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.

Preventing or slowing the spread of prostate cancer to the bones is a major goal of treatment if the cancer has grown outside of the prostate. If the cancer has already reached the bones, then it’s important to control or relieve pain and other problems.

Treatments mentioned earlier, such as hormone therapy, chemo, and vaccines may help with this, but other treatments target cancer spread to the bones and the problems it may cause.

Bisphosphonates

These drugs can help relieve bone pain and high calcium levels caused by cancer that has spread to the bones. They may also slow the growth of the cancer and strengthen bones in men who are getting hormone treatment.

These drugs work by slowing down cells called osteoclasts, which normally break down the hard mineral structure of bones to help keep them healthy. But osteoclasts often become too active when prostate cancer cells spread to the bones, which can cause problems.

The most common bisphosphonate is zoledronic acid (Zometa^®). It is given into the vein (IV), usually once every 3 or 4 weeks. Men given this drug are advised to take a supplement with calcium and vitamin D to prevent problems with low calcium levels.

Bisphosphonates can cause side effects, such as flu-like symptoms and bone or joint pain. They can also lead to kidney problems.

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 dental work done, so many cancer doctors recommend that patients have a dental check-up and have any tooth or jaw problems treated before they start taking bisphosphonates.

Denosumab

Denosumab (Xgeva^®) is also a drug that can help when prostate cancer spreads to bone. Like the bisphosphonates, denosumab blocks bone cells called osteoclasts, but it does so in a different way. In men whose cancer has already spread to the bones, denosumab can help prevent or delay problems like fractures.

This drug is given as a shot (injection) under the skin every 4 weeks. Men given this drug are often urged to take a supplement with calcium and vitamin D to prevent problems with low calcium levels.

Common side effects include nausea, diarrhea, and feeling weak or tired. Like the bisphosphonates, denosumab can cause jaw problems, so doctors recommend taking the same measures (such as having tooth and jaw problems treated before starting the drug).

Corticosteroids

Some studies suggest that corticosteroid drugs can relieve bone pain for some men.

Radiation

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

Drugs called radiopharmaceuticals can be used if the cancer has spread to many bones. This is a group of drugs that have 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. About 8 out of 10 prostate cancer patients with bone pain are helped by this treatment, at least for a while. The main side effect 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.