About

When prostate cancer spreads to the bone, it is called bone metastasis. This means that some prostate cancer cells are growing in your bones. This is not bone cancer. You still have prostate cancer except now it is metastatic. Metastases can occur in any bone in the body, but the spine is the most common site.

Other common sites include:

• Hip bone
• Upper leg bone
• Upper arm bone
• Ribs
• Skull

When the cancer spreads, it begins to interfere with the bone’s normal health and strength, which can lead to bone pain, fractures or other complications that can impair your health.

Many people who have metastatic prostate cancer live relatively normal, long lives with appropriate treatment. Unfortunately there is no cure; but there are ways to help control its spread and related symptoms.

FYI

OTHER TYPES OF ADVANCED PROSTATE CANCER
Advanced prostate cancer may be found in lymph nodes, the bladder, rectum or other parts of the body including the brain, liver and lungs. Bone metastasis remains the most common type of advanced prostate cancer, making up 90% of the cases.

Key Points about Cancer Metastasis

• Metastatic cancer is cancer that has spread from its origin to another place in the body.
• Metastatic cancer has the same name and same type of cancer cells as the original cancer.

Symptoms

Some people will have no or minimal symptoms. If there are symptoms, they are based on the location of the metastasis. Prostate cancer bone metastases can cause the following symptoms:

Bone pain.  This is the most common symptom. At first, the pain may come and go, worsening at night. Eventually, the pain gets worse and does not go away. 

Broken bones. Bone metastasis can weaken bones which increases the risk of breaking. The arms, legs and spine are most likely to break. Sudden pain in the middle of the back may also indicate a bone breaking.

Loss of appetite, nausea, thirst, constipation, tiredness, or confusion. These are all signs that there may be high levels of calcium in the blood. Bone metastases can cause a release of calcium into the bloodstream. This condition is called hypercalcemia. If untreated, could lead to a coma.

Spinal Cord Compression. If the bone metastasis occurs in the spinal area, it can result in spinal cord compression. This is when the tumor squeezes the spinal cord. This can lead to back pain or make walking painful and difficult. Symptoms include numbness or weakness, trouble urinating or having a bowel movement.  If left ignored the tumor can cause paralysis.

Other symptoms. If bone metastasis affects your bone marrow, your red blood cell count may drop and you may feel tired, weak, and short of breath. You may also get fevers, chills, fatigue, or pain as well as abnormal bruising. These symptoms may indicate you could be anemic.

Specifics:
Brain Metastasis: Symptoms may include headache, dizziness, visual problems, speech problems, nausea, difficulty walking or confusion.

Liver Metastasis: Symptoms include weight loss, nausea, loss of appetite, abdominal fluid or jaundice (yellowing of the skin and whites of eyes, dark urine, and light colored stools).

Lung Metastasis: Symptoms are usually vague and can be confused with symptoms of other lung conditions. They include a cough, coughing up blood, chest pain or shortness of breath.

Diagnosis

If you have any of the above symptoms, visit your healthcare provider. He/she will do the following tests to determine if the cancer has spread to your bones.

• Bone scan
• Computed tomography scan
• Lab tests
• Magnetic resonance imaging scan
• X-rays
• Biopsy

Questions to Ask Your Health Care Provider

It’s important that you become a proactive partner in your healthcare in order for you to get the best treatment. Here are some questions you can ask your healthcare provider.

1)    How extensive are my bone metastases?
2)    What is the best treatment for me and why?
3)    What are the risks, benefits and side effects of this treatment?
4)    Is the treatment you recommend intended to cure the cancer, help me live longer, or relieve or prevent some of the symptoms of the cancer?
5)    How will I know if the treatment is working?
6)    What are my treatment options for relieving the pain?
7)    What can I do to strengthen my bones and prevent them from breaking?
8)    What should I do if I break a bone?
9)    Are there any clinical trials that would be suited for me?

Treatments

Treatment for bone metastases will slow the spread of advanced prostate cancer and relieve symptoms. Your healthcare provider will determine appropriate treatment based on:

• Which bones (and how many) the cancer has spread to
• Whether any bones have been weakened or broken
• Which treatments you have already had
• Your general state of health

Treatments include:

• Bisphosphonates
• Denosumab
• Radiation therapy and radiopharmaceuticals
• Chemotherapy and hormone therapy
• Immunotherapy
• Surgery
• Other treatments, including physical therapy and drugs

Resources

For More Information on Advanced Prostate Cancer visit:

Prostate Cancer Roundtable
National Cancer Institute 

Support Groups:

US Too International
National Cancer Institute
Prostate Cancer, including information on clinical trials