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
Faqs About Prostate Cancer That Has Spread To The Bones
Learn what this diagnosis means for your health and your future, and what you can do to feel strong and well supported.
The prostate is a gland the size of a golf ball that sits below the bladder and in front of the rectum. Its responsible for making the fluid that forms semen. Many men develop cancer of the prostate gland its the second most common cancer among men in the United States. There are several stages of prostate cancer the earliest, when the cancer is still limited to the prostate gland itself, is the easiest to treat.
When the cancer has spread, or metastasized, beyond the prostate gland, its considered advanced, according to the American Cancer Society . When it spreads, its common for cancer cells to reach the bones first. Nine out of 10 men with advanced prostate cancer also have it in their bones.
At this advanced stage, the cancer cant be cured, says Scott T. Tagawa, MD, a medical oncologist at Weill Cornell Medicine and New York-Presbyterian Hospital in New York City. But with treatment, many men can live a long time. There are men Ive been treating for advanced prostate cancer for 10 or 20 years.
Arm yourself with the facts about what happens when prostate cancer spreads to the bones and what you can do to help manage it.
Enlarged Prostate Or Prostate Cancer
The prostate can grow larger as men age, sometimes pressing on the bladder or urethra and causing symptoms similar to prostate cancer. This is called benign prostatic hyperplasia . It’s not cancer and can be treated if symptoms become bothersome. A third problem that can cause urinary symptoms is prostatitis. This inflammation or infection may also cause a fever and in many cases is treated with medication.
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Risk Factors You Can Control
Diet seems to play a role in the development of prostate cancer, which is much more common in countries where meat and high-fat dairy are mainstays. The reason for this link is unclear. Dietary fat, particularly animal fat from red meat, may boost male hormone levels. And this may fuel the growth of cancerous prostate cells. A diet too low in fruits and vegetables may also play a role.
Soreness In The Groin
When prostate cancer spreads, its common for cancer cells to go to your lymph nodes and then move to more areas of your body. The lymph nodes are a network of glands that help your body filter fluids and fight infections.
There are several lymph nodes in your groin. These are the ones closest to your prostate, so its common for the cancer to spread to them first. Cancer cells prevent your lymph nodes from draining fluid and working properly. When this happens, your lymph nodes swell. As a result, you might experience pain or soreness in the area.
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What Types Of Testing Should I Expect For Monitoring My Condition
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.
Questions To Ask The Doctor
- What treatment do you think is best for me?
- Whats the goal of this treatment? Do you think it could cure the cancer?
- Will treatment include surgery? If so, who will do the surgery?
- What will the surgery be like?
- Will I need other types of treatment, too?
- Whats the goal of these treatments?
- What side effects could I have from these treatments?
- What can I do about side effects that I might have?
- Is there a clinical trial that might be right for me?
- What about special vitamins or diets that friends tell me about? How will I know if they are safe?
- How soon do I need to start treatment?
- What should I do to be ready for treatment?
- Is there anything I can do to help the treatment work better?
- Whats the next step?
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What Are The Signs That Prostate Cancer Has Spread
Approximately one in nine men will get prostate cancer in their lifetime. This is why screening is so important, especially if youre over the age of 50.
Unfortunately, many times symptoms of prostate cancer dont appear during the early stages. Some men dont notice the warning signs until its metastasized. Late detection is one of the reasons why only a very few men consider getting treatment, and survive prostate cancer.
If youre asking yourself, What are the signs that prostate cancer has spread, keep reading. Aside from using reputable websites such as drcatalona.com, this article will provide information over some late-stage symptoms.
Warning Signs Of Prostate Cancer
One of the challenges of prostate cancer is that it often doesnt present symptoms that alert men to its presence, particularly in the early stages. But the Urology Care Foundation notes that there may be some warning signs that you have problems related to your prostate, including the following:
If you get screened for prostate cancer, there are additional warning signs based on how the prostate gland cells look under a microscope, notes the American Cancer Society. Cells that may be concerning will exhibit some level of what is known as prostatic intraepithelial neoplasia . These cells may exhibit low-grade PIN, in which something is slightly off with the cells, or high-grade PIN, when they show clear abnormalities.
Under a microscope, prostate gland cells may also exhibit what is known as proliferative inflammatory atrophy . PIA indicates cells that are smaller than normal and show some signs of inflammation. These cells may be worth additional monitoring because they could develop high-grade PIN and ultimately prostate cancer.
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What Is Advanced Prostate Cancer
When prostate cancer spreads beyond the prostate or returns after treatment, it is often called advanced prostate cancer.
Prostate cancer is often grouped into four stages.
- Stages I & II: The tumor has not spread beyond the prostate. This is often called early stage or localized prostate cancer.
- Stage III: Cancer has spread outside the prostate, but only to nearby tissues. This is often called locally advanced prostate cancer.
- Stage IV: Cancer has spread outside the prostate to other parts such as the lymph nodes, bones, liver or lungs. This stage is often called advanced prostate cancer.
