Prostate Cancer and Osteoporosis Risk

Prostate cancer is the second most common male cancer (after skin cancer), and the second leading cause of cancer death (after lung cancer).  About 1/8 of men—mostly in the over-65 population—will get a diagnosis (source).  Prostate cancer is very survivable, but the standard treatments can produce a host of undesirable conditions.  High on this list is osteoporosis, with its associated risk of fractures.

How Prostate Cancer Treatments Contribute to Osteoporosis

Many cancers are driven by sex hormones.  Prostate cancer is often in this category; in other words, high levels of male hormones—testosterone and other “androgens”—can speed the growth of this type of cancer.  Therefore, many modern cancer-treatments work to suppress androgens.  Common forms of “Androgen Deprivation Therapy” (ADT) include:

• Orchiectomy – surgical removal of one or both testes to reduce androgen production.
• Chemical castration – LHRH drugs which decrease testosterone in the body.
• Antiandrogen therapy – pills that block the body’s uptake of androgens (which are also produced in the adrenal glands).

But as you might have guessed: you need your androgens!  Androgens have a host of crucial roles to play in the body, including telling the bones (and muscles) to build mass; so, “depriving” yourself of them is bound to cause issues elsewhere.

UroToday cites these disturbing findings:

“Although bone loss is most pronounced during initial ADT exposure, it persists throughout treatment. In one study of 390 men receiving long-term ADT for prostate cancer, the prevalence of osteoporosis was 35% at baseline, 43% after 2 years, 49% after 4 years, 66% after 8 years, and 81% after 10 or more years of ADT.”

Another study measured bone mineral density (BMD) loss during ADT and showed an average BMD reduction of up to 4.6% per year (PubMed).

So, avoid or limit ADT if you can.  If you cannot, then a) expect your osteoporosis risk to rise annually, and b) get help to make a “risk mitigation plan” and manage your health accordingly.

Also, as discussed in previous blog posts, know that other cancer treatments—many forms of chemo and radiation—carry their own risk of osteoporosis.  ADT is not the only culprit.

Detecting Prostate Cancer

(Note: for a discussion of how osteoporosis is detected/measured, see our previous blog post.)

This article from the American Cancer Society explains about how prostate cancer is screened for and detected.  A brief summary is that, while early detection is better than late, studies don’t really show much “real-life benefit” for lots of frequent screening: in many instances, the cancer is so slow-growing that it will never cause problems within your lifetime.  In a case like this, any conventional response (surgery, chemo, ADT, etc.) is defined as “overtreatment” and will cause more problems than it solves.  

So in general, you are better off focusing on creating a healthy lifestyle than on tests and treatment.  However, if you have a family history of prostate cancer, or other risk factors, your strategy perhaps should shift.

Natural Treatments for Prostate Cancer and Osteoporosis

Most drugs are targeted, disease-specific, and loaded with externalized costs, aka “side effects.”  Natural therapies tend to be whole-body, person-specific, and accompanied by “side benefits.”  Here are some of our favorite holistic responses to both cancer and osteoporosis, simultaneously.

Exercise

Exercise—the right kind of exercise—has been shown in many studies to increase bone density.  Additional good studies are forthcoming this year.  Many existing studies have only tracked participants for a few months; whereas some practicing physicians and physical therapists state that it takes 8-18 months to really see results on a bone density scan.  

However, this Egyptian study showed benefits, over 12 months, of 30 minutes of walking three times per week; these researchers found significant improvements in BMD, at both the spine and femur, in men over 50 who were suffering osteoporosis as a result of ADT.  In this study, all patients were taking calcium and vitamin D.  All experienced benefits, but the exercising group made much better progress (~40% improvement vs. ~15%).

More good news: acute endurance exercise has also been shown to inhibit prostate cancer cell growth (PubMed).  So, the right exercise routine can help fight both problems at once.

But a word of caution: some types of long-term exercise can have a negative effect when battling cancer.  And also, for those with osteoporosis, a number of exercises are “fracture-risky” and must be avoided (or modified).  So get professional advice before setting up an exercise routine.  

Here is a short list of exercises which are generally recommended—or not—for those with weak bones (source):

Indicated	Contraindicated
Weight-bearing exercise (holding up the body’s own weight) Weight training (exercising with weights) High-velocity movements (but with caution) Strengthening the “back-pulling” muscles Certain kinds of “impact” exercises, such as use of a rebounder (“mini trampoline”) Daily low-intensity vibration using an appropriate medical device	Anything that rounds the spine, compressing the front of the vertebrae.  (Even gentle yoga can cause problems.) Side bends and/or spinal rotation (no golf, tennis, or bowling without coaching) Anything that raises risk because of some other separate health condition (obesity, unhealed injuries, etc) Certain kinds of strong impacts

However, your specific situation may move some of these items from one column to another.  And even the “correct exercises” can be done incorrectly and dangerously (through poor posture / bad alignment / improper breathing / etc.).  Once again: establish a routine you can do yourself, at home, but do that with the help of someone with experience and training.

Remember, too, that 70-80% of fractures are “silent” and most fractures happen not while doing intense exercise, but while bending over, twisting, reaching for an object—normal daily activities.

So, if you are at risk for osteoporosis due to cancer treatment, you will have to learn some new movement patterns.  Don’t DIY that: you need a coach, and maybe some specialized equipment.  (We can help with both.)

One view of our exercise facility, with training beds/stairs, other equipment, and a rebounder at right.

Diet

Other articles on this blog speak in depth about nutrition for cancer, and for osteoporosis.  So here, just let us say: diet is crucial—for both conditions.

Some of the top recommendations that will aid in both situations are as follows:

• Vitamin D – 10,000 IU per day, or more, in an oil-based form, is not too much.
• Vitamin K2 – preferably in the MK4 form; others can help improve bone density but do not necessarily reduce fracture risk.
• Magnesium – but research; many forms are not very bioavailable.
• Green leafy vegetables, for calcium and other minerals.  
• Vitamin C – for a host of benefits, one of which is collagen production.  Bones are not “blocks of minerals,” they are “hard sponges,” designed to be porous, alive, ever-changing, and a bit flexible.  Collagen is the matrix that creates that structure and elasticity.
• Top foods: cruciferous vegetables, omega-3-rich foods, nuts and seeds, turmeric, prunes, and “live” fermented foods.

Get Ahead of Osteoporosis

Following articles will go into deeper detail about exercise and diet.  However, the common themes are: 

1. You must take responsibility for your health.
2. You cannot do it on your own. (Isn’t most of life this way?)

So please come talk to us.  At ORW, we can guide you through the areas of your cancer-rehab strategy where you need expertise or simply encouragement.  Many “common truths” have been listed up above, but even so, each person, health struggle, and situation is unique.  

Let us help you tailor a plan that gives the best return on your investment.  Please schedule a free 15-minute consultation to learn how we can help you.