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Prostate Cancer Metastasis To Spine

Quality Assessment Of Included Studies

Metastatic prostate cancer in the spine bones

Two reviewers performed the process of quality assessment independently using the Newcastle-Ottawa Scale . This scale employs a 9 stars system that assesses three domains: patient selection, comparability of study groups and ascertainment of study outcome. Studies with a score of less than 6 indicates a high chance of bias.

Quantitative data analysis

As the prognostic effects of the factors were represented with hazard ratio and 95% confidence interval in the primary studies, meta-analysis was performed using HR as effect size. In case with significant heterogeneity , random-effect model would be employed, while fixed-effect model was selected when no significant heterogeneity exists . Z test was used to test the significance of the pooled effect size.

When five or more studies were included in a quantitative analysis, sensitivity analysis and publication bias test would be conducted .

The statistical procedures were conducted through software of Stata version 15.0 . The statistical significance was defined at a two-sided p value of less than 0.05.

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.

Bone Metastases In Patients With Metastatic Crpc

In approximately 80% of PCa patients bone metastases represent the initial and main metastatic site and are an important prognostic factor . About half of PCa patients with untreated bone metastases will experience at least one SRE over the period of 2 years .

The knowledge of the mechanisms underlying the development of bone metastases and the correlation between bone and cancer cells is of special importance with regard to the different therapeutic options for the management and prevention of SREs. Bone metastases in PCa are frequently osteoblastic, however an osteolytic element has also been confirmed in various reports , and the majority of lesions tend to be heterogeneous .

In clinical trials of bone-modifying agents for the treatment of bone metastases, the incidence of SREs was used as a composite primary endpoint , and they are recognized by the US Food and Drug Administration as a suitable endpoint to assess the efficacy of agents for the treatment of bone metastases in patients with cancer .

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Can I Survive Advanced Prostate Cancer Whats The Prognosis

Prostate cancer is the second leading cause of death from cancer in men, according to the National Cancer Institute. While theres no cure, men can live with it for years if they get the right treatment. Each man with advanced prostate cancer is different, of course. You and your cancer have unique qualities that your doctor takes into consideration when planning the best treatment strategy for you.

According to Harvard Medical School, the prognosis for men with advanced prostate cancer is improving because of newer medications that help them get past a resistance to androgen-deprivation therapy that typically develops after a few years of treatment. With these medications, many men are living longer, and a number of men diagnosed with advanced prostate cancer are dying with the cancer, not from it.

Promptly treating prostate cancer bone metastases with the newest medication can help change a mans prognosis dramatically, Tagawa says. There are men who do well for decades, he says. Some men can even stop treatment, go on to live many years, and actually die of something unrelated.

Tagawa says that cancer specialists who use sophisticated imaging technologies, like positron-emission tomography scans, have gotten very good at finding even tiny bone metastases, which is valuable in diagnosing and removing early stage metastases.

Study Searching And Selecting

Science Source

The flowchart of the study searching and selecting is shown in Fig. . A total of 861 records were screened in the initial searching. After excluding of 158 duplicates, 703 titles /abstracts were assessed for potential eligibility. Then, 35 full-text articles were further screened, remaining 12 eligible studies for qualitative synthesis and 10 eligible studies for quantitative meta-analysis finally.

Fig. 1

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What Is Metastatic Spinal Cord Compression

MSCC happens when cancer cells that have spread from the prostate grow in or near to the spine and press on the spinal cord. You might hear it called malignant spinal cord compression or spinal cord compression.

The spinal cord is a long, thin bundle of nerves and other cells. It runs from your brain down through your spine. The nerves carry messages between your brain and all parts of the body. These messages allow you to move and to feel things like heat, cold, touch or pain. They also help control body temperature and how your internal organs work.

Cancer cells pressing on the spinal cord can cause problems with how these messages are carried. This can cause a range of symptoms that can get worse if left untreated. For example, you may be less able to walk and move around.

At its worst, MSCC can cause nerve damage and even paralysis. This could mean you cant walk or use your arms or legs normally. Remember, there are treatments available and getting treatment straight away can lower the risk of this happening, or of it being permanent.

