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Prostate Cancer In Bones And Lungs

What Types Of Testing Should I Expect For Monitoring My Condition

Bone Health in Prostate Cancer

Since metastatic prostate cancer isnt curable, your doctor will most likely set up regular visits to check the cancers location, and to manage any long-term side effects from the cancer or any medication youre taking.

And since treatments for advanced prostate cancer are changing so fast and need to be given in a certain sequence to be the most effective, youll probably have not only a prostate cancer doctor but other specialists taking care of you. Your care team should coordinate closely, say the authors of a major study of such teams published in August 2015 in the journal Annals of Oncology.

Along with regularly testing your prostate-specific antigen levels, your care team may request blood tests that measure such prostate cancer indicators as alkaline phosphatase and lactate dehydrogenase. Magnetic resonance imaging or PET scans of the spine or other bones can also help identify how your cancer responds to treatment.

If youve had radiation, youre at an increased risk for bladder and colorectal cancer and should get screened regularly for these as well.

The tests youll have and how often youll need them should be customized to you. Your care team will consider your overall health, medications that are safe for you to take, other health conditions you might have, and what stage your cancer was when you were diagnosed.

How Fast Does Prostate Cancer Spread To The Bones

Early detection can catch prostate cancer even before there are any symptoms. Some types of prostate cancer grow very slowly.

There are four main stages of prostate cancer. Within each stage, the cancer is graded based on factors like the size of tumor, prostate-specific antigen level, and other clinical signs.

If the cancer has spread to the bones, its considered to be the most advanced, or stage 4.

Newer lab tests look at the genes inside cancer cells. This can provide more information on how quickly the prostate cancer may progress.

Theres also a grading system known as the Gleason system, which assigns the cancer into a grade group based on how closely it resembles normal tissue.

During the biopsy to diagnose prostate cancer, the cells are closely examined. The more abnormal cells that are in the biopsy sample, the higher the Gleason score and grade group.

When more abnormal cells are present, the cancer is more likely to spread quickly.

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.

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Types Of Imaging Studies

If your doctor suspects your cancer might be spreading, they will likely order more imaging tests. A common imaging workup may include a bone scan and a CT scan of the abdomen and pelvis. An MRI might be done as well. Some research centers are also using magnetic MRIs or PET scans to further refine the staging of prostate cancer.

Prostate Cancer Doctor Discussion Guide

Get our printable guide for your next doctor’s appointment to help you ask the right questions.

How Prostate Cancer Spreads

Survival Rate For Patients With Prostate Cancer Metastasis ...

Cancer cells sometimes break away from the original tumor and go to a blood or lymph vessel. Once there, they move through your body. The cells stop in capillaries — tiny blood vessels — at some distant location.

The cells then break through the wall of the blood vessel and attach to whatever tissue they find. They multiply and grow new blood vessels to bring nutrients to the new tumor. Prostate cancer prefers to grow in specific areas, such as lymph nodes or in the ribs, pelvic bones, and spine.

Most break-away cancer cells form new tumors. Many others don’t survive in the bloodstream. Some die at the site of the new tissue. Others may lie inactive for years or never become active.

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What Are The Symptoms Of Advanced Prostate Cancer And Bone Metastases

When cancer cells spread to the bones, the condition weakens the very frame on which the body rests. The cells interfere with the strength and hardness of the bones structure, interrupting its normal cycle of building up and dissolving.

Theres no cure for advanced prostate cancer, but theres a lot that doctors can do to help with the symptoms that might develop. This includes managing pain. A common misconception is that if theres cancer in the bone, there must be pain, Tagawa says. Thats not true. Cancer can be in the bone without pain. However, if there is pain, he says, it can be controlled with anticancer therapies and pain medication, and good quality of life can be maintained.

In addition to pain, some men with bone metastases develop a condition called hypercalcemia, in which, because of the damage to bones from the cancer cells, too much calcium builds up in the blood. Hypercalcemia can make you feel constipated, thirsty, sleepy, or sluggish, and it can increase the urge to urinate, according to the ACS. Over time, hypercalcemia can cause muscle and joint achiness, as well as weakness in the muscles. In advanced stages, it can cause the kidneys to shut down.

There are treatments for hypercalcemia as well as for other complications from advanced prostate cancer, such as bones that become weak and break or fracture, and for growths in the spine that can press on the spinal cord and damage nerves.

Treatment Options For Metastatic Prostate Cancer

If you have metastatic prostate cancer, your doctor will recommend hormonal therapy. This is part of a palliative care approach. The treatment will slow the growth of the primary tumour and the metastases, and help to manage the symptoms. Your doctor may also recommend that you have a type of chemotherapy when you start hormone therapy as this has been shown to help men live longer

Another name for hormonal therapy is androgen deprivation therapy . It can be performed surgically or with drug treatment.

