through this forum, I am not aware of anyone else who has had the same issue? My fear is that there could be a comorbidity of some sort, but apparently they have ruled out the most likely possibilities, including hyperparathyroidism?
I am curious to know if anyone has any insights on this issue, or what it could mean? Researching about hypercalcemia has left me feeling uneasy, as it appears to be a very rare and not well understood side-effect of late stage PC?
Any help, insights, or advice would be so greatly appreciated. Thank you
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Prostate cancer caused hypercalcemia is a rare possibility. Has he had a bone density scan. The medications can cause osteoporosis. Hypercalcemia can occur wit bone degradation. Osteoporosis medication are often suggested at the start of hormone treatment, not usually by the oncologist but by an endocrinologist. Mets to the bone could be the contributor.
Bisphosphonates slow the breakdown of bones. They may be used to: reduce bone pain caused by bone metastases and to reduce high levels of calcium in the blood.
You are taking such good care. Bless you both.
I've never had my calcium levels checked, but I'm on 1000 mg of elemental calcium daily. This could be to counter the side effects of one of these medications: prednisolone, Zoladex, or abiraterone. Can anyone suggest whether, in my scenario, I need to get my calcium levels tested?
However, from the net I discover,
"If you're taking 1000 mg of elemental calcium daily, especially as part of a regimen that includes medications like prednisolone, zoladex, or abiraterone, it's prudent to monitor your calcium levels regularly. Each of these medications can affect calcium metabolism in different ways:
Prednisolone: This corticosteroid can lead to decreased calcium absorption in the intestines and increased calcium excretion by the kidneys, which might necessitate calcium supplementation to maintain bone health.
Zoladex (Goserelin): This medication, used in hormone-sensitive cancers, can lead to decreased bone density over time, potentially increasing the need for calcium and vitamin D supplementation to protect bone health.
Abiraterone: Used in prostate cancer, abiraterone can lower potassium levels and affect bone density, possibly requiring calcium supplementation to prevent osteoporosis and other bone-related issues.
Given these considerations, here are some reasons why you should get your calcium levels checked:
Prevent Hypercalcemia: Excessive calcium intake can lead to hypercalcemia, a condition where calcium levels in the blood are too high. Symptoms can include nausea, vomiting, constipation, and in severe cases, kidney stones and heart issues.
Ensure Adequate Calcium Levels: Conversely, despite supplementation, it's possible that your levels might still be low, especially if your medications are affecting calcium absorption or excretion.
Monitor Bone Health: Regular testing can help ensure that your bone metabolism is balanced and that you're not at increased risk of osteoporosis or fractures."
All of the anti-androgen medications present a risk for bone health. Biphosphonates clad the bone with a protective bone surface layer that lessens the breakdown of bone. In addition they reduces replicative growth of cancer cells in the bone marrow. Protective if you already have bone mets, and protective of spread of cancer from the marrow where it is thought resevoirs of cancer can hide for many years waiting for the end of treatment.
Hypercalcemia sometimes results from the lysis of bone. So calcium testing could be a warning, as can bone scans.