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Prostate Cancer Metastasis To Bone Prognosis

Managing Bone Pain And Weakness

Bone Metastasis At Diagnosis Predicts Early Prostate Cancer Mortality

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.

Survival Of Psa And Bsi Progression

Relationships between time to PSA progression and BSI tertiles were evaluated . The prognosis was significantly worse in the mHSPC group with a higher BSI , but did not differ in the mCRPC group. Survival until the start of BSI progression was worse among patients in the higher BSI tertiles for mHSPC, but did not significantly differ in the mCRPC group.

Progressionfree survival of PSA and BSI in mHSPC and mCRPC tertiles based on BSI.

Bone Metastases: When Cancer Spreads To The Bones

Cancer that has started in one place can spread to and invade other parts of the body. This spread is called metastasis. If a tumor spreads to the bone, its called bone metastasis.

Cancer cells that have spread to the bone can damage the bone and cause symptoms. Different treatments can be used to control the symptoms and the spread of bone metastases. To better understand what happens in metastasis, it helps to understand more about the bones.

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Bone Metastases And Mortality In Prostate Cancer Can We Be Doing More

Variable Migratory Pathways of Bone Metastases.Bone metastases are associated with higher mortality.Impact of Bone Metastases on Quality of Life

  • Difficulty sleeping as a result of pain: 42%
  • Difficulty performing normal activities: 40%
  • Anxiety or distress as a result of pain: 40%
  • Vomiting: 25%18
  • Loss of appetite18

Economic Burden of Bone MetastasesIs Earlier Detection of Bone Metastatic Disease of Value?Use of ALP and PSA to Predict Risk of Bone Metastatic Disease

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How Will My Cancer Be Monitored

Bone Metastases from Prostate Cancer: Radiotherapy

Your doctor will talk to you about how often you should have check-ups. At some hospitals, you may not have many appointments at the hospital itself. Instead, you may talk to your doctor or nurse over the telephone. You might hear this called self-management.

You will have regular PSA tests. This is often a useful way to check how well your treatment is working. Youll also have regular blood tests to see whether your cancer is affecting other parts of your body, such as your liver, kidneys or bones.

You might have more scans to see how your cancer is responding to treatment and whether your cancer is spreading.

Your doctor or nurse will also ask you how youre feeling and if you have any symptoms, such as pain or tiredness. This will help them understand how youre responding to treatment and how to manage any symptoms. Let them know if you have any side effects from your treatment. There are usually ways to manage these.

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What Is My Outlook

If youre diagnosed with advanced prostate cancer, you may want to know how well your treatment is likely to control your cancer and for how long it will control it. This is sometimes called your outlook or prognosis. But not all men will want to know this.

While it isnt possible to cure advanced prostate cancer, treatments can help keep it under control, often for several years. Treatments will also help manage any symptoms, such as pain.

No one can tell you exactly what your outlook will be, as it will depend on many things such as where the cancer has spread to, how quickly it has spread, and how well you respond to treatment. Some men may not respond well to one treatment, but may respond better to another. And when your first treatment stops working, there are other treatments available to help keep the cancer under control for longer. Speak to your doctor about your own situation and any questions or concerns you have.

Bsi Versus Number Of Hot Spots

The average BSI and number of hot spots were comparable between the mHSPC and mCRPC groups . The number of hot spots linearly correlated with BSI however, the correlation between PSA level and BSI was relatively weak . The BSI flare phenomenon occurred in 12% and 28% of the patients with mHSPC and mCRPC, respectively .

Linear regression line and confidence ranges of hot spots, PSA and BSI. HSN and BSI , and PSA versus BSI .

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What Are Bone Metastases

Bone metastases are not the same as cancer that starts in the bone. Cancer that starts in the bone is called primary bone cancer. There are different types of primary bone cancers, like osteosarcoma and Ewing sarcoma.

A tumor that has metastasized to bone is not made of bone cells. Bone metastases are made up of abnormal cancer cells that started from the original tumor site. For instance, lung cancer that spreads to the bone is made of lung cancer cells. In this case, the bone metastasis would be called metastatic lung cancer. In adults, metastatic bone cancer is much more common than primary bone cancer.

Cancer cells that spread to the bone often affect these places:

Cancer cells that spread from tumors in other parts of the body can form two main types of bone tumors:

  • The tumor may eat away areas of bone. This creates holes called osteolytic lesions. They can make bones fragile and weak. So the bones can break or fracture easily. These areas may be painful.

  • The tumor may cause the bone to form and build up abnormally. These areas of new bone are called osteosclerotic or osteoblastic lesions. Theyre hard, but theyre weak and unstable. They may break or collapse. They can also be painful.