When an early stage prostate cancer is found, it may be treated or placed on surveillance . If prostate cancer spreads beyond the prostate or returns after treatment, it is often called advanced prostate cancer. Stage IV prostate cancer is not curable, but there are many ways to control it. Treatment can stop advanced prostate cancer from growing and causing symptoms.
There are several types of advanced prostate cancer, including:
If your Prostate Specific Antigen level has risen after the first treatment but you have no other signs of cancer, you have “biochemical recurrence.”
Castration-Resistant Prostate Cancer
Non-Metastatic Castration-Resistant Prostate Cancer
Metastatic Prostate Cancer
- Lymph nodes outside the pelvis
- Other organs
Metastatic Hormone-Sensitive Prostate Cancer
How Doctors Find Metastatic Prostate Cancer
When you are diagnosed with prostate cancer, your doctor will order tests such as:
- 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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Screening For Prostate Cancer
There are no tests available with sufficient accuracy to screen populations of men for early signs of prostate cancer. However, early detection and treatment can significantly improve prostate cancer survival.
The test most commonly used to aid early detection of prostate cancer is the prostate specific antigen blood test. This is not a diagnostic test as it can only indicate changes in the prostate. If you are concerned about prostate cancer you should talk to your doctor and make an informed choice about whether to have one of the tests designed to find early signs of prostate cancer, in view of the potential risks and benefits.
There are no proven measures to prevent prostate cancer.
My Dad Has Advanced Prostate Cancer Metastatized To Bone
I’ve come here because I’m not sure where else to go. I’ve just found out in the past week that my Dad has prostate cancer, which has metasised to his pubic bone. His PSA levels were extrremely high, 164, and his Gleason score is 10. He’s 72, but you wouldn’t think it. He is so fit and healthy and he only went to the doctors in the first place because he had a pain in his leg, which we now know is because it spread to his bone. I am an only child, I’m 26, I live near my parents and have been staying over since we find out.
My Dad is mostly postive, he has started his hormone therapy and in July he will have 6 rounds of chemo. They can manage but they can’t cure. They said it’s really agressive cancer, but they can keep him going, but for how long? I can’t bear to watch my Dad go through this pain, he’s the kindest, sweetest most generous man. And my Mum, my Dad is my mums world, she just keeps asking me “how are we going to cope” – she’s imagining herself all alone in this home they built together, and to be honest, so am I. I am trying to be strong and resume normality but this has changed everything. I thought my Dad would live to see me get married, go far in my career. I want him to be there, to watch me grow. I don’t want him to leave Mum all alone. I don’t have any siblings to share this with – my friends are supportive and my boyfriend too but, I just feel so hopeless. Would be reassured to hear of anyone else in the same boat.
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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.
Treatment For Advanced Prostate Cancer
Although advanced prostate cancer cannot be cured, it can be controlled with treatment, sometimes for several years. Treatments can also help relieve symptoms and improve your quality of life.
A multidisciplinary team will meet to discuss the best possible treatment for you. This will depend on different factors, like your general health. Your cancer doctor will talk to you about the advantages and disadvantages of these treatments.
The main treatments are:
- Hormonal therapy
Hormonal therapies reduce the amount of testosterone in the body. This may slow the growth of the cancer or stop it growing for a while.
Chemotherapy uses anti-cancer drugs to destroy cancer cells. You may have it with hormonal therapy when you are first diagnosed with advanced prostate cancer. Or, it can be given when hormonal therapy is no longer controlling the cancer.
Radiotherapy is most often used to shrink cancer that has spread to the bones. External beam radiotherapy uses high energy rays to destroy cancer cells. Its given using a large machine. Radioisotope therapy is a type of internal radiotherapy given as an injection.
Surgery to remove the prostate is not suitable for advanced prostate cancer. Surgery may be used to help control symptoms or to help stabilise a bone that is at risk of breaking.
Your doctor or nurse will usually ask you to sign a form giving your permission for them to give you the treatment. They cannot give treatment without your consent.
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Your Cancer Care Team
People with cancer should be cared for by a multidisciplinary team . This is a team of specialists who work together to provide the best care and treatment.
The team often consists of specialist cancer surgeons, oncologists , radiologists, pathologists, radiographers and specialist nurses.
Other members may include physiotherapists, dietitians and occupational therapists. You may also have access to clinical psychology support.
When deciding what treatment is best for you, your doctors will consider:
- the type and size of the cancer
- what grade it is
- whether the cancer has spread to other parts of your body
How Prostate Cancer Is Diagnosed And Staged
Cancer staging helps you and your doctor understand how advanced your cancer is and how much it has spread at the time of diagnosis. Knowing your cancer stage also helps your doctor determine the best treatment options for you and estimate your chance of survival.
The most widely used staging system for cancer is the American Joint Committee on Cancers TNM system that classifies cancer from stage 1 to stage 4.
TNM stands for:
- Tumor: the size and extent of the tumor
- Nodes: the number or extent of nearby lymph node involvement
- Metastasis: whether cancer has spread to distant sites in the body
The TNM scale is used for many types of cancer. When a doctor uses it to determine your prostate cancer stage, theyll consider several other factors as well, including:
- grade groups
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