General Statement On Bone Metastases
Bone metastasis is a devastating condition that has wide-ranging negative impacts on the lives of patients with advanced cancer . To date, no large-scale etiological studies on the prevalence or incidence of bone metastasis have been conducted worldwide . However, the current 5-year survival rate for prostate cancer is> 95% across numerous countries , and an increase in survival time may increase the incidence of bone metastasis.
Irrespective of the primary malignant location, bone metastases are commonly found in the spine, pelvis, shoulder, and distal femur . These bone lesions can cause serious complications, such as spinal cord and nerve root compression, pathological fracture, and hypercalcemia . Bone metastases most commonly affect the axial skeleton. In adults, the axial skeleton contains red marrow, which suggests that the properties of the circulation, cells and extracellular matrix within this region assist in the formation of bone metastasis . Batson showed that venous blood from the breast and pelvis flowed not only into the vena cava but also into the vertebral venous plexus, which extends from the pelvis to throughout the epidural and peri-vertebral veins . Blood drainage to the skeleton via the vertebral venous plexus may, at least in part, explain the tendency of breast and prostate cancers to produce metastases in the axial skeleton and limb girdles .
Fig. 1
Batsons venous plexus. Cited from Diseases of the Spine and Spinal Cord
Fig. 2
What Is Advanced Prostate Cancer
Advanced prostate cancer is cancer that has spread from the prostate to other parts of the body. It develops when prostate cancer cells move through the blood stream or lymphatic system.
Watch our video about advanced prostate cancer.
You might hear cancer that has spread described as metastatic prostate cancer, secondary prostate cancer, secondaries, metastases or mets. It is still prostate cancer, wherever it is in the body.
Prostate cancer can spread to any part of the body, but most commonly to the bones and lymph nodes. Lymph nodes are part of your lymphatic system, which is part of the bodys immune system. Lymph nodes are found throughout the body including in the pelvic area, near the prostate.
Advanced prostate cancer can cause symptoms, such as fatigue , bone pain, and problems urinating.
The symptoms you have will depend on where the cancer has spread to. Speak to your doctor or nurse if you have any symptoms. There are treatments available to help manage them.
Its not possible to cure advanced prostate cancer. But treatments can help keep it under control and manage any symptoms.
What Is Metastatic Prostate Cancer
If your prostate cancer spreads to other parts of your body, your doctor may tell you that it’s “metastatic” or that your cancer has “metastasized.”
Most often, prostate cancer spreads to the bones or lymph nodes. It’s also common for it to spread to the liver or lungs. It’s rare for it to move to other organs, such as the brain, but that can happen.
It’s still prostate cancer, even when it spreads. For example, metastatic prostate cancer in a bone in your hip is not bone cancer. It has the same prostate cancer cells the original tumor had.
Metastatic prostate cancer is an advanced form of cancer. There’s no cure, but you take steps to treat and control it. Most men with advanced prostate cancer live a normal life for many years.
The goals of treatment are to:
- Manage symptoms
- Slow the rate your cancer grows
- Shrink the tumor
Some cancers are called “locally advanced.” That means the cancer has spread from the prostate to nearby tissue. It’s not the same as metastatic cancer since it hasn’t spread to other parts of your body. Many locally advanced prostate cancers can be cured.
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Recommended Imaging Methods And Parameters
In this section, we show the representative imaging methods used in our department.
We used the Siemens Magnetom Prisma scanner.
Multiple matrix coils covered patients from the lower neck to the proximal femur , which also covered the Batsons venous plexus. Excluding the lower leg is controversial. In the trial by Lecouvet et al. , none of the patients had isolated peripheral metastases with WB-MRI, and only the axial-skeleton MRI in prostate cancer was missed.
Fig. 5
Multichannel coil: 20-channel head coil, 32-channel spine coil, and two or three 18-channel body-array coils were combined to cover the area of Batsons venous plexus, which is an area with a predilection for bone metastases
The main examples of pulse sequences and case are as follows:
Table 1 Total Spine sagittal sequences
Total spine sagittal sequences
T1-weighted imaging and short T1 inversion recovery consist of three stations .
Body coronal sequences
Dixons method consists of three stations .
Axial diffusion-weighted sequences
Axial diffusion sequences are obtained with b value of 1000 and 0, and the ADC map consists of four or five stations .
