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© The Canadian Journal of Urology™; 18(Supplement 1); April 2011
might consider offering medical therapy in these
instances. It should also be noted that denosumab is
also approved as the brand name Prolia (Canada and
US) for post-menopausal osteoporosis at a different
dosage (60 mg every 6 months versus 210 mg every 4
weeks for Xgeva).
Antiandrogens
Antiandrogens are oral agents that block the androgen
receptors required for prostate cancer progression
and growth, Table 8c. There are two different
classes of antiandrogens: non-steroidal (flutamide
TABLE 8b.
Medications for prevention of skeletal related events secondary to advanced or castrate resistant
prostate cancer (CRPC) and newer agents for treatment of CRPC
Name (Brand)
Dose
Mechanism
Side effects/Notes
Zoledronic acid
4 mg IV infusion over
Bisphosphonate
Reduce dose in patients with
(Zometa)
15 min every 3-4 weeks
renal insufficiency; rare
reports of osteonecrosis of
the jaw; given with Vitamin
D and calcium
supplementation (indicated
for treatment of bone
metastases only in Canada)
Denosumab
120 mg every 4 weeks SC
Monoclonal
Severe hypocalcemia can be
(Xgeva [US,
antibody
seen; reports of osteonecrosis
not Canada])
targeting
of the jaw; given with
RANKL
Vitamin D and calcium
supplementation (Note there
is different formulation/
dosing than denosumab
[Prolia] used in female
osteoporosis)
Docetaxel
75 mg/m
2
IV infusion
Suppresses microtubule
Should not be given
(Taxotere)
over 1 hour every 3 weeks
assembly dynamics
in patients
Given in combination with
with elevated LFTs or who
5 mg prednisone oral twice daily
are neutropenic; severe fluid
retention can also result
Cabazitaxel
25 mg/m
2
IV infusion
Same as for docetaxel
Contraindicated in
(Jevtana [US,
over 1 hour every 3 weeks
neutropenic patients or
not Canada])
Given in combination with
those with previous
10 mg prednisone oral once daily
hypersensitivity; renal and
GI toxicity reported
Sipuleucel-T
Leukapheresis process
Utilizes patients own
Fevers; chills; fatigue;
(Provenge [US,
2-3 days prior to each dose
immune cells to target
weakness; respiratory issues;
not Canada])
to collect patient’s own
cancer cells
dizziness; headache;
immune cells; IV infusion in
GI upset all reported
3 doses given 2 weeks apart
[Euflex], nilutamide [Anandron], and bicalutamide
[Casodex]) and steroid antiandrogens (cyproterone
acetate [Androcur, Canada only]). As previously
discussed, antiandrogens are frequently prescribed
to prevent the hormonal surge associated with initial
LHRHAadministration. Complete androgen blockade
for treatment of advanced prostate cancer with
combination LHRHAor LHRHAN and antiandrogen
therapy has beendebated and should be patient specific
determined by a cost-benefit analysis.
73
Antiandrogen
monotherapy for prostate cancer should be avoided by
the general practitioner and used only in highly select
35
Pharmacology for common urologic diseases: 2011 review for the primary care physician