Although The Percentage Of Cases In Men Is Much Lower Than In Women Male Breast Cancer Accounts For A Por

Prostate Cancer and Bone Metastasis

Hearing the doctor tell you that youve got cancer is undoubtedly one of the worst things you may experience. One in seven men in the united states will receive a prostate cancer diagnosis during his lifetime. Although the percentage of cases in men is much lower than in women, male breast cancer accounts for a por. There are a number of different treatments doctors recommend. Although it is the most commonly diagnosed cancer in american women, breast cancer can impact people of all genders. Here are 10 more facts about prostate cancer. Understanding liver cancer is important if you want to develop an effective treatment plan and live a long and healthy life. Of course, your specialist is the main person whose advice you should follow but it doesnt do anyone harm. Breast cancer is the second most common cancer found in women after skin cancer but that doesnt mean men arent at risk as well. The hormones that your thyroid gland produces help regulate several of your bodily functions. Although screenings for prostate cancer are one tool for early detecti. To detect the spread of cancer to the bones It may grow slowly and its typically treatable.

But hearing the words can still be scary. When malignant cancer cells form and grow within a persons breast tissue, breast cancer occurs. The hormones that your thyroid gland produces help regulate several of your bodily functions.

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Where Do These Numbers Come From

The American Cancer Society relies on information from the SEER database, maintained by the National Cancer Institute , to provide survival statistics for different types of cancer.

The SEER database tracks 5-year relative survival rates for prostate cancer in the United States, based on how far the cancer has spread. The SEER database, however, does not group cancers by AJCC TNM stages . Instead it groups cancers into localized, regional, and distant stages.

  • Localized: There is no sign that the cancer has spread outside the prostate.
  • Regional: The cancer has spread outside the prostate to nearby structures or lymph nodes.
  • Distant: The cancer has spread to parts of the body farther from the prostate, such as the lungs, liver, or bones.

Surgically Removing The Prostate Gland

A radical prostatectomy is the surgical removal of your prostate gland. This treatment is an option for curing prostate cancer that has not spread beyond the prostate or has not spread very far.

Like any operation, this surgery carries some risks, such as urinary incontinence and erectile dysfunction.

In extremely rare cases, problems arising after surgery can be fatal.

Its possible that prostate cancer can come back again after treatment. Your doctor should be able to explain the risk of your cancer coming back after treatment, based on things like your PSA level and the stage of your cancer.

Studies have shown that radiotherapy after prostate removal surgery may increase the chances of a cure, although research is still being carried out into when it should be used after surgery.

You may want to ask your doctors about storing a sperm sample before the operation so it can be used later for in vitro fertilisation .

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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.

Environment For Image Interpretation

Metastatic Prostate Cancer to Bone

The size of the imaging data is enormous therefore, the environment for image interpretation is important. In our department, two 324.9×432.2 mm monitors are used for viewing all station-combined sagittal and coronal direction images simultaneously. Three image planes should always be shown, equipped with a reference line .

Fig. 6

Imaging layout. This image was captured using WB-MRI by the radiologists and comprised two monitors. On the left side of the monitor, the sagittal T1W images and STIR images are displayed by longitudinal two partings, and on the right side of the monitor, the coronal in-phase T1W images, coronal reconstructed DW images, axial b=0, and axial b=1000 images were displayed by four partings. For all image planes, reference lines were used to detect the precise level of the regions

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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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Prostate Cancer Is Common With Aging

After skin cancer, prostate cancer is the most common cancer in men. About 1 in 7 men will be diagnosed with prostate cancer in their lifetime. And these are just the men who are diagnosed. Among very elderly men dying of other causes, a surprising two-thirds may have prostate cancer that was never diagnosed.

Only 1 in 36 men, though, actually dies from prostate cancer. That’s because most prostate cancers are diagnosed in older men in whom the disease is more likely to be slow-growing and non-aggressive. The majority of these men eventually pass away from heart disease, stroke, or other causes — not their prostate cancer.

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Staging And Grading Of Advanced Prostate Cancer

The stage of a cancer describes its size and how far it has spread, based on your test results. Doctors often use the TNM staging system or a number staging system.

A doctor decides the grade by how the cancer cells look under the microscope. This gives an idea of how quickly the cancer might grow or spread. You and your doctors can then talk about the best treatment choices for you.

Stage Iv Prostate Cancer Prognosis

Prostate Cancer Osteoblastic Bone Metastases

Prostate cancers detected at the distant stage have an average five-year survival rate of 28 percent, which is much lower than local and regional cancers of the prostate. This average survival rate represents stage IV prostate cancers that have metastasized beyond nearby areas to lymph nodes, organs or bones in other parts of the body.