A Potential Method To Prevent Prostate Cancer From Spreading In The Future

Recent studies have detected a transcription factor known as STAT3 as a promoter of prostate cancer metastasis. It has been proposed as a potential target to inhibit metastasis.

A study published in 2021 showed for the first time how a STAT3 inhibitor could obstruct the progression of prostate cancer. In other words, it wont allow prostate cancer to spread to the bone .

However, we should note that the latter is the first study performed in animal models. It should be replicated and tested several times in clinical trials before finding an application in humans.

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Where Does Prostate Cancer Spread

One of the most recent studies involving a nationwide sample of near 75,000 patients considered the answer to this question.

The most common sites of metastasis in advanced prostate cancer included :

  • Local spread: We should first consider local spread, which comes before metastasis. We also call it locally advanced prostate cancer. Local spread is found in the pelvic organs, rectum, and seminal vesicles. Patients with metastasis almost always had local spread before leaving the pelvis.
  • Bone metastasis: This accounts for 85% of metastasis sites. The bone matrix is a very common target organ. It attracts cancer cells as a blood and nutrient-rich area where they can easily thrive.
  • Metastasis in distant lymph nodes: They are lymph nodes located anywhere but the pelvic region. It accounts for 10% of metastasis sites. It is a sign of lymphatic spread instead of blood-borne spread.
  • Liver metastasis: Another 10% of these patients had metastasis in the liver.
  • Metastasis in thoracic organs: This is mainly lung metastasis. It accounts for 9% of metastasis sites in prostate cancer patients.

According to this study, one out of five patients with advanced disease had more than one metastatic site.

Anatomy And Metastasis Of Prostate Cancer

Prostate Cancer and Bone Metastasis

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.

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Data Source And Studies Retrieval

This review was conducted according to the guidelines outlined in Preferred Reporting Items for Systematic Reviews and Meta-analysis statement . Two individual reviewers retrieved the platforms of PubMed, Embase and CENTRAL, from the inception to October 2019. The key words used for searching include spinal metastasis, prostate cancer, overall survival and prognostic factor. In additional, the reference lists of the included studies were screened and potentially related studies were hand-searched for possible inclusion.

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.

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Signs Of Prostate Cancer

Osteoblastic metastases from prostate carcinoma

Early on, you may notice few signs of prostate cancer. Thats because even if a tumor grows within the organ, the prostate doesnt push against anything to create pain, so the cancer may be difficult to detect.

As the disease advances, you may notice difficulty urinating, bloody urine or semen, swelling in the legs or pelvic area, erectile dysfunction or painful ejaculation.

When prostate cancer cells have entered the bloodstream and traveled to the bone, you may notice bone pain, weak bones , spinal cord compression, stiffness, or pain in the hip, thighs or back. You also may have higher levels of calcium in the blood, which occurs as cancer cells replace normal bones. This imbalance can result in vomiting, dehydration and confusion.

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Further Pushing The Limits

It isnt surprising that a higher radiation dose is better, but SBRT technology is what allowed that dose to be delivered safely, said Dr. Buchsbaum. In short, careful patient selection and a higher dose yielded the expected results.

Moving forward, its important that practitioners apply this treatment approach on patients with limited spinal metastases, and not the general population of all patients with spinal metastases, he added.

This isnt for the patient who has pain everywhere , which is unfortunately the majority of patients, agreed Dr. Sahgal. But if you have a defined region of metastatic disease in the spine, and you can pinpoint the pain to that region, that’s going to be who benefits.

His team hopes to test if further pushing the limits of spinal SBRT could help a greater number of patients with limited spinal metastases. They plan to test both 28 Gy in two fractions, and an ultra-high single dose of 24 Gy, to see if either regimen can reduce pain in more patients while maintaining the level of safety seen in the current trial.

They are also designing trials to see if SBRT can eliminate pain from bone metastases in other parts of the body, such as the arms or the ribs, Dr. Sahgal explained.

