Bisphosphonates are drugs that can help manage bone problems when prostate cancer has spread to the bones. If cancer spreads to your bones, it may damage and weaken them. This can cause bone pain and increase your risk of broken bones.

Your bones are made of living tissue and are constantly changing. In healthy bones, cells are always breaking down and rebuilding bone tissue - this is called the bone cycle. When prostate cancer spreads to the bone, it upsets the careful balance between the breakdown of old bone and the building of new bone.

Bisphosphonates prevent the breakdown of bone and encourage bone building in places where too much bone has been broken down. This can help to relieve pain. Bisphosphonates can also be used to treat a condition called hypercalcaemia which is high levels of calcium in the blood.

In some hospitals, bisphosphonates might also be used to manage bone thinning caused by hormone therapy, or to help prevent and slow down further bone damage. For more information about bone thinning in prostate cancer, read our pages about living with hormone therapy.

What other treatments are available?

What are the advantages and disadvantages?

What might be an advantage for one man might be a disadvantage for another. Talk to your doctor or nurse about your own situation.

Advantages

  • Bisphosphonates help to relieve bone pain and stop it getting worse. They can also help to prevent any new bone pain.
  • You may find it easier to move around if you have less bone pain.
  • Bisphosphonates may help to reduce your risk of broken bones.
  • Bisphosphonates lower the amount of calcium in your blood and treat the symptoms of hypercalcaemia.

Disadvantages

  • Like all treatments, bisphosphonates can cause side effects.
  • If you are having zoledronic acid you will have to travel to the hospital every three or four weeks for treatment.
  • Bisphosphonates can take up to three months to start helping with bone pain.
  • You may need to have regular dental check-ups.

Discuss the advantages and disadvantages with your doctor or nurse to help you decide whether to take bisphosphonates.

What does treatment involve?

A bisphosphonate called zoledronic acid (Zometa®) is usually used to treat men with prostate cancer. You will have your treatment at the hospital every three or four weeks. Zoledronic acid is a fluid which is given through a drip into a vein. The treatment takes about fifteen minutes.

Before treatment, you will have some tests to check your kidneys. This is because bisphosphonate drugs may affect how well the kidneys work.

You might need to have a full dental check up before you start treatment. This is to lower the risk of developing a condition called osteonecrosis of the jaw.

Speak to your doctor or nurse about any medical or dental problems you have had in the past. And let them know about any medicines you are taking at the moment.

What are the side effects?

Side effects vary from person to person. Some of the possible side effects are listed below.

Common side effects:

Flu-like symptoms

Tell your doctor or nurse if you have this. They may recommend pain-relieving drugs such as paracetamol to help manage this.

Feeling sick (nausea) and being sick (vomiting)

You may feel or be sick after having bisphosphonates. This shouldn't last for more than a few days. If it does carry on, your doctor or nurse can give you anti-sickness medicines which will help.

Loss of appetite

You may feel less hungry after having treatment. This should improve in a few days, but it is important to drink plenty and eat healthily while you are having bisphosphonates.

Increased pain

Some men may experience a slight increase in joint, muscle or more bone pain when taking bisphosphonates. Pain-relieving drugs can help until the pain settles down, but you can stop treatment if it continues for more than a few days.

Low blood calcium and phosphate levels

Bisphosphonates can cause the levels of minerals such as calcium and phosphate in your blood to become too low. Your doctor or nurse will check this regularly and prescribe supplements if you need them.

Kidney problems

Bisphosphonates can change how well your kidneys work. You will have regular tests to check this. These changes may not be serious, and your kidneys will return to normal if you stop taking bisphosphonates.

Red or sore eyes (conjunctivitis)

Your eyes may feel itchy, sore or dry. Your doctor or nurse can prescribe eye drops to help with this.

Less common side effects:

Rash or itching

You may notice a rash on your skin or feel quite itchy. This can be uncomfortable but should not last for more than a few days. Tell your doctor or nurse about this so they can prescribe medicine to help.

Stomach or bowel problems

You may feel stomach pain or notice changes in your bowel habits. For example, you may have loose and watery stools (diarrhoea).Or you may find it harder to pass stools and completely empty your bowels (constipation). This should not last more than a few days.

Risk of heart problems

Bisphosphonates may slightly increase your risk of heart problems, including a fast and irregular heartbeat and stroke. Talk to your doctor about this if you are worried about it, or if you have a history of heart problems.

Jaw problems (osteonecrosis of the jaw)

Osteonecrosis of the jaw is a rare side effect. It happens when the healthy bone in the jaw becomes damaged and dies. Keeping your teeth and mouth clean may help to lower your risk of getting osteonecrosis of the jaw. Ask your dentist if you have any questions about this.

Questions to ask your doctor or nurse

  • Would you recommend bisphosphonate treatment for me?
  • What are the main benefits of bisphosphonates?
  • What are the main side effects of bisphosphonates?
  • Who do I contact if I have side effects?
  • Are there any clinical trials which I can take part in at my own hospital or somewhere else?

References

  • Full list of references used to produce this page  

    This publication was written and edited by:

    Prostate Cancer UK's Information Team

    It was reviewed by:

    • Lawrence Drudge-Coates, Urological Oncology Clinical Nurse Specialist and Honorary Lecturer, King's College Hospital NHS Foundation Trust, London
    • Rob Jones, Senior Lecturer and Honorary Consultant in Medical Oncology, Beatson West of Scotland Cancer Centre, Glasgow
    • Philip Reynolds, Advanced Urological Practitioner, Cancer Outpatients Clinic, Guy's and St. Thomas' Hospital, London
    • Bruce Turner, Uro-oncology Nurse Practitioner, Homerton University Hospital and Bart's Health, London
    • Deborah Victor, Urological Oncology Clinical Nurse Specialist, Royal Cornwall Hospitals Trust, Truro
    • Cathryn Woodward, Consultant Clinical Oncologist, West Suffolk Foundation Trust Hospital, Bury St Edmunds
    • Prostate Cancer UK Specialist Nurses
    • Prostate Cancer UK Volunteers

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