Bisphosphonates
The information on this page comes from our Tool Kit fact sheet on bisphosphonates. To order your own tailored copy of the Tool Kit, visit our publications page. You can also download and print a PDF version of this fact sheet.
- Why might I need to take bisphosphonates?
- How do bisphosphonates work?
- What does treatment with bisphosphonates involve?
- What happens afterwards?
- What are the side effects?
- Summary
- Questions to ask your specialist team
- Links
Bisphosphonates are a group of drugs which may be used by men with prostate cancer that has spread to the bones. This page describes how this treatment works, possible side effects, alternative treatments and where you can find additional information and support. Each hospital and specialist team will do things slightly differently so use this page as a general guide and ask your specialist team for more details about the care you will receive.
Why might I need to take bisphosphonates?
Bisphosphonates may benefit men with prostate cancer that has spread to the bones and is no longer responding to hormone therapy 1. They do not actually treat the cancer but the drug binds to areas of bone where there is a lot of damage.
Bisphosphonates relieve pain caused by prostate cancer that has spread to the bone. They also help to prevent and slow down the breakdown of bone 2. However, we do not yet have enough evidence to show whether they significantly reduce the risk of bone fractures. They also help prevent a rare condition called hypercalcaemia, where the amount of calcium in your blood increases. This causes thirst, drowsiness and sickness.
How do bisphosphonates work?
Knowing how your normal bones work and how your cancer can affect your bones can help you understand how bisphosphonates work. The break down and rebuilding of bone tissue is done by two groups of cells:
- Cells which break down old bone (osteoclasts)
- Cells which build new bone (osteoblasts)
Healthy bones are constantly breaking down and rebuilding. They absorb old and weak bone tissue and re-build healthy new tissue. This is how our bones stay strong. When prostate cancer spreads to the bone it can cause the bone tissue to break down too fast. Your bones try to replace this but it is difficult as the bones become weak and prone to breaking easily.
Other treatments that can help with bone problems include:
- Palliative radiotherapy, either external beam or an injection of a radioactive substance (Strontium 89)
- Surgery to stabilise or fix the bone
- Pain-relieving drugs, which can be used alone or in combination with the other treatments described above.
When deciding on a treatment, you will need to consider the risk of side effects and how effective the treatment is likely to be. It is very important that you discuss all these options with your specialist team to ensure that you receive the best care for your situation. Knowing what to expect from your treatment can help ease any anxiety.
What does treatment with bisphosphonates involve?
There are several bisphosphonate drugs on the market but zoledronic acid (Zometa) is the only one licensed in the UK for treating and preventing bone problems in men with advanced prostate cancer. Your doctor may prescribe you other bisphosphonate drugs such as pamidronate (Aredia). You may have pamidronate if you have high calcium levels in your blood or if you have had bad side effects from zoledronic acid. Your doctor will explain which drug they are recommending for you and why. Research is ongoing to find out how effective other types of bisphosphonates are in helping men with prostate cancer that has spread to the bones.
Zoledronic acid is usually given as an infusion into a vein every three to four weeks. Treatment takes about 15 minutes. You will need to go to the hospital for each treatment. A nurse will put a fine tube (cannula) into a vein in your arm. This can sometimes feel uncomfortable when it goes in but it should not cause any pain once it is in.
Before you start bisphosphonate treatment, tell your doctor if you have ever had any problems with your liver, kidneys, heart or jaw. Before each infusion, drink plenty of water to stop you getting dehydrated. Your doctor can give you advice on this.
If you are having long term treatment with bisphosphonates your doctor is likely to suggest that you take calcium and vitamin D supplements. This is to make sure that you are getting enough calcium to build new bone. You will not take these supplements if you have high calcium levels in your blood.
What happens afterwards?
If you are taking bisphosphonates to help relieve pain, prevent and control bone damage you can take them for as long as they are working for you. There may be some side effects from taking these drugs but your specialist team will discuss these with you before you begin your treatment.
As well as getting medical help most men say it helps to get some emotional support as well. It is very important not to feel alone if you are having problems with pain and difficulty getting around. Your family and friends are likely to be a great support. But you may find it also helps to talk to your specialist team. Many specialist nurses have counselling training and can help you work through some of your concerns. They also know a lot about cancer pain and how to manage it. A great deal of your anxiety may be relieved if you know your options so that you can make informed decisions about your care. If you do not already have contact with one of these nurses you can ask your GP to refer you to their services.
Doctors are continually trying to find ways to improve treatment and care for men with prostate cancer. This includes ongoing research into the use of bisphosphonates for cancer that has spread to the bones. Several very small studies have shown that treating cancer that has spread to the bones as early as possible with bisphosphonates helps prevent some of these complications and maintains the strength of your bones. We need results from larger scale studies to confirm this 3. Trials continue to look at using zoledronic acid (Zometa) in men with prostate cancer and how it may help improve survival. Read our fact sheet called A Guide to Prostate Cancer Clinical Trials for information about where to look for trials going on that you may be suitable for.
What are the side effects?
Because each person is different, their reactions to individual drugs will vary. Also, it depends on which drug you are taking. Overall, bisphosphonates are well tolerated. The most common side effects with zoledronic acid and pamidronate are listed below 4. In some men, these side effects may be caused by their cancer even if they are not taking bisphosphonates. However, bisphosphonates increase your risk of the side effects listed here.
