As prostate cancer spreads, it tends to move outward, usually first spreading locally. The most common first stops are in the lymph nodes adjoining the prostate bed or in the location of the most immediate bones, the pelvis, upper thighs and the lower spine. Many men will experience pain, especially pelvic area pain, as the cancer spreads into these bones.

When prostate cancer does spread into the bones there are aggressive management tools that can be used to slow down the growth of the metastases and its subsequent damage as well as minimizing the pain. Additional, there are tools available that can pinpoint the exact location of the met and assess how best to treat it.

The bone scan is the “gold standard” test to detect bone metastases. The scan is performed by injecting a radioactive substance (marker) that acts like a dye, into a vein, then images of the entire skeleton are taken. The radioactive material shines in the areas where bone tissue is changing rapidly, or in the areas where the cells are quickly metabolizing the marker. Quick cellular metabolism can be a sign of prostate cancer bone metastases.

Not all “hot areas” of heavy cellular activity are caused by prostate cancer bone metastases. “Hot areas” also show changes in the bone due to a old fractures, infections, arthritis, or even bone loss that resulted from the use of hormone therapy. A complete medical history along with a skillful doctor can assess the results of the bone scan and decide the best treatment approach, if any is needed.

Other types of scans, such as x-rays, CT scans, MRIs, and PET scans are excellent tools used to monitor the effects of the metastases over time and to determine whether any new changes on a bone scan are caused by bone metastases.

Bone pain, especially in the pelvic area needs to be followed up with your doctor.

Joel T Nowak MA, MSW