In surgical therapy, both testicles are removed in a procedure called bilateral orchiectomy.

Drug therapy to stop the production of androgens is done with LHRH agonists or LHRH antagonists. These drugs are available as depot injections right under the skin or into the muscle. Anti-androgens are drugs that block the action of androgens. They come as a pill. All of these therapies cause castration.

Castration has physical and emotional consequences. The most common are hot flushes, lower sex drive, and erectile dysfunction. The effects of surgical castration are permanent. In chemical castration, some of the symptoms may disappear after the treatment. Do not hesitate to discuss any concerns with your doctor.

If you have bone metastases which cause symptoms while you receive drug treatment, radiation therapy may help to relieve them and prevent fractures.

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Anatomy And Metastasis Of Prostate Cancer

The pudendal nerve innervates the few striated muscles within the prostatic capsule. The parasympathetic nerves emanate from S2 to S4 and form the pelvic nerve. The sympathetic preganglionic nerves, which reside in the thoracolumbar region between T6 and L2, provide the major neural input to the prostate and reach the pelvis through the hypogastric nerve .

Anatomic structures and major veins of the male pelvis.

FIGURE 1.

Anatomic structures and major veins of the male pelvis.

Prostate cancer has been shown to metastasize by following the venous drainage system through the lower paravertebral plexus, or Batson’s plexus.4,9 Although hematogenous spread of other malignancies is most commonly to the lungs and liver, 90 percent of prostatic metastases involve the spine, with the lumbar spine affected three times more often than the cervical spine. Prostate cancer also spreads to the lungs in about 50 percent of patients with metastatic disease, and to the liver in about 25 percent of those with metastases.4

Epidural metastases are the result of contiguous spread from lesions of the calvaria to the meninges. Because of the protective layer of the dura mater, subdural and intra-parenchymal metastases from prostate cancer are rare .

FIGURE 2.

FIGURE 2.

What Is Metastatic Disease

Detecting the signs of lung cancer

Prostatecancer can spread to other organs or lymph nodes outside the pelvic area. This is called metastatic disease. The tumours in other organs or lymph nodes are called metastases. Your doctor may recommend treating metastatic disease with hormonal therapy.

It is important to realise that metastatic disease cannot be cured. Instead, your doctor will try to slow the growth of the tumour and the metastases. This will give you the chance to live longer and have fewer symptoms.

If prostate cancer metastasises, it usually spreads to the bones or the spine. At a later stage, prostate cancer may also spread to the lungs, the liver, distant lymph nodes, and the brain . Most metastases cause a rise in the level of prostate-specific antigen in your blood.

Metastases in the spine can cause symptoms like severe back pain, spontaneous fractures, or nerve or spinal cord compression. They can also be asymptomatic. In rare cases, lung metastases may cause a persistent cough.

Imaging can be used to detect metastases. Bone metastases can be seen on a bone scan. A CT scan may be recommended to get more detailed information about bone metastases, or to detect metastases in the liver, the lungs, or the brain.

This section addresses different types of hormonal therapy, which you should discuss with your doctor.

This is general information, which is not specified to your individual needs. Keep in mind that individual recommendations may depend on your country and health care system.

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Where Prostate Cancer Spreads In The Body Affects Survival Time

Sarah Avery

EMBARGOED FOR RELEASE until 4 p.m. on Monday, March 7, 2016

DURHAM, N.C. — Patients with lymph-only metastasis have the longest overall survival, while those with liver involvement fare worst. Lung and bone metastasis fall in the middle.

Smaller studies had given doctors and patients indications that the site of metastasis in prostate cancer affects survival, but prevalence rates in organ sites were small, so it was difficult to provide good guidance, said Susan Halabi, Ph.D., professor of biostatistics at Duke and lead author of the study published online March 7 in the Journal of Clinical Oncology.

With the large numbers we analyzed in our study, we were able to compare all of these different sites and provide information that could be helpful in conveying prognosis to patients, Halabi said. This information could also be used to help guide treatment approaches using either hormonal therapy or chemotherapy.

Halabi and colleagues from leading U.S. and international cancer research centers pulled data from nine large, phase III clinical trials to analyze outcomes of 8,736 men with metastatic prostate cancer. The patients had all undergone standard treatment with the chemotherapy drug docetaxel.

Site of metastases was categorized into four groups: lung, liver , lymph nodes only, bone with or without lymph nodes and no other organ metastases.

Halabi said more research is needed to understand how and why prostate cancer spreads to different organs.