Theres data that suggests it will, but we need to prove it, he said. If it can, that will change the game overall for patients with bone metastases.

Inclusion And Exclusion Criteria

All retrieved records were screened for final inclusion based on the following inclusion criteria: patients diagnosed as spinal metastasis from PCa studies associated with evaluating the prognostic effect of predict factors of overall survival studies designed as observational clinical study, including cohort studies and case-control studies would be eligible for inclusion. Studies would be excluded based on the following criteria: duplicated studies animal studies, literature review, commentary studies and meta-analyses studies used the same cohort.

Study selection and data extraction

After excluding the duplicates, the remained records were screened with their titles /abstracts according to the inclusion criteria. Then, the potentially related titles /abstracts were further assessed for the final inclusion using their full texts.

Two authors independently extracted the following data from included studies:

  • Study characteristics: lead author, publication year, lead authors country, study design and study period

  • Patients information: numbers of involved patients and patients with MSCC, median age, pre- and post-treatment neurological status, performance status, visceral metastasis, extraspinal bone metastasis, number of involved vertebrae, distribution of involved vertebrae, prostate-specific antigen , Gleason grade of PCa, and hormonal status

  • Outcomes information: overall survival and the associated prognostic factors.

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    Bone Metastases: Symptoms And Relation To Prostate Cancer

    Prostate cancer is one of the most common cancers affecting men, with 1 in 9 men diagnosed with it during their lifetime. Despite its high occurrence, when caught early, prostate cancer often can be treated successfully. Most prostate cancers are a type called adenocarcinomas, which are very slow growingso much so that aggressive treatment of this type of cancer may be unnecessary.

    However, thats not true in all cases. Some prostate cancers, while rarer, grow rapidly and can metastasize or spread to bones, including the hip, spine, pelvis and other organs. The more the cancer spreads, the more challenging it is to treat, and is considered advanced prostate cancer.

    Even if prostate cancer travels to your bones, it is not considered bone cancer. Rather, it is still considered prostate cancer because that was the original location of the disease development.

    Intradural Extramedullary Spinal Cord Metastasis Of The Prostate: A Case Presentation And Review Of The Literature

    Prostate Cancer w/ Bone Metastases

    Published online by Cambridge University Press: 10 May 2016

    Amparo Wolf
    Affiliation:Department of Clinical Neurological Sciences, Division of Neurosurgery, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada.
    Ryan Johnstone
    Affiliation:Department of Clinical Neurological Sciences, Division of Neurosurgery, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada.
    Fawaz Siddiqi
    Affiliation:Department of Clinical Neurological Sciences, Division of Neurosurgery, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada.

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    Can You Prevent Prostate Cancer From Spreading

    The only 100% reliable way to prevent cancer from spreading is by taking it down while it is still localized. Other than that, we can only slow its progression or keep a careful look at it for any alarming sign.

    Some patients treat their prostate cancer with a combination of surgery, radiation therapy, and other treatments.

    Other patients may engage in watchful waiting or active surveillance. It consists of following-up cancer when it has a very low chance of spreading.

    What Symptoms Do I Need To Watch Out For

    MSCC can cause any of the following symptoms.

    • Pain or soreness in your lower, middle or upper back or neck. The pain might be severe or get worse over time. It might get worse when you cough, sneeze, lift or strain, go to the toilet, or lie down. It may wake you at night or stop you from sleeping.
    • A narrow band of pain around your chest or abdomen that can move towards your back, buttocks or legs.
    • Pain that moves down your arms or legs.
    • Weakness or loss of control of your arms or legs, or difficulty standing or walking. You might feel unsteady on your feet or feel as if your legs are giving way. Some people say they feel clumsy.
    • Numbness or tingling in your legs, arms, fingers, toes, buttocks, stomach area or chest that doesnt go away.
    • Problems controlling your bladder or bowel. You might not be able to empty your bladder or bowel, or you might have no control over emptying them.

    These symptoms can also be caused by other conditions, but it’s still important to get medical advice straight away in case you do have MSCC.

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