Many of these side effects generally only last a few days. Your doctor or specialist nurse will be able to give you medication to relieve the symptoms if necessary. For example, paracetomol may help relieve possible fever and joint pain (flu-like symptoms). Pain-relieving drugs can help with bone pain until it calms down.
Common side effects may include:
- An increase in bone pain when you first take the drugs.
- Flu-like symptoms such as joint pain, bone pain and fever. These symptoms usually only last a few hours after treatment.
- Feeling very tired (fatigue). Avoid driving home after treatment.
- Feeling or being sick (nausea and vomiting).
- A drop in the level of red blood cells (anaemia).
- Headaches.
There are some less common side effects that can happen if you take bisphosphonates. These include 5:
- Possible changes in how well your kidneys work. Your doctor will do regular blood tests to check this.
- Lowered levels of calcium and other minerals in your body such as potassium and magnesium. Your doctor will keep a check on these by doing regular blood tests.
There is also a rare condition called osteonecrosis of the jaw that can develop in people who take bisphosphonates long term (more than a year). In simple terms this means that healthy bone underneath the teeth dies off because of a poor blood supply to this area. This seems to happen more commonly in people who have been having dental treatment while they are taking bisphosphonates. If possible you should not have any dental work done if you are using these drugs. Tell your doctor if you have any loose teeth, gum problems (pain, swelling, infections) and numbness or a heavy feeling in the jaw. It is also important to have good oral hygiene and let your dentist know that you are taking bisphosphonates. You may wish to visit your dentist before starting bisphosphonate treatment to get any existing dental problems sorted out.
Summary
The advantages of taking bisphosphonates can include:
- Helping to relieve bone pain caused by the cancer spreading into your bones
- Decreasing your risk of your bones breaking (fractures)
- Controlling and reducing high blood calcium levels which can cause serious side effects if left untreated
- Many men may have a better quality of life due to less pain and being able to move around more easily
Possible disadvantages may include:
- Side effects such as feeling sick, tiredness and flu-like symptoms
- Having to make a trip to the hospital every three or four weeks for treatment. This can be tiring for many men especially if you live a long way from the hospital. Some hospitals provide outreach services to help with this problem.
- More research is needed before we will know which bisphosphonate drug is most effective at relieving pain.
Questions to ask your specialist team
- Would you recommend bisphosphonate treatment for me?
- How long will I need to take bisphosphonates?
- What are the main benefits for me if I take bisphosphonates?
- What are the main side effects of taking bisphosphonates?
- Who do I contact if I have side effects?
Links
The following organisations provide further information relevant to this page.
Cancerbackup
www.cancerbackup.org.uk
For information on coping with cancer and treatment.
Macmillan Cancer Support
www.macmillan.org.uk
Practical, emotional and financial support for people with cancer, family and friends.
Marie Curie Cancer Care
www.mariecurie.org.uk
Marie Curie run hospice centres throughout the UK and provide a nursing service for patients in their own home day and night, free of charge.
Hospice Information
http://search.hospiceinformation.info/FrontPage.aspx
For a list of hospices in the UK
Reviewed by:
- Pauline Bagnall, Uro-oncology Nurse Specialist, North Tyneside General Hospital, Northumbria Healthcare NHS Foundation Trust
- Ronald P. Beany, Consultant Clinical Oncologist, Guy’s Hospital, London
- Lawrence Drudge-Coates, Macmillan Urology Clinical Nurse Specialist, King's College Hospital, London
- Charlotte Etheridge, Uro-oncology Nurse Specialist, Ipswich Hospital
- Richard Gledhill, Prostate Cancer Charity Specialist Nurse, Queen Elizabeth Hospital, Birmingham
- Dr Christopher Scrase, Macmillan Consultant Clinical Oncologist and Honorary Senior Lecturer, Ipswich Hospital
- Deborah Victor, Urology Cancer CNS, Royal Cornwall Hospitals NHS Trust, Truro
- Dr Duncan Wheatley, Clinical Oncologist, Royal Cornwall Hospitals NHS Trust, Truro
- The Prostate Cancer Charity Information Volunteers
- The Prostate Cancer Charity Support & Information Specialist Nurses
Written by:
Annie Angle, Specialist Oncology Nurse Writer
Edited by:
The Prostate Cancer Charity Information Team
Sources used in the compilation of this page
1 British Association of Urological Surgeons, The Prostate Cancer Charity. The BAUS Guidelines for the management of metastatic prostate cancer: an overview. London : The Prostate Cancer Charity; 2005. http://www.prostate-cancer.org.uk/news/features/baus_1.asp
2 Yuen KK, Shelley M, Sze WM, Wilt T, Mason MD. Bisphosphonates for advanced prostate cancer. Cochrane Database of Systematic Reviews 2006, Issue 4.
3 Saad F,Sternberg CN. Multidisciplinary management of bone complications in prostate cancer and optimizing outcomes of bisphosphonate therapy. Nat Clin Pract Urol. 2007; 4 (Suppl 1):S3-13.
4 Electronic medicines compendium (http://emc.medicines.org.uk/)
5 Electronic medicines compendium (http://emc.medicines.org.uk/)