- When prostate cancer spreads, the bones are typically the first area affected.
- Bone metastases can weaken your bones and lead to symptoms like bone pain.
- There’s no cure for metastatic bone cancer, but treatment options may help alleviate symptoms to keep you comfortable.
Prostate cancer is one of the types of cancer that is most likely to spread, or metastasize, to bones. There are four main stages of prostate cancer, and stage 4 often involves bone metastases.
Bone metastases occur in more than 60 percent of those with advanced prostate cancer. Although prostate cancer that spreads to the bones can’t be cured, you can take steps to strengthen weakened bones and manage symptoms like bone pain.
Any type of cancer has the potential to spread to your bones. The types that are most likely to metastasize to the bones are:
- breast cancer
- lung cancer
- prostate cancer
When cancer starts in one place then spreads to bones, it’s called metastatic bone cancer.
The tumors that start growing in the bones are called bone metastases (or bone mets for short). This is different from primary bone cancer, where the cancer starts in the bones.
With prostate cancer, the areas most likely to be affected by bone metastases are your:
It’s not possible to predict exact life expectancy after a diagnosis of metastatic bone cancer. It can be influenced by factors like age and how much the cancer has spread. People with more than one site of cancer spread have a lower life expectancy.
Findings from one 2017 study estimated that in those with prostate cancer that spreads to the bones:
- 35 percent have a 1-year survival rate
- 12 percent have a 3-year survival rate
- 6 percent have a 5-year survival rate
Early detection of bone mets may help improve this prognosis.
Early detection can catch prostate cancer even before there are any symptoms. Some types of prostate cancer grow very slowly.
There are four main stages of prostate cancer. Within each stage, the cancer is graded based on factors like the size of tumor, prostate-specific antigen (PSA) level, and other clinical signs.
If the cancer has spread to the bones, it’s considered to be the most advanced, or stage 4.
Newer lab tests look at the genes inside cancer cells. This can provide more information on how quickly the prostate cancer may progress.
There’s also a grading system known as the Gleason system, which assigns the cancer into a grade group based on how closely it resembles normal tissue.
During the biopsy to diagnose prostate cancer, the cells are closely examined. The more abnormal cells that are in the biopsy sample, the higher the Gleason score and grade group.
When more abnormal cells are present, the cancer is more likely to spread quickly.
The prognosis for prostate cancer with bone metastases depends on several factors. When prostate cancer spreads to the bones, it’s stage 4, an advanced stage.
There’s no cure for stage 4 prostate cancer, but treatment can help strengthen weakened bones and alleviate symptoms like bone pain.
You may also want to consider palliative care. Palliative care focuses on symptom management and supporting your overall well-being.
You can continue cancer treatment while under palliative care. Talk with your cancer care team about palliative care.
You can access palliative care services at any stage of your cancer journey.
Once cancer spreads outside the prostate, the main goal of treatment is to prevent or slow down the spread to the bones.
If prostate cancer has already metastasized to the bones, the main treatment goal is to alleviate symptoms and prevent other complications, such as bone fracture or cord compression.
Treatment plans vary from person to person. Options may include:
- Chemotherapy. Chemotherapy drugs target and destroy cancer cells. This can slow the progression and spread of cancer to the bones. It may also be used to shrink tumors to reduce effects of the tumor.
- Pain medications. If you have bone pain from advanced prostate cancer, taking pain medications like anti-inflammatories or opioids may help. You may also take medications for nerve pain.
- Corticosteroids. These medications are often used to treat prostate cancer that’s spread. They can help relieve bone pain for some and may also help lower PSA levels.
- External radiation. If there are only a few bone tumors, radiation may be used to destroy cancer cells and reduce pain.
- Radiopharmaceuticals. If the cancer has metastasized to multiple bone sites, these radioactive medications can be given by injection to destroy cancer cells. This helps reduce tumor size and pain.
- Bisphosphonates. These are oral or injectable medications that strengthen bones to prevent them from thinning. Making bones stronger can reduce pain and risk of fractures. Zoledronate (Zometa) is commonly used for prostate cancer spread to bones.
- Denosumab (Xgeva). Similar to bisphosphonates, this injectable medication can help strengthen bones to prevent or slow the delay of bone fractures. It’s typically used for those who already have cancer that’s spread to the bones or are undergoing hormone therapy.
- Surgery. If prostate cancer spreads to and weakens the spine, a minor surgery called kyphoplasty may be done to stabilize the affected spinal bones with a cement-like mixture.
Bone pain is often the first sign that prostate cancer has spread to bones. Pain is caused by changes to the structure of the bones and inflammation from cancer cells.
It may feel like a sharp pain or dull ache. It can be localized to one area or affect your whole body. The bone pain may come and go, and often worsens at night.
Other signs and symptoms include:
- Bone fractures or broken bones. Bone metastases can weaken the bones, increasing your risk of fractures or bone breaks. These commonly occur in the ribs, vertebrae, and legs.
- Spinal cord compression. This happens when the cancer presses on the spine. It may lead to symptoms like loss of balance or tingling or weakness in your limbs.
- Hypercalcemia. Also known as high blood calcium levels, this occurs when too much calcium escapes the bones and enters the blood stream. It may lead to symptoms like constipation, frequent urination, loss of appetite, and extreme thirst.
There are several tests and scans that can assess and monitor prostate cancer:
- PSA testing. The PSA level can help to determine the stage of cancer. Regular monitoring can help to check if treatments are working.
- Biopsy. The results of biopsy can help determine whether the cancer is likely to grow and spread quickly. This helps inform treatment decisions.
- Genetic testing. If the cancer has certain high-risk features or has spread to other areas in the body, genetic testing may be recommended.
- Imaging. If bone metastases are suspected, you’ll likely undergo imaging test like an X-ray, MRI scan, bone scan, PET scan, or CT scan to investigate.
- Routine blood work. Blood work can be done to monitor for any changes in calcium levels or red blood cells. These can be early signs of bone spread.
If the cancer is suspected to have spread to bones, additional testing can be done to gather more information.
In advanced stages of prostate cancer, the cancer may start to spread to the bones. This weakens the bones, which can lead to pain.
Although metastatic prostate cancer can’t be cured, many treatments are available. These medications target the prostate cancer but also help strengthen bones and manage symptoms like bone pain.