Prostate Cancer Overview

+ -Text Size

Treating Prostate Cancer TOPICS

Preventing and treating prostate cancer spread to bone

If prostate cancer grows outside of the prostate gland itself, it may first grow into nearby tissues or spread to nearby lymph nodes. After this, prostate cancer nearly always spreads to the bones. Spread of cancer to the bones can be painful and can also cause other problems, such as breaks or high blood calcium levels.

Treatments mentioned earlier, such as hormone therapy, chemo, and vaccines may help with the cancer spread overall. Often, though other treatments that target cancer spread to the bones are also needed. This can involve drugs like bisphosphonates and denosumab, pain medicines, and radiation.

Drugs to protect the bones

Patients who have prostate cancer spread to bone can be helped by drugs that help stop the cancer cells from breaking down the bone. These drugs lower the chance of serious problems like bones breaking from cancer spread. They also can help with bone pain and high calcium levels. Drugs called bisphosphonates can be used for this. The one most often used is called zoledronic acid (Zometa®), but sometimes others are used. Denosumab (Xgeva®) is another kind of drug that is also used.

Zoledronic acid is given into the vein (IV), usually once a month.

Denosumab is given as a shot (injection) under the skin once a month.

Men taking these drugs are often advised to take a supplement with calcium and vitamin D to prevent problems with low calcium levels.

Some men have a very rare, but serious side effect from these drugs. They have pain in the jaw and their doctors find that part of the jaw bone has died. This can lead to loss of teeth or infections of the jaw bone. These problems seem to be more common after having certain kinds of dental work done (like having a tooth pulled). Doctors often recommend that patients have a dental check-up and have any tooth or jaw problems treated before they start taking either of these drugs.

Bisphosphonates can cause side effects, such as flu-like symptoms and bone or joint pain. They can’t be used in men with kidney problems because they can damage the kidney.

Common side effects of denosumab include nausea, diarrhea, and feeling weak or tired. This drug doesn’t cause kidney damage and is safe for people with kidney problems.


External radiation treatment can be used to treat bone pain caused by cancer that has spread to one or a few areas of bone.

Radiopharmaceuticals are another way to treat cancer that has spread to bones. These are drugs that contain radioactive elements. They are given into a vein. They settle in areas of bones that contain cancer and the radioactive part kills the cancer cells there. Because they go throughout the body, they are a way to treat many areas of cancer in the bones at once. This can be very helpful in treating bone pain. The most serious side effect of these drugs is a lowering of blood cell counts. This could increase your risk of getting an infection or bleeding easily.

Pain medicines

Pain medicines work very well. When the drugs are used as prescribed to treat cancer pain, it is very rare for them to cause addiction or dependence. Constipation and feeling sleepy are the most common problems, but there are things you can do to help prevent these. Side effects can often be managed by changing the dose or by adding other medicines.

It is very important that you get good treatment for your pain. This will help you feel better and allow you to focus on the people and things that are most important to you. There are many ways to treat your pain, so be sure and tell all members of your prostate cancer care team about your symptoms.

More details about the treatments discussed in this section can be found in our document Prostate Cancer.

More information about the treatment of cancer spread to bone can be found in our document Bone Metastases.

Last Medical Review: 08/27/2013
Last Revised: 09/12/2014