Prostate Cancer (cont.)
Jay B. Zatzkin, MD, FACP
John P. Cunha, DO, FACOEP
John P. Cunha, DO, FACOEP
John P. Cunha, DO, is a U.S. board-certified Emergency Medicine Physician. Dr. Cunha's educational background includes a BS in Biology from Rutgers, the State University of New Jersey, and a DO from the Kansas City University of Medicine and Biosciences in Kansas City, MO. He completed residency training in Emergency Medicine at Newark Beth Israel Medical Center in Newark, New Jersey.
In this Article
Monoclonal antibody therapy
Denosumab (Xgeva) is a monoclonal antibody agent that inhibits the work of osteoclasts in a manner different from bisphosphonates. The medication inhibits a protein that tells the osteoclasts to remove bone. This drug is useful as a treatment for all of the conditions for which bisphosphonates are used. Given as an injection under the skin at intervals, it has a better side effect profile than the bisphosphonates. It does not require dose adjustments if kidney function deteriorates. It can still cause osteonecrosis of the jaw to occur. It is considered an important new drug in the treatment of bone metastases in prostate cancer patients. In some studies it appears to be more effective than Zometa in delaying skeletal-related events in patients with bone metastases.
The use of substances that are radioactive as a treatment for bone metastases has been tried for years. Strontium-89 and samarium-153 have been used in the past. They decrease pain in patients with prostate cancer with bone metastases but they do not prolong life; these medications lower levels of healthy blood cells in patients who receive them.
Recently a form of radium called Ra-223 (Xofigo) has been approved for use in prostate cancer patients with metastases to bone but not to other internal organs. Radium is like calcium and it migrates to bone where it acts locally. As an alpha emitter, radiation from radium does not travel far enough in the body to damage other healthy tissues. It reduces pain and can prolong survival. It is administered by an injection into a vein. It can cause nausea, diarrhea, and low blood counts.
Medically Reviewed by a Doctor on 9/4/2014
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