The total examination time, including the positioning of the patient, is approximately 23 min.
After image acquisition, image processing is performed.
A Genetic Biomarker Test For Newly Diagnosed Prostate Cancer
Results from a study of a different genetic biomarker test suggest that it could one day help inform treatment decisions for men newly diagnosed with localized prostate cancer.
According to findings published February 24 in JCO Precision Oncology, a biomarker test called the Oncotype DX Genomic Prostate Score accurately predicted the long-term risk of metastasis and death from prostate cancer in men with localized disease. The test needs to be validated in larger forward-looking studies before it can be used to guide treatment, the study researchers noted.
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Presentations Of Some Typical Cases Of Bone Metastases In Prostate Cancer
WB-MRI is useful not only for diagnosing the distribution and spread of bone metastases, but also for monitoring the therapeutic effect.
In this section, we presented several cases that compare CT findings.
1. Primary osteoblastic metastases .
In general, osteoblastic-type metastases are frequently observed in prostate cancer in the initial stage. In this case, osteosclerotic change is evident on CT images and appears as low intensity on T1WI images and high intensity on DWI images.
2. Primary mixed-type metastases/inter-trabecular metastases .
Other types, such as osteolytic and inter-trabecular types, are also detectable.
In this case, CT images do not show the abnormal findings, such as bone formation or destruction, and DWI of MRI show high signal intensity.
3. Primary unknown osteoblastic metastases histologically confirmed as prostate cancer .
During routine clinical experiences, we often encounter cases of osteoblastic metastases in men with an unknown primary site of origin, and prostate cancer is confirmed following initial radiological examinations. In such cases, multiple high-intensity areas are noted in WB-DWI images, and these are diagnosed as multiple bone metastases. In addition, the prostate gland is carefully observed on axial and coronal reconstructed DWI images. Predicting the primary site before assessing for high serum PSA levels is sometimes possible.
4. Therapeutic effect of bone metastases .
Fig. 8
DWI enables precise evaluation of such lesions.
The Role Of The Pharmacist
An important aspect of the ordering process of denosumab for patients with bone metastases is the distinction between brand names that are used for different indications. Denosumab is sold under two brand names, Prolia and Xgeva. Xgeva is FDA approved for the treatment of hypercalcemia of malignancy as well as bone metastases.16,22 In addition, zoledronic acid is available under two brand names, Reclast and Zometa, which carry different indications.9,23 For the treatment of metastatic bone disease, Zometa carries the FDA approval and should be the only formulation ordered for this indication.9 Zoledronic acid dosing adjustments must be distinguished between oncologic indications. For bone metastases, there are strict adjustments for renal function due to the concern for accumulation with repeated dosing.9 In contrast, dose adjustments are not required for hypercalcemia of malignancy that can be observed in patients with metastatic PCa as well.9 Close attention should be paid to the differences in dosing and indication for these products to ensure that the indication is clarified and in accordance with the selected product for a given patient. In addition, the cost of denosumab is substantiallyhigher than that of zoledronic acid.
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Survival Rates And Outlook
There is currently no cure for advanced prostate cancer, but advances in treatments are extending life expectancy and improving quality of life.
The ACS states that the 5-year relative survival rate for individuals with prostate cancer that has spread to distant lymph nodes, organs, or the bones is 31% . Therefore, people with this stage of prostate cancer are about 31% as likely as those without the condition to live for at least 5 years after diagnosis.
However, survival rates are only estimates, and everyone is different. The following factors are among those that can affect a personâs outlook:
- how cancer responds to treatment
- how far cancer has spread
Ongoing cancer research is also facilitating the development of more effective treatments and leading to improved survival rates.
Here are some answers to questions people often ask about prostate cancer moving to the bones.
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:
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Bone Scans In Diagnosis Of Prostate Cancer
A bone scan uses tiny amounts of radioactive materials called tracers that are injected into the patient. These tracers accumulate in certain organs and tissues, such as bones, and give off a type of radiation called gamma radiation. The gamma rays can be seen by using a special camera, which produces images that can be interpreted by radiologists or by specialists in nuclear medicine.
A clever way to think about a bone scan is that it is the complete opposite of a X-ray examination. In an X-ray examination the radiation passes into or through your body from an external machine to create an image on film placed on the other side of your body. In a bone scan, the source of the radiation is inside your body and travels to the surface, where a camera detects it.
