Treatments For Prostate Cancer Spread To Bones
If prostate cancer spreads to other parts of the body, it nearly always goes to the bones first. Bone metastasis can be painful and can cause other problems, such as fractures , spinal cord compression , or high blood calcium levels, which can be dangerous or even life threatening.
If the cancer has grown outside the prostate, preventing or slowing the spread of the cancer to the bones is a major goal of treatment. If the cancer has already reached the bones, controlling or relieving pain and other complications is also a very important part of treatment.
Treatments such as hormone therapy, chemotherapy, and vaccines may help with this, but other treatments specifically target bone metastasis and the problems it may cause.
Comparative Outcomes Of Surgery And Observation For Prostate Cancer
The Scandinavian Prostate Cancer Group Study 4 cited previously, compared radical prostatectomy to watchful waiting among men with localized prostate cancer diagnosed in the era prior to PSA screening. After 15 years of follow-up, men that underwent surgical treatment had significantly lower rates of distant metastatic disease and death from prostate cancer. This benefit of surgery was seen only among men below age 65 years, but not in those age 65 years and above in whom surgery did not provide a benefit in terms of freedom from metastatic disease or prostate cancer death. These data highlight an important aspect of prostate cancer management the unlikely probability that treatment will improve health outcomes for older men with low risk disease .
The PSA era Prostate Cancer Intervention versus Observation Trial , compared radical prostatectomy to watchful waiting among 731 men with localized prostate cancer. At 12 years, a subset of men with a PSA above 10 ng/ml and those with intermediate to high risk disease had a reduction in prostate cancer death with surgery as compared to watchful waiting.
The findings from the SPGS-4 and PIVOT should inform practice for the older man with low risk disease, especially those with associated comorbidities unlikely to benefit from curative intervention. For these men, no treatment may be the most rational initial management considering that harm is likely to outweigh any benefit .
Prostate Cancer Bone Metastasis
In the U.S., prostate cancer is the third leading cause of cancer death among men. It is estimated that about 1 out of 8 men will be diagnosed with PCa, and nearly one in 40 will die from it. If left untreated, prostate cancer tumors will grow, become more aggressive, and begin to metastasize to other areas of the body.
When a man is diagnosed with PCa, the doctor determines the extent of the cancer:
- Localized the cancer is confined to the prostate gland and capsule
- Regional the cancer has spread beyond the capsule to nearby tissues, e.g. seminal vesicles, prostate bed, pelvic lymph nodes
- Distant the cancer has spread to distant lymph nodes, bones or other organs, and systemic treatments are used to control but not cure the disease 1
PCa cells have certain molecular factors that give them a preference for spreading to bone. This is called prostate cancer bone metastasis, or bone mets. At this stage, treatment has two goals:
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What Are The Chances Of Getting Metastatic Prostate Cancer
About 50% of men diagnosed with local prostate cancer will get metastatic cancer during their lifetime. Finding cancer early and treating it can lower that rate.
A small percentage of men aren’t diagnosed with prostate cancer until it has become metastatic. Doctors can find out if it’s metastatic cancer when they take a small sample of the tissue and study the cells.
Treating Symptoms Of Metastatic Prostate Cancer
Metastatic prostate cancer means that a cancer that began in the prostate has spread to another part of the body such as the bones. It is also known as advanced prostate cancer.
Symptoms of metastatic prostate cancer depend on where the cancer has spread to. Symptoms might include:
- tiredness and feeling unwell
- weight loss and loss of appetite
- sexual problems such as difficulty getting an erection
The symptoms can be difficult to cope with. But your doctors and nurses can support you and give you treatments to help relieve the symptoms.
Treatments such as chemotherapy, radiotherapy or hormone therapy might shrink the cancer, reduce symptoms and help you feel better. You can also have other medicines to help relieve symptoms, such as painkillers.
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How Prostate Cancer Is Treated
In cancer care, different types of doctorsincluding medical oncologists, surgeons, and radiation oncologistsoften work together to create an overall treatment plan that may combine different types of treatments to treat the cancer. This is called a multidisciplinary team. Cancer care teams include a variety of other health care professionals, such as palliative care experts, physician assistants, nurse practitioners, oncology nurses, social workers, pharmacists, counselors, dietitians, physical therapists, and others.
The common types of treatments used for prostate cancer are described below. Your care plan may also include treatment for symptoms and side effects, an important part of cancer care.
Treatment options and recommendations depend on several factors, including the type and stage of cancer, possible side effects, and the patients preferences and overall health.
Cancer treatment can affect older adults in different ways. More information on the specific effects of surgery, chemotherapy, and radiation therapy on older patients can be found another section of this website.
Because most prostate cancers are found in the early stages when they are growing slowly, you usually do not have to rush to make treatment decisions. During this time, it is important to talk with your doctor about the risks and benefits of all your treatment options and when treatment should begin. This discussion should also address the current state of the cancer:
What Are The Treatments For Metastatic Prostate Cancer
It mainly depends on the stage of your cancer. Metastatic prostate cancer is stage IV, and doctors divide it into two types: IVA and IVB.
