Pain can often be a symptom of advanced prostate cancer, particularly pain felt deep in the bones.
Since more than 60 percent of men with advanced prostate cancer will go on to develop bone metastases, or cancer cells that have spread to the bones, achy bones may be a sign that prostate cancer has metastasized.
While achiness due to weakened bones can be quite painful, there are various ways to manage the pain.
Here’s what to be on the lookout for if you’re concerned about metastatic prostate cancer, what bone pain really feels like, and how pain and discomfort can be treated.
Metastatic prostate cancer is cancer that has spread to distant sites. This means cancer cells have escaped the prostate area and are spreading, or metastasizing.
This advanced form of prostate cancer tends to spread to the lymph nodes first. It can also spread to the bloodstream, which leads to cancer cells being deposited in your bones. In fact, 85 to 90 percent of metastatic prostate cancer sees metastases developing within the bones.
Prostate cancer that has spread to the bones is considered stage 4, an advanced stage. Although there’s no cure for stage 4 prostate cancer, there are treatments to minimize discomfort and slow the growth of prostate cancer that has spread to the bones.
There are different signs of metastatic prostate cancer, depending on where the cancer has spread. However, these are the most common symptoms:
- bone pain
- feeling generally unwell
- unexplained weight loss
When prostate cancer has spread to the bones, it can metastasize in the spine, pelvis, ribs, or skull. Bone pain is the most common symptom of bone metastases, particularly if it’s persistent.
Bone pain from metastatic prostate cancer generally doesn’t go away on its own. It can be near constant, in fact. Some men may even wake up throughout the night from the pain, which can be a dull ache or a stabbing sensation.
Not all men with cancer in their bones will experience bone pain, but those who do liken it to a throbbing in the bones, like a terrible toothache. Affected areas can be tender to touch or make it difficult to move, particularly if the cancer has spread to the spine.
Pain can sometimes begin in one area and eventually spread to other parts of the body.
Bone metastases can also cause your bones to become weaker, which can result in bones that are easier to break, making fractures common.
These fractures of the vertebra can cause compression. In addition, metastatic tumor deposits can also cause spinal cord compression, which is when a mass like a tumor or bone fragment puts pressure on the spinal cord.
Some symptoms of spinal cord compression are:
- severe pain and weakness in the legs
- severe numbness in the back of the legs and inner thighs
- a loss of bowel and bladder control
Motor skills and coordination may be affected as well.
For people with prostate cancer, spinal cord compression occurs when cancer that has spread to the spine puts pressure on the spinal cord, preventing nerves from being able to work properly. Back pain generally occurs.
Hypercalcemia, or high blood calcium levels, is another possibility with bone metastases. This condition occurs when too much calcium leaves the bones and enters the bloodstream, which can result in constipation, frequent urination, loss of appetite, and extreme thirst.
Treating bone pain is the main goal for prostate cancer that has metastasized in the bones.
Hormone therapy, chemotherapy, and vaccines may be considered, but treatments specifically designed for bone metastasis and pain or complications are also available.
Drugs for osteoclasts
Bisphosphonates, or drugs that slow down bone cells called osteoclasts, can be used to alleviate pain and high calcium levels that result from bone metastasis.
Since osteoclasts can become overactive in advanced prostate cancer that has spread to the bones, these help slow the growth of cancer cells while also preventing fractures and strengthening the bones.
Bisphosphonate, taken orally or received via intravenous injection every 3 to 4 weeks, help strengthen thinning bones. Zoledronate (Zometa) is a type of drug specifically used for treating the bones in people whose prostate cancer has spread.
Similar to bisphosphonates, denosumab can also be used to block osteoclasts and help prevent fractures. This drug is injected under the skin every 4 weeks.
Corticosteroids may be considered as a pain reliever for bone metastases as well. Drugs like prednisone and dexamethasone can potentially control pain while also lowering PSA levels, or prostate-specific antigens, levels that indicate the presence of prostate cancer.
Bone pain can also be reduced through external radiation therapy. This is a helpful approach when pain is limited to one bone or a few areas of bone, since radiation can be aimed directly at tumors. Radiation can help relieve spinal cord pressure and even prevent paralysis.
Drugs that contain radioactive elements, or radiopharmaceuticals, can be injected into a vein to then settle into areas of bones where cancer has spread to. Once these drugs arrive at the bones, the radiation kills cancer cells. It also helps relieve pain from bone metastases.
In more serious cases, surgery can be used to stabilize collapsed bones in a spine affected by prostate cancer. Kyphoplasty is a minor procedure where a balloon is placed into a weak spinal bone. The balloon, which is first filled with air and then a cement-like mixture, will harden to help stabilize the area.
Bone pain can also be treated with traditional pain relievers, such as nonsteroidal anti-inflammatory drugs like ibuprofen or naproxen. These drugs work best when taken regularly. Stronger pain medications, like opioids, may also be considered for severe pain.
Palliative care, which may include taking opioids for pain, focuses on symptom management and supporting your overall well-being. This type of care is intended to maximize a person’s comfort and alleviate pain to protect the quality of life in a person’s remaining days.
More recently, however, palliative care specialists may begin treatment earlier in the disease process.
It’s essential for men with prostate cancer to keep an eye on symptoms, particularly bone pain.
While bone pain can be a sign that prostate cancer has become advanced or metastasized, catching it early can help you get the treatment you need and better manage any symptoms.
Bone pain can be managed, so it’s important to speak to your doctor if you’re experiencing achy bones or have concerns related to advanced prostate cancer.