27th February 2025

A-68-year old gentleman has metastatic prostate cancer. Goserelin (Zoladex) was recently stopped due disease progression

A-68-year old gentleman has metastatic prostate cancer. Goserelin (Zoladex) was recently stopped due disease progression despite treatment. He has been admitted with severe lower back pain with no focal neurological. Lumbar X-ray shows pathological fractures of L4 and L5. His bloods show hypercalcemia, with adjusted calcium of 3.1 (2.1-2.6).

He has received IV fluids, and oral analgesia (IV paracetamol, morphine MST and PRN Oramorph) with little effect on pain or hypercalcemia within 48 hrs. What is the next most appropriate option which could help reduce bony pain and treat hypercalcemia in this patient?

Select the SINGLE most appropriate option from the list below. Select ONE option only.