If you have stage IVA prostate cancer, that means the disease has spread to nearby lymph nodes but not to distant parts of your body. If youâre healthy enough to get treatment, or if youâre having symptoms from the cancer, your doctor may recommend one of these treatment options:
External beam radiation treatment with androgen deprivation therapy . During EBRT, a machine outside your body sends beams of radiation to your prostate gland. Radiation destroys cancer cells.
ADT is a type of hormone therapy. It involves taking medications to lower the levels of male sex hormones that your testicles make, or getting surgery to remove the testicles. Androgens, like testosterone, often fuel the growth of prostate cancer cells.
Along with ADT, your doctor might also have you take a drug called abiraterone . It helps stop cells in other parts of your body, like your adrenal glands, from making androgens.
ADT with or without abiraterone. If your doctor recommends this option, you wonât need to get external beam radiation treatment along with it.
If you have stage IVB prostate cancer, the disease has spread to distant organs, like your bones. Your doctor can give you treatments that help keep your cancer under control for as long as possible and improve your quality of life.
Some treatment options are:
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Clinical Manifestations Of Bone Complications In Prostate Cancer
The American Cancer Society estimates for 2009 included over 192,000 new cases of prostate cancer in the United States, accounting for 25% of cancer diagnoses in men, and over 27,000 deaths from metastatic disease. The major site of hematogenous spread of prostate cancer is bone, seen in 80-90% of men with castration-resistant metastatic prostate cancer undergoing therapy, and 90% of patients at autopsy. The most common sites of bone metastasis are the vertebral column, pelvis, ribs, long bones, and skull. These are areas of active hematopoiesis in adults and are hypothesized to provide tumor cells with a rich growth environment. Unlike other cancers that commonly metastasize to bone and cause osteolytic lesions, prostate cancer causes predominantly osteoblastic lesions.
Bone metastases from prostate cancer are a major cause of morbidity. Pain is the most common symptom. Vertebral metastases may cause compression fractures, spinal cord compression, nerve root compression, and cauda equina syndrome. Pathologic fractures of proximal long bones occur at lower rates compared with vertebral fractures. Hypocalcemia, as a result of excessive bone formation, and subsequent secondary hyperparathyroidism is common. Ineffective erythropoiesis due to bone metastases and cancer therapies contributes to a high prevalence of anemia among men with advanced prostate cancer.
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What Is The Life Expectancy Of Someone With Metastatic Prostate Cancer
In the past, the life expectancy of men with metastatic prostate cancer was 2-3 years. But with advancements in medicine and care, the life expectancy of men with metastatic prostate cancer has increased to about 5-6 years.
The 5-year survival rate of metastatic prostate cancer is 28%, which is much lower than local and regional prostate cancers. This refers to the percentage of people diagnosed with a particular cancer who can expect to live for at least 5 years after diagnosis.
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The Tnm System For Prostate Cancer Stages
As they do for most cancers, doctors use the TNM system to describe prostate cancer stages. The system uses three different aspects of tumor growth and spread:
- Tumor. Whatâs the size of the main area of prostate cancer?
- Nodes. Has it spread to any lymph nodes? If so, how far and how many?
- Metastasis. How far has the prostate cancer spread?
Ethics Approval And Consent To Participate
As the data used was extracted from SEER dataset , Ethics approval and Consent to participate could be checked in SEER. We were permitted to have Internet access after our signed data-use agreement was approved by the SEER administration . The date collected from the Second Affiliated Hospital of Zhejiang University School of Medicine was approved by the Ethics Committee of Zhejiang University .
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Coping With Mood Changes
You might find it difficult to cope when you are diagnosed with metastatic or advanced cancer.
It is common for people with metastatic prostate cancer to feel sad or become depressed. You may find it helpful to understand this as a part of your illness. Talk to your specialist nurse about how you are feeling. They can arrange for more support if you need it.
Enzalutamide Improves Survival In Patients With Metastatic Prostate Cancer
Summary
In an international randomizedphase III clinical trial, the hormone therapy enzalutamide extended survival in men with metastatic prostate cancer that had progressed during treatment with androgen deprivation therapy. Participants in the trial had not received chemotherapy.
New England Journal of Medicine, June 1, 2014.
Background
Early in their development, prostate cancers need relatively high levels of male sex hormones to grow. The testes are the main source of androgens, and treatments that stop the testes from producing male sex hormonesknown as hormone therapy or androgen deprivation therapy are therefore a common treatment for androgen-sensitive prostate cancer. However, most prostate cancers eventually become castrate resistantthat is, they can grow even when androgen levels in the blood are very low. ADT does not block production of the small amount of androgen that is made by the adrenal glands and by prostate cancer cells themselves, and this low level is sufficient to fuel the growth of castrate-resistant prostate cancers.
Enzalutamide is among several hormone therapies that have been developed to prevent the androgen-fueled growth of castrate-resistant prostate cancers. This drug works by keeping androgens from binding to the androgen receptors on prostate cancer cells.
The Study
Men in the trial were randomly assigned to receive 160 mg of enzalutamide or a placebo taken orally once daily.