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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Survival Rate For Patients With Prostate Cancer Metastasis Higher When The Liver Is Not Involved

Given a diagnosis of cancer, most patients immediately ask, “Can it be cured? How much time do I have?” And in a new analysis, Duke Cancer Institute researchers say where prostate cancer metastasizes, or spreads, will directly impact a mans survival time. Patients with metastasis to the lymph alone survive the longest overall, their report indicates. When the liver becomes involved men fare the worst, while those patients who develop a lung or bone metastasis fall in the middle.

“This study is important because of the large number of men that we have analyzed, and confirms that site of metastases is an important factor for survival,” Dr. Susan Halabi, a professor of biostatistics, told Medical Daily in an email.

The prostate is a gland found only in men. It sits beneath the bladder and surrounds the urethra, which is the tube that carries urine and semen through the penis. Usually the size and shape of a walnut, the prostate gland makes semen, the fluid that carries sperm. When a man develops prostate cancer, the website of Prostate Cancer UK explains, some men will show no signs of disease, while others may experience one or some of these symptoms:

  • a need to pee more often, especially at night
  • difficulty starting to urinate
  • straining, or taking a long time to finish
  • a weak flow
  • a feeling that the bladder hasnt emptied properly
  • a need to rush to the toilet, and the occasional leak
  • dribbling urine

Bone Metastasis And Skeletal

Advanced Prostate Cancer: Signs of Metastatic Disease
  • Roles Data curation, Formal analysis, Methodology, Resources, Software

    Affiliation Research Institute, National Health Insurance Service Ilsan Hospital, Goyang, Republic of Korea

  • Roles Conceptualization, Data curation, Investigation, Writing review & editing

    Affiliation Department of internal medicine, Seoul Red Cross Hospital, Seoul, Republic of Korea

  • Kyoung Min Kim,

    Roles Conceptualization, Data curation, Investigation, Writing review & editing

    Affiliation San Francisco Coordinating Center, California Pacific Medical Center Research Institute, San Francisco, CA, United States of America

  • Roles Supervision, Writing review & editing

    Affiliation Centre for Big Data Research in Health, University of New South Wales, Sydney, NSW, Australia

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Where In The Body Does Prostate Cancer Spread

Metastatic prostate cancer can affect one or more parts of your body. The most common place for prostate cancer to spread to is your bones. Prostate cancer may also spread to other parts of the body such as your lymph nodes, your lungs, liver or brain.

The metastatic cancer is made up of prostate cancer cells, even if it is found in other parts of your body. It will be treated with prostate cancer treatments.

Note:

We use the term man / men in our prostate cancer information but we understand that not everyone who has a prostate gland identifies as a man.

It doesnt matter who you are or where you come from, we are here for you. For confidential advice, information and support, contact our Support Line on Freephone 1800 200 700.

What Are Bone Metastases With Prostate Cancer

The ACS describes bone metastases as areas of bone containing cancer cells that have spread from another place in the body. In the case of prostate cancer, the cells have spread beyond the prostate gland. Since the cancer cells originated in the prostate gland, the cancer is referred to as metastatic prostate cancer.

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. Other areas cancer cells commonly travel to, according to the ACS, include the pelvis, upper legs and arms, and the ribs.

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Managing Bone Pain And Weakness

Symptoms like nausea, hot flashes, and pain can usually be relieved with medication. Some people find that complimentary treatments like acupuncture or massage help manage side effects.

Your doctor may also recommend orthopedic surgery to stabilize your bones, relieve pain, and help prevent bone fractures.

Neurologic Complications Of Prostate Cancer

Radiofrequency Ablation for Metastatic Bone Cancer | UCLA Vital Signs

RAMSIS BENJAMIN, M.D., M.P.H., Keck School of Medicine of the University of Southern California, Los Angeles, California

Am Fam Physician. 2002 May 1 65:1834-1841.

This article exemplifies the AAFP 2002 Annual Clinical Focus on cancer: prevention, detection, management, support, and survival.

Neurologic complications continue to pose problems in patients with metastatic prostate cancer. From 15 to 30 percent of metastases are the result of prostate cancer cells traveling through Batson’s plexus to the lumbar spine. Metastatic disease in the lumbar area can cause spinal cord compression. Metastasis to the dura and adjacent parenchyma occurs in 1 to 2 percent of patients with metastatic prostate cancer and is more common in those with tumors that do not respond to hormone-deprivation therapy. Leptomeningeal carcinomatosis, the most frequent form of brain metastasis in prostate cancer, has a grim prognosis. Because neurologic complications of metastatic prostate cancer require prompt treatment, early recognition is important. Physicians should consider metastasis in the differential diagnosis of new-onset low back pain or headache in men more than 50 years of age. Spinal cord compression requires immediate treatment with intravenously administered corticosteroids and pain relievers, as well as prompt referral to an oncologist for further treatment.

More Common Neurologic Complications in Patients with Metastatic Prostate Cancer*

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