For patients who are newly diagnosed with prostate cancer, the value of a bone scan is limited. It would be unusal for the doctor to request a bone scan for any patient with a Gleason score of less than 7 and a PSA level of less than 20 ng/mL.
Patients with a Gleason score of 7 or higher may, however, be candidates for a bone scan, whatever their PSA level. A bone scan may be considered important in any patient with a Gleason score of 7 or higher who appears to be at high risk of bony metastatic disease. A bone scan is also indicated for any patient with prostate cancer who has symptoms suggesting bony metastases.
Content on this page last reviewed and updated April 26, 2008.
Developmental History Of Wb
Reports comparing BS with MRI for the detection of bone metastases have been available since the last century . However, our research has indicated that the oldest reports that included the term whole-body MRI date back to 1997 . Since the beginning in the twenty-first century, various devices have been developed to enable a whole-body scan in a single session without the need to change the directions of the body, which include multichannel coil and table-top extenders .
In 2004, Takahara et al. used DWI with background body signal suppression . Until the development of this method, DWI was predominantly used for investigations of the central nervous system, especially in cases of acute stroke . However, several researchers have reported that various malignancies in the body show similar high signal intensities .
To date, many therapeutic agents have been developed , such as radium-223 dichloride for castration-resistant prostate cancer , which has a high occurrence of bone metastases . With the increase in the number of treatment options and improvements in patient survival, the use of WB-MRI for providing accurate diagnosis and therapy monitoring has become crucial.
Since the mid-2010s, research has focused on the standardization and therapy monitoring of WB-MRI .
Fig. 4
MET-RADS-P template . The MET-RADS-P template form allocates the presence of unequivocally identified disease to 14 predefined regions of the body
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How Long Does It Take For Prostate Cancer To Metastasize To Bone
prostate cancerspreadspread to bonesbones
The cancer cells spread to the bones by breaking away from the prostate gland and escaping attack from your immune system as they travel to your bones. These cancer cells then grow new tumors in your bones. Cancer can spread to any bone in the body, but the spine is most often affected.
Also, what is the treatment for prostate cancer that has spread to the bones? Men with prostate cancer that has spread to the bones may consider treatment that infuses a radioactive substance into a vein. Strontium-89 , samarium-153 and radium-223 are medications that target fast-growing cancer cells in the bones, and may help relieve bone pain.
One may also ask, how do you know if prostate cancer has spread?
Prostate cancer that has spread to the liver, intestines, or bones of the abdomen and pelvis can usually be found with a CT scan. Cancer which has spread to the lymph nodes can sometimes be detected if the lymph nodes have become enlarged.
What is the prognosis for prostate cancer that has spread to the bones?
There is currently no cure for advanced prostate cancer, but advances in treatments are extending life expectancy and improving quality of life. The ACS state that the 5-year relative survival rate for individuals with prostate cancer that has spread to distant lymph nodes, organs, or the bones is 29 percent.
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The Impact Of Prostate Cancer
Next to skin cancer, prostate cancer is the most common type of cancer among American men. The cancer usually grows very slowly, however, and most men who are diagnosed with prostate cancer live for many years. Still, prostate cancer can be serious and, in some cases, life threatening.
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How Do Doctors Find Metastatic Prostate Cancer
When you are diagnosed with prostate cancer, your doctor will order tests such as:
These tests may focus on your skeleton and in your belly and pelvic areas. That way doctors can check for signs that the cancer has spread.
If you have symptoms such as bone pain and broken bones for no reason, your doctor may order a bone scan. It can show if you have signs of cancer spreading to your bones.
Your doctor will also ask for blood tests, including a check of PSA levels, to look for other signs that the cancer is spreading.
PSA is a protein made by the prostate gland. A rise in PSA is one of the first signs your cancer may be growing. But PSA levels can also be high without there being cancer, such as if you have an enlarged prostate, a prostate infection, trauma to the perineum, or sexual activity.
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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Managing Symptoms Of Advanced Prostate Cancer
Symptoms can often be improved by treating the cancer, but there are other ways to control symptoms. Tell your doctor or specialist nurse if you have new symptoms or symptoms get worse.
You may see a doctor or nurse who specialises in pain and symptom control. They are sometimes called palliative care specialists.
Some people find complementary therapies such as relaxation, gentle massage, or aromatherapy help you feel better and more in control.