Bone metastasis and prostate cancer
About 80 percent of the time prostate cancer cells metastasize, or spread, they will spread to bones, such as the hip, spine, and pelvis bones. It can be by direct invasion or by traveling through your blood or lymphatic system. Metastatic prostate cancer is considered advanced prostate cancer.
Once relocated, the cells begin to grow and form new tumors. This new growth is still classified as prostate cancer because the cancer first developed in the prostate. You may notice new or different symptoms once you have bone metastases.
Having bone metastases will change your treatment options, prognosis, and outlook. As you begin to consider your next steps, it’s important to know that you have many options.
What are the symptoms?
Symptoms of advanced prostate cancer include:
- difficulty urinating
- bloody urine or semen
- erectile dysfunction
- painful ejaculation
- swelling in pelvic area or legs
- unexplained weight loss
After the cancer cells spread to the bones, you may experience:
- bone pain
- weak bones, increasing your risk for fractures
- spinal cord compression and related weakness or numbness
- high blood calcium levels
- stiffness or pain in the hip, thighs, or back
These symptoms can cause severe discomfort and disability. Spinal cord compression can result in nerve damage, which can lead to muscle weakness or paralysis, numbness in the legs or arms, or loss of control of bladder and bowel functions.
Higher levels of calcium in the blood can occur as cancer replaces normal bone. This can trigger:
Talk to your doctor if you have any of the above symptoms. Early treatment can help slow the cancer’s progression in your bones and improve your life expectancy.
What’s the outlook?
No cure for metastatic prostate cancer is currently available, but new therapies are extending life beyond what was possible a few years ago.
In general, your long-term outlook and life expectancy will depend on factors like:
- overall health, including other conditions you have
- the extent of the metastases
- grade of the tumor
- Gleason score
- prostate specific antigen (PSA) levels
- the types and response to treatments you receive
Prostate cancer and treatments can affect men differently. Some treatments will be more effective for some people than others. Your doctor will be able to discuss your long-term outlook with you. This can be helpful when making plans for the future.
How is survival affected?
A study by researchers in Denmark investigated the effect that bone metastasis had on survival rates for men with prostate cancer.
The results are below:
|Advanced prostate cancer||One-year survival||Five-year survival|
|without bone metastasis||87 percent||56 percent|
|with bone metastasis||47 percent||3 percent|
|with bone metastasis and skeletal-related events||40 percent||less than 1 percent|
Skeletal-related events (SREs) refer to a complication of bone metastases. According to the Canadian Urological Association Journal, SREs are when bone metastases:
- cause spinal cord compression
- cause bone fractures
- require surgical treatment to the bone
- require radiation for pain or impending fracture treatment
Occurrence and mortality of prostate cancer in the United States
Statistics about the long-term outlook for advanced prostate cancer may not be entirely accurate. The numbers available today don’t reflect the newer treatment options. But the overall mortality rate for prostate cancer continues to drop as treatments advance.
How are bone metastases treated?
There’s currently no cure for advanced prostate cancer with bone metastases. Treatment options for your condition will vary depending on your:
- where the cancer has spread
- if any bones are broken or weakened
- overall health
Your doctors will work with you to determine the best treatment option for your prostate cancer and bone metastases. Treatments may be systemic (affecting the whole body) or local (focused in the bone). These include:
- androgen deprivation therapy (ADT), which works by decreasing testosterone levels and slowing cancer growth
- hormonal therapies like abiraterone and enzalutamide
- chemotherapy, often used after the body stops responding to hormone therapy
- vaccines and immunotherapy such as Sipuleucel-T
- radiation therapy
- radiopharmaceuticals, such as Metastron or Xofigo
- bisphosphonates, a group of drugs to reduce the risk of SREs and bring calcium levels down
- denosumab, another option to reduce the risk of SREs
- ablation technique, using a needle to destroy tumors with heat, cold, or electric currents
Where can you find out about new
Clinical trials focus on finding new strategies for treating, preventing, and controlling certain diseases, including advanced prostate cancer. These studies also explore the effectiveness of various treatment options in different groups of people. Talk to your doctor for more information on clinical trials you may be eligible for. Researchers are always looking for participants.
Prostate cancer research funding
Most of the funding for prostate cancer research goes to treatment.
What are the side effects of treatment?
You may experience fatigue, hair loss, or mood changes. These are common side effects of bone metastases and cancer treatments. But side effects will vary depending on treatment and person. They can include:
- hot flashes
- erectile dysfunction or decreased interest in sex
- mood changes
- swelling or tenderness in breast
- weight gain
- trouble with focus and memory
Let your doctor know if you are having new symptoms. Pain can be treated, managed, or relieved. And as always, talk to your doctor before taking ibuprofen and other nonprescription drugs or supplements, especially if you’re already taking other medications.
Bisphosphonate side effects
A rare but serious complication of bisphosphonates is osteonecrosis of the jaw (ONJ). ONJ is when the jawbone loses blood supply and dies. There is no treatment for ONJ. It’s important to get a dental evaluation prior to starting these drugs. The biggest risk for developing ONJ is pre-existing cavities or decayed teeth. Bisphosphonates aren’t recommended for men with poor kidney function, but denousumab is safe to use if you have kidney disease.
Managing bone pain and weakness
Symptoms like nausea, hot flashes, and pain can usually be relieved with medication. Some people find that complimentary treatments like acupuncture or massage help manage side effects.
Your doctor may also recommend orthopedic surgery to stabilize your bones, relieve pain, and help prevent bone fractures.
What are next steps?
Bone metastasis have a profound effect on the long-term outlook for prostate cancer. But it’s important to remember that the numbers are only statistics.
The good news is that life expectancy for advanced prostate cancer continues to increase. New treatments and therapies offer both longer life and better quality of life. Speak to your doctor about your treatment options and long-term outlook.
Everyone’s cancer experience is different. You may find support through sharing your treatment plan with friends and family. Or you can turn to local community groups or online forums like Male Care for advice and reassurance.