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Prostate Cancer Spread To Spine

What Is My Risk Of Developing Mscc

What is advanced prostate cancer?

MSCC isnt common, but you need to be aware of the risk if your prostate cancer has spread to your bones or has a high risk of spreading to your bones. Your risk of MSCC is highest if your prostate cancer has already spread to your spine.

Speak to your doctor or nurse for more information about your risk of MSCC.

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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    The Seed And The Soil Hypothesis

    Stephen Paget, more than 100 years ago, observed in women autopsies that, in cancer of breast the bones suffer in a special way . This landmark observation has led to the seed and soil hypothesis that postulates the reciprocal need of the seed and the soil so that metastasis can occur in distant individual organs. The uniqueness of the microenvironment in the individual organs supports or opposes the colonization events that lead to the secondary tumor growth.

    The tumor cells that leave the primary site and enter circulation are defined as circulating tumor cells only a fraction of these cells has the capability to extravasate at a distant site and persist/survive as DTCs. Of these DTCs, an even smaller fraction is capable of forming metastasis .

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    Characteristics Of Bone Metastasis

    The propensity of PCa cells to metastasize to the skeleton, and further progression to other organs, is a principal cause of morbidity and mortality among the male population. Although bone metastases can be initially asymptomatic, their consequences are often detrimental due to the occurrence of skeletal-related events such as fractures, bone pain, and spinal cord compression that markedly reduce the quality of life. While most of the solid tumors, such as breast cancer and melanoma, tend to cause osteolytic lesions with excessive bone resorption, bone lesions resulting from PCa are primarily osteoblastic and associated with uncontrolled low-quality bone formation .

    In summary, despite significant progress into mechanisms of PCa, further analyses need to be addressed in order to unravel the molecular basis of bone metastasis at both early and late stages. This will help to reduce the rate of metastasis formation and eventually develop new molecular targeting strategies for PCa management.

    What Are The Complications Associated With Metastatic Spinal Tumors

    Advanced Prostate Cancer: Signs of Metastatic Disease

    Some metastatic spinal tumors grow large enough to cause spinal cord compression . Spinal cord compression can cause numbness and weakness in your arms and legs. It can also impair body functions including bladder and bowel control. In severe cases, spinal cord compression can cause paralysis.

    In some cases, a spinal tumor weakens the bone so much that it fractures . Other complications of metastatic spinal tumors may include difficulty with balance or walking, and a decreased ability to feel cold, heat and pain.

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    How To Tell If Your Cancer Has Metastasized

    Prostate cancer metastasis may be suspected if you have specific symptoms such as new lower back pain or elevated liver enzymes. These may be signs your cancer has spread to your spine or your liver, respectively. If your prostate-specific antigen levels continue to rise despite treatment, especially if they are rising particularly fast, this may be a sign that cancer is metastasizing somewhere in your body.

    Bone Metastases In The Clinic

    Metastatic PCa remains an important clinical problem given the growing number of men with advanced disease, its impact on the quality of life, and, ultimately, as a cause of mortality. Osteoblastic bone lesions to the axial skeleton are the most common metastasis in men with advanced PCa. Palliative treatment is a priority, with the goals of relieving pain, improving mobility, and preventing complications such as pathologic fractures or epidural cord compression.

    ADT remains the treatment for metastatic PCa, and whereas this reduces the symptoms and tumor growth, recurrence of CRPC is almost certain. Histopathology of end-stage bone metastases acquired at autopsy or a result of surgical resections for spinal cord compressions or pathological fractures has shown that, even within an individual patient, bone metastases are heterogeneous. It is important to note that, although nuclear androgen receptor staining is generally prominent in most cells, non-NE, AR-negative tumor cells are clearly observed in both CRPC and treatment-naïve metastasis . These findings indicate that AR-independent cell survival in the bone microenvironment does occur, and any mechanisms that contribute to such survival are of great interest. Heterogeneity of metastatic disease suggests that second generation, AR-directed therapies such as abiraterone and enzalutamide will most likely need to be conjoined by therapies directed against non-AR pathways and bone-targeting therapies.

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    Treating Prostate Cancer That Doesnt Go Away Or Comes Back After Treatment

    Can Prostate Cancer Metastasis Be Stopped Before It Starts?

    If your prostate-specific antigen blood level shows that your prostate cancer has not been cured or has come back after the initial treatment, further treatment can often still be helpful. Follow-up treatment will depend on where the cancer is thought to be and what treatment youve already had. Imaging tests such as CT, MRI, or bone scans may be done to get a better idea about where the cancer is.

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    The Stages Of Prostate Cancer: What You Need To Know

    After a prostate cancer diagnosis, your oncologist will refer to the stage of your cancer. All cancers are categorized into four distinct stages, each of which identifies the progress of the growth of cancerous cells within clinically defined standards. These stages help doctors determine the most appropriate care for each patient based on his or her condition, and can also provide easy-to-understand context for your diagnosis. Learn more about the stages of prostate cancer, how each stage will affect your treatment plan and the survival rates for each stage, then contact Regional Cancer Care Associates to schedule a consultation.

    What Is Cancer Of The Lymph Nodes

    When cancer originates in the lymph nodes or other areas of the lymphatic system, its referred to as lymphoma.2 The most common types are hodgkins lymphoma and non-hodgkins lymphoma. In rare instances, theres also a chance for the development of lymphoma of the skin. If youre wondering, Is lymphoma hereditary, we cover this question in our latest blog article.

