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If prostate cancer grows outside the prostate gland, it often first grows into nearby tissues or spreads 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 broken bones 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.

Drugs to protect the bones

Drugs that help stop the cancer cells from breaking down the bone lower the chance of serious problems like bones breaking. They also can help with bone pain and high calcium levels. Two types of drugs can be used for this.

  • Bisphosphonates: The one most often used is called zoledronic acid (Zometa®), but sometimes others are used. Zoledronic acid is given into the vein (IV), usually once a month.
  • Denosumab (Xgeva®): This drug works in a slightly different way.
  • It 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.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 kidneys.

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.

Some men have a very rare, but serious side effect from these drugs. Part of the jaw bone loses its blood supply and dies. 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 (like having a tooth pulled). Doctors often advise patients to have a dental check-up and have any tooth or jaw problems treated before they start taking either of these drugs.


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 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 lower 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. Pain medicines work best when they are taken on a regular schedule. They do not work as well if they are only used when the pain becomes severe.

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 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 Prostate Cancer.

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

Last Medical Review: 01/09/2015
Last Revised: 02/09/2016