Treatment for prostate cancer that has spread to the bones

The prostate is a gland the size of a golf ball that sits below the bladder and in front of the rectum. It’s responsible for making the fluid that forms semen. Many men develop cancer of the prostate gland; it’s the second most common cancer among men in the United States. There are several stages of prostate cancer — the earliest, when the cancer is still limited to the prostate gland itself, is the easiest to treat.

When the cancer has spread, or metastasized, beyond the prostate gland, it’s considered “advanced,” according to the American Cancer Society (ACS). When it spreads, it’s common for cancer cells to reach the bones first. Nine out of 10 men with advanced prostate cancer also have it in their bones.

At this advanced stage, the cancer can’t be cured, says Scott T. Tagawa, MD, a medical oncologist at Weill Cornell Medicine and New York-Presbyterian Hospital in New York City. “But with treatment, many men can live a long time. There are men I’ve been treating for advanced prostate cancer for 10 or 20 years.”

And today even better treatments are available, Dr. Tagawa says. For a long time, he says, men with advanced prostate cancer lived three to five years on average. But that changed since around 2012, as newer, more effective drugs have been introduced. Tagawa says he often starts men on these recently approved drugs right away, “when they walk in the door with prostate cancer that has spread.” This has led to longer survival and better quality of life for many of the men he treats.

Arm yourself with the facts about what happens when prostate cancer spreads to the bones and what you can do to help manage it.

What are bone metastases with prostate cancer?

The ACS describes bone metastases as areas of bone containing cancer cells that have spread from another place in the body. In the case of prostate cancer, the cells have spread beyond the prostate gland. Since the cancer cells originated in the prostate gland, the cancer is referred to as metastatic prostate cancer.

The cancer cells spread to the bones by breaking away from the prostate gland and escaping attack from your immune system as they travel to your bones.

These cancer cells then grow new tumors in your bones. Cancer can spread to any bone in the body, but the spine is most often affected. Other areas cancer cells commonly travel to, according to the ACS, include the pelvis, upper legs and arms, and the ribs.

What are the symptoms of advanced prostate cancer and bone metastases?

When cancer cells spread to the bones, the condition weakens the very frame on which the body rests. The cells interfere with the strength and hardness of the bone’s structure, interrupting its normal cycle of building up and dissolving.

There’s no cure for advanced prostate cancer, but there’s a lot that doctors can do to help with the symptoms that might develop. This includes managing pain. “A common misconception is that if there’s cancer in the bone, there must be pain,” Tagawa says. “That’s not true. Cancer can be in the bone without pain.” However, if there is pain, he says, “it can be controlled with anticancer therapies and pain medication, and good quality of life can be maintained.”

In addition to pain, some men with bone metastases develop a condition called hypercalcemia, in which, because of the damage to bones from the cancer cells, too much calcium builds up in the blood. Hypercalcemia can make you feel constipated, thirsty, sleepy, or sluggish, and it can increase the urge to urinate, according to the ACS. Over time, hypercalcemia can cause muscle and joint achiness, as well as weakness in the muscles. In advanced stages, it can cause the kidneys to shut down.

There are treatments for hypercalcemia as well as for other complications from advanced prostate cancer, such as bones that become weak and break or fracture, and for growths in the spine that can press on the spinal cord and damage nerves.

Additional symptoms of prostate cancer may include a weak urine flow, frequent urination, and constipation.

But no matter what symptoms you might develop, palliative care can help. This type of supportive care aims to ease any discomfort you’re experiencing and improve your overall quality of life with prostate cancer.

Can I survive advanced prostate cancer? What’s the prognosis?

Prostate cancer is the second leading cause of death from cancer in men, according to the National Cancer Institute. While there’s no cure, men can live with it for years if they get the right treatment. Each man with advanced prostate cancer is different, of course. You and your cancer have unique qualities that your doctor takes into consideration when planning the best treatment strategy for you.

According to Harvard Medical School, the prognosis for men with advanced prostate cancer is improving because of newer medications that help them get past a resistance to androgen-deprivation therapy (ADT) that typically develops after a few years of treatment. With these medications, many men are living longer, and a number of men diagnosed with advanced prostate cancer are dying with the cancer, not from it.

Promptly treating prostate cancer bone metastases with the newest medication can help change a man’s prognosis dramatically, Tagawa says. “There are men who do well for decades,” he says. “Some men can even stop treatment, go on to live many years, and actually die of something unrelated.”

Tagawa says that cancer specialists who use sophisticated imaging technologies, like positron-emission tomography (PET) scans, have gotten very good at finding even tiny bone metastases, which is valuable in diagnosing and removing early stage metastases.

What are my treatment options with advanced prostate cancer?

The treatments your doctor recommends will depend on factors specific to you, from your overall health to how advanced your cancer was when it was first diagnosed.

Many men receive ADT, a type of hormone therapy, which deprives the body of the male hormones that the cancer needs to keep growing.