    People with hodgkins lymphoma usually experience enlarged lymph nodes with a small number of Reed-Sternberg cells present surrounded by normal immune cells. With classic hodgkins lymphoma, which accounts for 9 out of 10 cases of this type of cancer, there are four subtypes that may develop.3 These are:

    • Nodular sclerosis hodgkins lymphoma is the most common and tends to start in the lymph nodes in the neck or chest. Though it is more prevalent in teens and young adults, it can develop at any age.
    • Mixed cellularity hodgkins lymphoma is the second most common subtype and occurs mainly in the lymph nodes found in the upper half of the body. Its mostly detected in people with HIV infection and affects mostly children and the elderly.
    • Lymphocyte-rich hodgkins lymphoma is a rarer subtype and usually occurs in the upper half of the body in a few lymph nodes.
    • Lymphocyte-depleted hodgkins lymphoma is the rarest subtype of this type of cancer and occurs mainly in older people with HIV infection. Its mostly found in lymph nodes in the stomach, spleen, liver, and/or bone marrow.

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    Overview Of The Staging System

    After a thorough assessment by your oncologist, your cancer will be assigned a stage between I and IV. Prostate cancer stages are based on the American Joint Committee on Cancer TNM system. Using the TNM system, your oncologist:

    • Examines the tumor
    • Determines if the cancer has spread to any lymph nodes
    • Assesses whether the cancer has metastasized
    • Considers the prostate-specific antigen level from blood testing
    • Assigns a grade group based on how abnormal the cancer appears under a microscope

    With this information in mind, you can better understand how stages are assigned and what they mean for patients in general.

    How Doctors Find Metastatic Prostate Cancer

    Prostate Cancer and Back Pain: Is it a Symptom?

    When you are diagnosed with prostate cancer, your doctor will order tests such as:

    • X-rays
    • MRI scans
    • PET scans

    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 spread in 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 can also cause PSA level to be high.

    If you’ve been treated, especially if a surgeon removed your prostate, your PSA levels should start to go down. Doctors usually wait seve,ral weeks after surgery before checking PSA levels. A rise in PSA after treatment may suggest the possibility cancer is back or spreading. In that case, your doctor may order the same tests used to diagnose the original cancer, including a CT scan, MRI, or bone scan. The radiotracer Axumin could be used along with a PET scan to help detect and localize any recurrent cancer.

    Though very rare, it’s possible to have metastatic prostate cancer without a higher-than-normal PSA level.

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    The Role Of Inflammation

    Acute inflammation is a biological response triggered by harmful stimuli such as infection, trauma, and tissue injury to eliminate the source of damage . The tumor microenvironment is unequivocally linked with inflammation, whether the infiltration of immune cells engages with tumor cells causing inflammation or chronic inflammation promotes the malignant transformation of cells and carcinogenesis .

    In an experiment performed by Morrissey et al., it was found that IL-6 was highly expressed in prostate cancer bone metastases. PC-3 cells inhibited osteoblast activity and induced osteoblast to produce IL-6 that promoted osteoclastogenesis . In addition, a recent study by Roca et al. observed that macrophage-driven efferocytosis induced the expression of pro-inflammatory cytokines, such as C-X-C motif chemokine ligand 5 by activating the signal transducer and activator of transcription 3 and the nuclear factor kappa-light-chain-enhancer of activated B cells signaling. CXCL5-deficient mice had reduced tumor progression. These findings suggested that the myeloid phagocytic clearance of apoptotic cancer cells accelerated CXCL5-mediated inflammation and tumor growth in bone . In summary, findings from available evidence suggest the alleviation of chronic inflammation as a potential therapeutic approach for prostate cancer bone metastases.

    What Screening Tests Are Used For Prostate Cancer

    There are two tests used for prostate cancer screening:

    The American Cancer Society recommends that men make an informed decision on whether or not they should be screened after talking about the risks and benefits of screening with their healthcare provider. Screening is not recommended in men without symptoms of prostate cancer if they have a life expectancy of less than ten years. Men at average risk of developing prostate cancer should begin this conversation at age 50. African American men and men with one relative with prostate cancer should talk with their healthcare provider about screening beginning at age 45. Men at the highest risk, those with more than one first degree relative with prostate cancer at an early age should begin talking about screening at age 40. Repeat screening is based on baseline PSA results, but typically occurs every 1-2 years.

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    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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    Quality Assessment Of Included Studies

    Metastatic Tumors Of The Spine – Everything You Need To Know – Dr. Nabil Ebraheim

    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.

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    Bone Loss From Prostate Cancer Treatment

    Testosterone, the male sex hormone, fuels the growth of prostate cancer but it also is crucial to bone health. Treatment of prostate cancer with hormone therapy, also called androgen deprivation therapy , blocks the production of testosterone which stops or slows the growth of the cancer. Without testosterone, bones can become weak and break more easily. When a man is on ADT recovery from a bone fracture takes longer than for other men. It is especially important for men taking ADT to speak with their physician about how to plan for and manage the bone loss before a problem arises. Bone strength can also be decreased as a result of radiation and chemotherapy used to treat prostate cancer.

    Fortunately there are ways to strengthen and repair your bones including medicines and lifestyle changes.

    • Bisphosphonates can prevent the thinning of the bone and help make them stronger
    • Oral bisphosphonates include Fosamax and Actonel
    • The intravenous bisphosphonate is Zometa
    • Strive for a healthy diet and make sure to get enough calcium and vitamin D
    • When exercising, include weight bearing and muscle strengthening exercises
    • Avoid tobacco and excessive alcohol


    Symptoms Of Advanced Prostate Cancer

    If you are worried about prostate cancer, we have more information about the signs and symptoms.

    Symptoms of prostate cancer may not develop for many years. The symptoms of advanced prostate cancer may be caused by an enlarged prostate. Or symptoms may be a sign of secondary cancer, where the cancer has spread to another part of the body.

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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 doctors appointment to help you ask the right questions.

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