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Bone Metastasis

EDU-BoneHealth-CoverOnlyMany men experience bone related problems as a result of prostate cancer or its treatment. Among other things, the spread of the prostate cancer to the bones (bone metastases) can cause severe pain and fracture (bone breaks). Hormonal therapy for prostate cancer can also cause bone loss, fracture, and joint pain. All men are at risk for fractures as they age and this risk is compounded when living with a prostate cancer diagnosis. We have resources on maintaining bone health during prostate cancer, including this webpage and our brochure, Prostate Cancer and Bone Health.

View our webinar, The Latest on Prostate Cancer and Bone Health, and hear Benjamin Lowentritt, M.D., F.A.C.S. from Chesapeake Urology Associates discuss how prostate2015-EDU-WEB-Webinars cancer can affect bone health and what treatments are available both to treat bone metastases and address bone loss as a side effect of prostate cancer treatment.

 

Bone Metastases 

When prostate cancer spreads beyond the prostate to another organ, most frequently it spreads to the bone. Prostate cancer that spread to the bone is still considered prostate cancer. It is still treated with therapy for prostate cancer. A man whose prostate cancer spread to the bone does not have bone cancer.

More than 60 percent of men with advanced prostate cancer will eventually develop bone metastases. The bones most commonly affected are the spine, hips, and ribs. Once prostate cancer has spread to the bone it can become a painful process, but treatments like pain medications or radiation therapy to those areas can dramatically reduce pain and improve quality of life.

bone-metastasisWhen making a treatment plan, it is important to include strategies to maintain good bone health. In addition to complications from the spread of the cancer, prostate cancer treatment can negatively affect bones and increase risk of fracture and other skeletal related events (spinal cord compression/paralysis, or needing surgery or radiation for bone pain). Fortunately there are several treatments available to strengthen bones, prevent metastases, and manage spread and pain. These include bisphosphonates or denosumab, radiation, and radiopharmaceuticals.

Bisphosphonates

Can prevent the thinning of the bone, help make them stronger, and help relieve bone pain. Zometa (zolendronic acid) is the most commonly used bisphosphonate. It is usually given once every 3 or 4 weeks, or once every 12 weeks, by an intravenous (IV) infusion through a vein. Men given this drug are often advised to take a calcium and vitamin D supplement to prevent problems with low calcium levels. Some side effects related to bisphosphonate use include flu-like symptoms, bone or joint pain, and kidney problems. A rare but serious side effect is osteonecrosis of the jaw (ONJ). This is a condition where part of the jaw bone loses its blood supply and dies, which can lead to tooth loss and jaw bone infections. Men are often advised to have a dental checkup and any dental problems treated before they start taking a bisphosphonate.

Xgeva (denosumab)

Works to prevent or delay problems like fractures and is given as an injection under the skin every 4 weeks. Men given this drug are often advised to take a calcium and vitamin D supplement  to prevent problems with low calcium levels. Some common side effects include diarrhea, nausea, weakness, and fatigue. Similar to bisphosphonates, ONJ is a rare but serious side effect. Therefore, the same precautions are recommended.

Radiation

There are several types of radiation therapies that can be used to treat and manage the cancer and the pain it can cause when it grows in the bones. While these types of therapies will not eliminate all cancer cells or cure the cancer, they do relieve bone pain and can slow the growth of cancer. External radiation can be given to the affected bone, or single area of treatment and can be used as a series of treatments. After the end of the series of radiation treatments, pain continues to lessen over several weeks.

Radiopharmaceuticals

If several areas of the skeletal system are affected by cancer then radiation, in the form of radiopharmaceuticals, can be administered via IV injection into the blood stream through a vein. They are then quickly absorbed by the bones, especially in areas with cancer in the bone, and work by bringing small doses of radiation to the cancer cells.

There are several medications in this family of treatments that can help relieve pain caused by bone metastases. One form of infused radiation approved by the FDA, Xofigo (Radium-223), gives off an alpha wave radiation and has also been shown to help those with prostate cancer spread only to their bones live longer. Other radiopharmaceuticals are Metastron (Strontium-89) and Quadramet (Samarium-153). These treatments give off a beta wave, and are approved by the FDA to reduce the pain caused by the cancer in the bones. The main side effect associated with these drugs is a blood cell count decrease, which can increase the risk for bleeding or infection.

Bone Loss from Prostate Cancer Treatment

Testosterone, the male sex hormone, fuels the growth of prostate cancer but it also is crucial to bone health. Treatment of prostate cancer with hormone therapy, also called androgen deprivation therapy (ADT), blocks the production of testosterone which stops or slows the growth of the cancer. Without testosterone, bones can become weak and break more easily. When a man is on ADT, recovery from a bone fracture takes longer than for other men. It is especially important for men taking ADT to speak with their doctor about how to plan for and manage the bone loss before a problem arises. Bone strength can also be decreased as a result of radiation and chemotherapy used to treat prostate cancer.

Fortunately there are ways to strengthen and repair your bones including medicines and lifestyle changes.

  • Bisphosphonates can prevent the thinning of the bone and help make them stronger
  • Oral bisphosphonates include Fosamax (alendronate) and Actonel (risendronate)
  • The intravenous bisphosphonate is Zometa (zolendronic acid)
  • Strive for a healthy diet and make sure to get enough calcium and vitamin D
  • When exercising, include weight bearing and muscle strengthening exercises
  • Avoid tobacco and excessive alcohol