For most men, however, hormone therapy stops working at some point. Alternatives to hormone therapy were approved by the Food and Drug Administration in 2018, and Tagawa often starts men on these therapies as soon as they’re diagnosed with bone metastases. Other treatment options may be available through clinical trials.

In addition, chemotherapy, surgery, and immunotherapy — as well as radiation treatments, like external beam radiation, which directly target bone problems — may be considered. Major cancer centers, such as Memorial Sloan Kettering Cancer Center in New York City and MD Anderson Cancer Center in Houston, have teams of prostate cancer specialists, as well as sophisticated radiation and other treatment equipment consolidated in one place, which can help with the coordination of care.

For bone metastases themselves, the ACS says treatments are often effective in shrinking or slowing their growth, which in turn may improve symptoms such as constipation and pain. Your doctor will discuss with you the available treatments that may work best for you; they may include systemic treatments, designed to work throughout your body, or more targeted treatments that zero in on affected bones.

Should I make any lifestyle changes, including in my diet or physical activity?

Achieving and maintaining a healthy weight by eating a balanced diet with plenty of fruits, vegetables, and whole grains, and staying physically active, can help your overall health. These lifestyle changes can also have a positive effect for men with bone metastases, Tagawa says. “Both diet and exercise,” he says, “are things that are under a man’s direct control.”

A healthy lifestyle can help you better manage side effects from treatment as well. Try setting small but realistic goals for yourself when it comes to eating a healthy diet and getting plenty of exercise.

While no single food is likely to have a benefit for prostate cancer, smart food choices may help you feel better day to day. Start by cutting out foods high in sugar, saturated fat, and added flavorings and preservatives.

If you’re not sure which healthy foods to choose, ask your doctor for a referral to a dietitian. This specialist can help you develop a meal plan that includes foods that offer the best chance of slowing the cancer’s growth and keeping you as healthy as possible.

As an oncologist, Tagawa says he concentrates on treating the cancer itself, but he’s aware that many of the men he sees with advanced prostate cancer are older and more likely than younger men to have health problems that can benefit from diet and exercise.

“I focus on the cancer,” Tagawa says, "but I don’t want to see [these men] go through all of that and then die from a heart attack or stroke. Attention to both diet and exercise can lead to improvements in quality and quantity of life.”

The recommendation for adults with any type of cancer is to get at least 40 minutes of exercise that elevates their heart rate four times a week. For men who aren’t able to achieve that, Tagawa says, “walking is always good.”

When it comes to exercise, what matters is that you do it — just keep moving your body. Swimming, bicycling, walking, and gardening all count. Aim for a certain number of steps each day, and consider using a pedometer to help stay on track. Mix things up, set goals for yourself, and try being active with a friend or group to stay motivated.

And if you’re on hormone therapy, talk to your doctor about investing in some weights or elastic resistance bands to support your bone strength too.

What types of testing should I expect for monitoring my condition? 

Since metastatic prostate cancer isn’t curable, your doctor will most likely set up regular visits to check the cancer’s location, and to manage any long-term side effects from the cancer or any medication you’re taking.

And since treatments for advanced prostate cancer are changing so fast and need to be given in a certain sequence to be the most effective, you’ll probably have not only a prostate cancer doctor but other specialists taking care of you. Your care team should coordinate closely, say the authors of a major study of such teams published in August 2015 in the journal Annals of Oncology.

Along with regularly testing your prostate-specific antigen (PSA) levels, your care team may request blood tests that measure such prostate cancer indicators as alkaline phosphatase and lactate dehydrogenase. Magnetic resonance imaging (MRI) or PET scans of the spine or other bones can also help identify how your cancer responds to treatment.

If you’ve had radiation, you’re at an increased risk for bladder and colorectal cancer and should get screened regularly for these as well.

The tests you’ll have and how often you’ll need them should be customized to you. Your care team will consider your overall health, medications that are safe for you to take, other health conditions you might have, and what stage your cancer was when you were diagnosed.

Where can I find support?

It can be very difficult to deal with a diagnosis of advanced prostate cancer. It’s natural to wonder if you’re doing all you can to fight the cancer and how to handle guilt, intimacy with a partner, and concerns about masculinity. And finding and paying for the best care can, of course, be a challenge.

But emotional and practical support can help you move forward. An important thing to remember is that you’re not alone. There are many kinds of help available, and the right cancer resources can make a world of difference.

Ask your doctor for resources you can contact, including social workers and support systems in your community. The Patient Navigator Program of the ACS can be reached at 1-800-227-2345 — you’ll be connected to a patient navigator at a cancer treatment center who can help you with practical and emotional issues.

The Prostate Cancer Foundation (PCF) has links to in-person and online support groups around the country, and the ACS lists nationwide support programs as well. The PCF also offers resources ranging from help with housing during cancer treatment to finding ways you can look good and feel better while living with cancer.

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