NCCN Guidelines for Patients® | Prostate Cancer - page 58

58
NCCN Guidelines for Patients
®
: Prostate Cancer
Version 1.2014
Part 6: Monitoring and salvage treatment
6.1 ADT risks
ADT can cause many side effects. One known side effect
of ADT is osteoporosis. Calcium and vitamin D3 may help
prevent or control osteoporosis. Both are recommended
if you are older than 50 years old. Calcium 1200 mg
(
m
illi
g
ram) and vitamin D3 800 to 1000 IU (
i
nternational
u
nit) should be taken each day.
If you are at high risk for bone fracture, there are drugs
that may strengthen your bones. Before treatment,
you should receive a DEXA (
d
ual
e
nergy
X
-ray
a
bsorptiometry) scan to measure your bone density.
Denosumab (120 mg every 6 months), zoledronic acid
(5 mg every year), or alendronate (70 mg every week)
are recommended. Desosumab is injected under the
skin. Zoledronic acid is injected into a vein. Alendronate
is a pill that is swallowed. One year after treatment has
started, another DEXA scan is recommended.
Denosumab, zoledronic acid, and alendronate have
possible side effects. They have been linked to
osteonecrosis—bone tissue death—of the jaw. Other
side effects are hypocalcemia and arthralgias. You may
be at higher risk of jaw osteonecrosis if you already have
dental problems. Thus, it’s important to get a dental exam
and dental treatment before starting any of these drugs.
Diabetes and cardiovascular disease are common in
older men. ADT increases the risk for these diseases.
Thus, screening and treatment to reduce your risk for
these diseases are recommended.
For advanced cancer, the risks of ADT can be reduced
by using ADT intermittently rather than continuously.
However, ADT can’t be given intermittently if being
used to make radiation more effective. Intermittent
ADT improves quality of life without affecting survival.
Intermittent ADT often begins with about 1 year of
continuous ADT and then is stopped. ADT is resumed
when a certain PSA level is reached or symptoms
appear. PSA levels that trigger restarting ADT usually are
10, 20, or 40 ng/mL.
Screening, prevention, and treatment
Osteoporosis
• Calcium (1200 mg every day) and vitamin D3
(800–1000 IU every day) if older than 50 years old
• Denosumab (60 mg every 6 months), zoledronic
acid (5 mg every year), or alendronate (70 mg
every week) if at high risk for bone fracture
• DEXA scan before and 1 year after treatment
Diabetes
• Follow guidelines for general population
Heart (cardiovascular) disease
• Follow guidelines for general population
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