Prostate cancer preferentially metastasizes to bone and the mortality from prostate cancer is 70% once bone metastases are present. In addition, prostate cancer-induced bone metastases are associated with significant complications including severe pain, skeletal fractures, spinal cord compression and bone marrow suppression.
Most doctors structure their treatment protocols against bone metastases by treating the cancer systemically (other than targeted radiation to treat pain). Systemic therapies spread throughout the body, through the blood stream, either by intravenous delivery or by ingesting a pill. Systemic treatment differs from is local therapies, which are directed at a single area. Systemic therapies for prostate cancer include chemotherapy or hormone therapy. Local therapies include surgery, targeted radiation or intensive microwaves and
Hormonal therapy is the usual the first line of treatment and it has been the mainstay of treatment for bone metastatic disease for many years. However, the results are often short-lived. There are presently no chemopreventive or curative therapies for prostate cancer bone metastases.
There are also drugs called bisphosphonates that can help make diseased bones stronger and help prevent fractures. These drugs are used to supplement the chemotherapy and hormonal therapy to retard the growth of bone metastasis and to prevent fractures resulting from the loss of bone density.
Local treatments such as radiation therapy can relieve the pain in a bone by destroying the cancer and reducing the size of the tumor. Sometimes, a doctor will look at an x-ray and determine that a bone is close to breaking. Depending upon what bone has been affected sometimes your doctor will recommend a surgery that involves placing a thin steel rod in the bone to add strength. It is much easier to prevent a damaged bone from breaking than to repair it after it has broken.
Bone metastases are significant and need to be aggressively dealt with. Let your doctor know if you feel any bone pain as soon as possible.
Joel T Nowak MA, MSW