Most men probably know that familiar twinge in the back that comes from lifting something too heavy or exercising too hard. But what does it mean when the pain doesn’t respond to a favorite home remedy? Back pain can be a symptom of a variety of diseases, including:
- Hodgkin’s lymphoma
- Paget's disease
- breast cancer
- metastatic prostate cancer
Back pain from metastatic prostate cancer can occur if the cancer has spread to the bones of the back.
It’s also possible for cancer and other conditions to cause pain in a part of the body other than the actual site of the disease. That kind of pain is called “referred pain.” For example, prostate cancer can cause pain the back, hips, and upper thighs even if the cancer hasn’t spread.
Joint pain, such as pain in the back, hip, or neck, seems to be linked to prostate cancer. In a 2013 study, researchers followed up on men who reported these kinds of pains after one year and again after 10 years. The incidence of prostate cancer was five times higher a year later among men who had back pain compared to what would have been expected. Ten years later, prostate cancer was about 50 percent more common among the men with back pain.
In the same study, hip and neck pain also signaled a higher than expected rate of prostate cancer. Shoulder pain, though, didn’t seem to have any connection to prostate cancer.
Prostate cancer that spreads to the bones of the back often affects the cells that create new bone. The affected cells create new bone tissue. This can show up on images as denser than normal bone tissue. Doctors sometimes will call this “ivory vertebrae” to describe the color and density of the affected tissue.
Less often, prostate cancer also can affect the normal process in which bones are broken down and renewed. When this happens, the image might look like the bone is incomplete or eaten away.
Back pain is just one of several symptoms that suggest prostate cancer. In a 2006 study, researchers looked at the medical history of men for two years before they received a prostate cancer diagnosis. The men reported several symptoms more often than similar men who didn’t have prostate cancer.
These symptoms included:
- an inability to urinate
- trouble urinating
- frequent urination
- a need to pass urine at night
- blood in the urine
- weight loss
There doesn’t seem to be one major risk factor for prostate cancer. The single biggest risk factor is age. About 80 percent of cases appear in men over the age of 65. It’s about 40 percent more common and about twice as deadly in African-American men compared to white men. Environmental factors such as where a person lives, a high-fat or high-calorie diet, and sedentary lifestyle also increase the risk.
A doctor’s first step in finding out the cause of back pain typically is to take an image, usually an X-ray or CT scan.
“For men who have early stage or localized prostate cancer, that it would spread to the bone is very unusual,” says Chris Filson, a doctor at the Atlanta Veterans Administration Medical Center. “However, if a patient has more advanced prostate cancer, we have to do additional tests to ensure there’s no involvement of the cancer in the bone.”
A doctor who suspects or already has diagnosed prostate cancer will look for characteristic changes in the bone. The X-ray or CT scan also can indicate how much of your spine is affected and where.
In addition, an MRI can detect problems that an X-ray or CT scan can’t.
Chiropractors are often the ones who first spot or suggest the presence of prostate cancer. Joint pain, especially back pain, often sends people to chiropractic care when they don’t have any other symptoms of prostate cancer.
Whether you’re seeing a chiropractor or medical doctor, be sure to provide your complete medical history. This can help your doctor diagnose your back pain. It’s especially important to mention any personal or family history of cancer.
A digital rectal exam will allow your doctor to feel whether your prostate is enlarged or has an unusual shape. A test for prostate-specific antigen will measure whether the level of this enzyme in your blood is higher than expected. Both of these tests are common if a doctor suspects prostate cancer. Because prostate cancer is more common in older men, a doctor may recommend them as part of routine care.
Treating pain, especially cancer pain, can be difficult. The right pain treatment for you will depend on the exact cause of the pain and how far along the cancer has developed.
Prostate cancer pain can be related to the cancer itself, to the treatment, or even be unrelated to either one. By the time prostate cancer is terminal, about 90 percent of people will experience some kind of pain.
It’s likely that treating your cancer pain will require your doctors to confer and agree on the best options. They might suggest one or more of the following:
Drugs to strengthen the bones
Treatment for bone pain is usually reserved for men with advanced prostate cancer. IF you have advanced prostate cancer, it’s likely you’re already receiving cancer drugs to treat the cancer directly. For bone pain specifically, Filson says bisphosphonates are the usual course of treatment. Cancer drugs that lower testosterone can weaken bones, and doctors prescribe bisphosphonates to help reverse the process.
Drugs that treat the cancer itself
Drugs that treat prostate cancer include chemotherapy and medication to disrupt hormones, such as testosterone, that feed the cancer. Drugs currently under investigation may prevent prostate cancer from traveling to the bones and help reduce bone pain.
The right medication will vary according to whether the pain is mild, moderate, or severe. For mild pain, guidelines call for nonsteroidal anti-inflammatory drugs (NSAIDs). For moderate pain, you may also be prescribed weak opioids such as codeine. For severe pain, general protocol calls for the addition of strong opioids such as morphine.
Surgery or radiation
Surgery can help treat the cancer, the pain, or both. Radiation can treat both the cancer and the pain. It can be delivered in a variety of ways, usually through the skin or in chemicals injected into a vein.
“[Treatment] is generally palliative,” Filson says. “We’re not doing it to treat the cancer, but to decrease the pain. It’s treating that one deposit, but radiating or treating a single painful bone lesion is not going to change their survival necessarily.”
In 2013, the U.S. Food and Drug Administration approved the use of Xofigo for men who have bone pain from the cancer that has spread from the prostate. Xofigo carries radiation treatment through the bloodstream directly to the site of the bone cancer. Unlike most radiation treatments for this type of prostate cancer, Xofigo seems to produce a modest increase in survival.
Cancer pain is often undertreated, especially for minorities. It’s important to communicate with your doctor about what kind of pain treatment works best for you.
Pain from prostate cancer often appears in the back. Cancer that has spread to the bones of the back may cause the pain, or the pain may appear in the back without the spread of the cancer. Treatment for prostate cancer can help reduce the pain. In addition, NSAIDs and opioids may lessen the discomfort.