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Should I Make Any Lifestyle Changes Including In My Diet Or Physical Activity

Achieving and maintaining a healthy weight by eating a balanced diet with plenty of fruits, vegetables, and whole grains, and staying physically active, can help your overall health. These lifestyle changes can also have a positive effect for men with bone metastases, Tagawa says. Both diet and exercise, he says, are things that are under a mans direct control.

A healthy lifestyle can help you better manage side effects from treatment as well. Try setting small but realistic goals for yourself when it comes to eating a healthy diet and getting plenty of exercise.

While no single food is likely to have a benefit for prostate cancer, smart food choices may help you feel better day to day. Start by cutting out foods high in sugar, saturated fat, and added flavorings and preservatives.

If youre not sure which healthy foods to choose, ask your doctor for a referral to a dietitian. This specialist can help you develop a meal plan that includes foods that offer the best chance of slowing the cancers growth and keeping you as healthy as possible.

As an oncologist, Tagawa says he concentrates on treating the cancer itself, but hes aware that many of the men he sees with advanced prostate cancer are older and more likely than younger men to have health problems that can benefit from diet and exercise.

And if youre on hormone therapy, talk to your doctor about investing in some weights or elastic resistance bands to support your bone strength too.

Treatments To Help Manage Symptoms

Advanced prostate cancer can cause symptoms, such as bone pain. Speak to your doctor or nurse if you have symptoms there are treatments available to help manage them. The treatments above may help to delay or relieve some symptoms. There are also specific treatments to help manage symptoms you may hear these called palliative treatments. They include:

This is the team of health professionals involved in your care. It is likely to include:

  • a specialist nurse

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Death Predicted By Proportional Hazard Analysis

Allcause death among patients in the mHSPC group was assessed by univariate proportional hazards analysis . Among the variables, BAP, 1CTP, CRP, hemoglobin, BSI and number of hot spots were significantly associated with death. However, multivariate proportional hazards analysis selected only the number of hot spots in the mHSPC group when adjusted for other variables. The same variables were associated with death among patients with mCRPC , whereas multivariate proportional hazards analysis found that none of the variables were significant, and CRP was borderline significant . When the contribution of PSA and the BSI to allcause death was compared, BSI was more significant than PSA in the mHSPC group, but neither was significant in the mCRPC group .

Pharmacologic Agents In Prostate Cancer

Comparative survival curves of patients with bone metastatic prostate ...

Gonadotropin-releasing hormone analogues suppress ovarian and testicular steroidogenesis by decreasing luteinizing hormone and follicle stimulating hormone levels, whereas GnRH antagonists lower serum testosterone levels by suppressing LH and FSH.

Bisphosphonates are analogues of pyrophosphate that act by binding to hydroxyapatite in bone matrix, thereby inhibiting the dissolution of crystals. These agents prevent osteoclast attachment to the bone matrix and osteoclast recruitment and viability.

Antiandrogens are used as combination agents to treat prostate cancer. Antifungal agents produce a response similar to that of antiandrogens. These drugs inhibit various cytochrome P-450 enzymes, including 11-beta-hydroxylase and 17-alpha-hydroxylase, which in turn inhibit steroid synthesis. The antiandrogen abiraterone is a 17 alpha-hydroxylase/C17, 20-lyase inhibitor that was approved by the US Food and Drug Administration in 2011 for use in combination with prednisone for treatment of metastatic castration-resistant prostate cancer in patients who received prior chemotherapy containing docetaxel.

An ultramicronized abiraterone tablet was approved in May 2018 for CRPC in combination with methylprednisolone. The ultramicronized formulation may be administered with or without food, whereas, the original tablet formulation must be administered 1 hour before or 2 hours after meals.

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Survival By Disease Recurrence

If a man develops an elevated PSA level after cancer surgery, then the disease is viewed as recurrent.

The number of lymph nodes at the time of prostatectomy can influence the risk of recurrence. One study suggests the removal of a large number of nodes is associated with an improvement in odds of recurrence, but this doesnt appear to impact overall survival.

But disease recurrence doesnt always influence survival times. If a recurrence does occur, the 15-year survival rate at the time of diagnosis may be as high as 94% in those with low-risk recurrence.

The main factors influencing survival rates are:

  • The Gleason score
  • The PSA doubling time
  • Whether the recurrence occurred within three years or after three years

A recurrence that occurs within three years reduces survival rates by anywhere from 15 to 20%and even more, if the doubling time is short.

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