Results
- Posted:June 27, 2014
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Outlook For Advanced Prostate Cancer
Even though a cure for advanced prostate cancer doesnt exist today, significant research regarding treatment is constantly occurring as scientists study how combined therapies may improve prognosis, how to identify cancers that are resistant to certain treatments, and how new technologies such as artificial intelligence can provide better information about prostate cancer cells.
Metastatic Prostate Cancer Treatment
If youve been diagnosed with prostate cancer and youre concerned about prostate cancer metastasis, talk with your doctor about your risk of prostate cancer metastasis and your treatment options.
Treatments for metastatic prostate cancer may depend on where in the body the disease has spread. Options include:
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Treatment By Stage Of Prostate Cancer
Different treatments may be recommended for each stage of prostate cancer. Your doctor will work with you to develop a specific treatment plan based on the cancers stage and other factors. Detailed descriptions of each type of treatment are provided earlier on this same page. Clinical trials may also be a treatment option for each stage.
Early-stage prostate cancer
Early-stage prostate cancer usually grows very slowly and may take years to cause any symptoms or other health problems, if it ever does at all. As a result, active surveillance or watchful waiting may be recommended. Radiation therapy or surgery may also be suggested, as well as treatment in clinical trials. For those with a higher Gleason score, the cancer may be faster growing, so radical prostatectomy and radiation therapy are often recommended. Your doctor will consider your age and general health before recommending a treatment plan.
ASCO, the American Urological Association, American Society of Radiation Oncology, and the Society of Urologic Oncology recommend that patients with high-risk early-stage prostate cancer that has not spread to other areas of the body should receive radical prostatectomy or radiation therapy with hormonal therapy as standard treatment options.
Locally advanced prostate cancer
Watchful waiting may be considered for older adults who are not expected to live for a long time and whose cancer is not causing symptoms or for those who have another, more serious illness.
Treatment For Advanced Prostate Cancer
Although advanced prostate cancer cannot be cured, it can be controlled with treatment, sometimes for several years. Treatments can also help relieve symptoms and improve your quality of life.
A multidisciplinary team will meet to discuss the best possible treatment for you. This will depend on different factors, like your general health. Your cancer doctor will talk to you about the advantages and disadvantages of these treatments.
The main treatments are:
- Hormonal therapy
Hormonal therapies reduce the amount of testosterone in the body. This may slow the growth of the cancer or stop it growing for a while.
- Chemotherapy
Chemotherapy uses anti-cancer drugs to destroy cancer cells. You may have it with hormonal therapy when you are first diagnosed with advanced prostate cancer. Or, it can be given when hormonal therapy is no longer controlling the cancer.
- Radiotherapy
Radiotherapy is most often used to shrink cancer that has spread to the bones. External beam radiotherapy uses high energy rays to destroy cancer cells. Its given using a large machine. Radioisotope therapy is a type of internal radiotherapy given as an injection.
- Surgery
Surgery to remove the prostate is not suitable for advanced prostate cancer. Surgery may be used to help control symptoms or to help stabilise a bone that is at risk of breaking.
Your doctor or nurse will usually ask you to sign a form giving your permission for them to give you the treatment. They cannot give treatment without your consent.
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Metastatic Prostate Cancer Symptoms
With metastatic prostate cancer, you may notice different symptoms than those generally associated with other stages of the disease. Some of the most frequently occurring symptoms include:
- Bone pain, particularly in the pelvis, ribs, skull and spine
- Unexplained weight loss
- General feeling of being unwell
- Changes in urinary habits, such as needing to go more often
- Cough, breathlessness or other changes involving your lungs and chest
Not everyone with metastatic prostate cancer will experience each of these symptoms, but you should speak with your care team if you notice any such changes.
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Where Does Prostate Cancer Spread
The most common place for prostate cancer to spread to is the bones. It can also spread to the:
A large tumour in the prostate gland can spread into or press on areas around the prostate, such as the back passage or urethra. The urethra is the tube which carries urine from the bladder to the outside of the body.
What Tests Will I Have
You may have tests to find out how far the cancer has spread. If you are generally not very well it may not be necessary to do extra tests. Your doctor will still be able to recommend treatment. Some of these tests can also be used to check how you are responding to treatment.
You may have some or all of the following tests:
PSA blood test
Prostate specific antigen is a protein that can rise due to disease in your prostate gland. A sample is taken from your blood and measured. A PSA test can also show how well your cancer is responding to treatment.
Biopsy
A biopsy is where a sample of your prostate tissue is taken and examined under a microscope. It isnt common to have a biopsy with metastatic prostate cancer, but if this is your first prostate cancer diagnosis it may be necessary. Treatment can still start without a biopsy.
Bone scan
Metastatic prostate cancer often spreads to the bones. Bone scans can find cancer spots before they show up on an ordinary X-ray. For this test, a tiny amount of radioactive liquid is put into a vein, usually in your arm. After the injection you will have to wait up to 3 hours. A scan is then taken of all the bones in your body. Abnormal bone takes up more radioactive liquid than normal bone. These areas will show up on the scan and are known as ‘hot spots’. The scan can also show bone changes like arthritis.
Read more about cancer tests.
These tests will help your doctor to decide on the best treatment for you.
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