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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, and hormonal therapy for prostate cancer can 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.

2015-EDU-WEB-WebinarsYou can also click here to listen to our webinar, Prostate Cancer and Bone Health featuring Dr. Alicia Morgans, a genitourinary oncologist at Vanderbilt Ingram Cancer Center.

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 prostate cancer when doctors look at it under the microscope. It is still treated with therapy for prostate cancer. A man whose prostate cancer spread to the bone does not have bone cancer. He has prostate cancer that now has the ability to travel through his blood, land in his bones, and grow.

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 skeletal related events (fracture, 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 and help make them stronger. Zometa (zolendronic acid) is the most commonly used bisphosphonate and is usually given once every four weeks by an intravenous infusion through a vein.

Xgeva (denosumab)

Works to prevent or delay problems like fractures and is given as an injection under the skin every four weeks.

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 and are causing pain, radiation, in the form of radiopharmaceticals, can be administered in the blood stream through a vein. There are several medications in this family of treatments. One newer form of infused radiation, Xofigo or radium-223, acts like calcium in the body and quickly absorbed by the bones, especially in areas with cancer in the bone. It works by bringing small doses of radiation to the cancer cells. Importantly, the alpha wave radiation that it gives off does not travel far outside of the cancer in the bones and causes very little damage to healthy tissue around the cancer. Importantly, it decreases pain and makes people live longer.

Other radiotherapies include Samarium-153 and Strontium-89, which are given intravenously (through a vein) to destroy the cancer cells in the bone in men with metastatic castration-resistant prostate cancer and decrease pain. They do not make people live longer.

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 physician 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

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