Hair loss Treatment Center

PARTICIPANTS Michael G. Oefelein, MD Assistant Professor of Urology and Oncology, Case Western Reserve University School of Medicine Matthew R. Smith, MD, PhD Assistant Professor of Medicine, Harvard Medical School EDITORIAL CONSULTANT Roger Waltzman, MD St. Vincent's Comprehensive Cancer Center, New York

MATTHEW SMITH, MD: Androgens, or, more specifically, testosterone, is a growth factor for prostate cancer. It's required for the normal growth and development of the prostate gland, and tumors that arise from the prostate are typically dependent on testosterone for their growth. So the major form of hormone therapy for prostate cancer is, in fact, treatments that dramatically lower the testosterone levels, or so-called androgen deprivation therapy.

ANNOUNCER: However the downside of these effective treatments are side effects, which can be significant.

MATTHEW SMITH, MD: In recent years there's been greater recognition and understanding of the important side effects of hormone therapy, including weight gain, loss of muscle mass and progressive bone loss.

MICHAEL OEFELEIN, MD: They'll develop osteoporosis, and this will set the ground for a potential skeletal related event. In general, we have about a fourfold higher risk of skeletal fractures in men with prostate cancer.

ANNOUNCER: In fact bone complications may also occur since prostate cancer may often spread to the bone. And while bone loss or fracture may not sound serious, in fact it can have a variety of consequences, some of them life-threatening.

MICHAEL OEFELEIN, MD: Certainly a broken bone is an important and possible outcome. Also, when prostate cancer spreads to the bone, you will have issues related to locomotion or ambulation that will diminish, and doctors call that performance status. And also, normal functioning of the bone marrow will be impaired, and anemia and other problems with infection fighting will also ensue.

ANNOUNCER: In fact a recent study has even shown that complications from bone loss could in fact contribute not only to a difficult and dependent existence, but even to a shorter life.

MICHAEL OEFELEIN, MD: Well, skeletal fractures are important clinically. For instance, if an individual breaks a hip bone, they're bed-ridden and it dramatically changes their life. But it also negatively impacts on survival. We looked at a large group of men on hormonal therapy, and we found an important observation, that being that men who broke bones lived significantly shorter on therapy, even though they had the same stage of disease and extent of disease, than men who didn't break their bones.

ANNOUNCER: The hospital stay that accompanies fractures might also contribute to increased mortality.

MICHAEL OEFELEIN, MD: Other issues that might be important as to why people die sooner after breaking the bone might relate to hospital-acquired infections, overall depression. The patient might become moribund or thinking that this is the beginning of the end, and, and I think that's a very important issue, because if someone gives up on living; they will die sooner. There's no question about it.

ANNOUNCER: An answer to the problem may have been found with medications called bisphosphonates, which help prevent accelerated bone loss.

MATTHEW SMITH, MD: By interrupting this vicious cycle of excess bone loss, you can both prevent the problem of further bone loss and actually help the skeleton regain some of the lost bone mineral density.

MICHAEL OEFELEIN, MD: It's also been very effective in cancer patients at reducing skeletal related events. So they are very effective.

MATTHEW SMITH, MD: In the most recent study, zoledronic acid, or Zometa, was shown to dramatically increase bone mineral density when administered every three months. So it's a convenient treatment. It takes about 15 minutes in the office. It's an outpatient procedure.

ANNOUNCER: It's also important that the side effects from this treatment are seen to be mild and have little impact on a patient's day-to-day life.

MATTHEW SMITH, MD: All treatments have potential side effects, and this is no exception. About one third of the men have some aches and pains or low-grade fever sort of similar to a flu that would last one to two days after the first treatment.

Typically, that didn't occur with subsequent treatments, so it was really a first treatment phenomenon.

ANNOUNCER: Taking bone loss seriously is an important issue for men with prostate cancer, and using treatments to prevent it can both improve someone's life and make sure the life they live is one that's productive.

MICHAEL OEFELEIN, MD: Most people in general don't appreciate health until they lose it, and so in general people don't think that these things can have such a devastating impact on their life as they do.

So most people that engage in these therapies are forward-thinking and hoping to ward off problems that maybe they've known someone in their family has had a similar event, and they're trying to do everything possible to prevent it.