Prostate cancer can sometimes spread from the prostate to the bones, which is known as bone metastasis. Although there is no cure for bone metastases, treatment can help relieve symptoms and extend life.
Even when cancer has spread from the prostate to the bones, doctors still refer to it as prostate cancer rather than bone cancer because it started in the prostate.
When treating bone metastases, doctors aim to minimize any further spread of cancer and relieve pain and other symptoms.
In this article, we discuss the symptoms of advanced prostate cancer and bone metastases. We also cover treatment options for bone metastases, the side effects of treatment, and survival rates.
Early prostate cancer often has no symptoms. Once the disease has spread beyond the prostate, doctors refer to it as advanced prostate cancer.
Symptoms of advanced prostate cancer can include:
- difficulty urinating or a reduced or slow urine stream
- the need to urinate more frequently, usually at night
- blood in the urine or semen
- erectile dysfunction
- weakness or a numb feeling in the legs or feet
- loss of control of bladder or bowel
Although many of these symptoms can result from conditions other than cancer, anyone who experiences them should consult a doctor.
Once prostate cancer has spread to the bones, symptoms can include:
- bone pain
- weak bones that are more likely to fracture
- pain or stiffness in the neck or back
- trouble urinating
- numbness and weakness from spinal cord compression
Bone metastasis can cause bones to release their calcium into the bloodstream, resulting in high levels of the substance building up in the blood. This condition is known as hypercalcemia. Without treatment, hypercalcemia can be very dangerous and cause the following symptoms:
- appetite loss
- feeling very thirsty
- urinating more frequently
- fatigue and weakness
- bone pain
- depression, memory loss, and irritability
People who experience any of these symptoms should speak with a doctor immediately. Treating bone metastases early on can help prevent further complications.
Treatment for bone metastasis can help relieve pain and prevent complications. A doctor will work with the individual to develop a suitable treatment plan.
The person will receive these treatments alongside the treatment for the primary tumor, such as hormone therapy and chemotherapy. They will not have to give up curative treatment to receive bone pain relief.
Treatment options for bone metastasis include the below.
Bisphosphonates are drugs that work by reducing bone loss. They can help:
- strengthen bones
- relieve bone pain
- reduce high calcium levels in the blood
- lower the risk of fractures
- slow cancer growth in the bones
Bisphosphonates can also reduce the side effects of hormone therapy, which some people may receive to treat their prostate cancer.
Zoledronic acid (Zometa) is the bisphosphonate that doctors most commonly prescribe for individuals with prostate cancer. They usually administer this drug by intravenous injection into the veins every
Denosumab, which has the brand names Xgeva and Prolia, is another drug that reduces bone loss. It can help lower the risk of fractures, especially if zoledronic acid is not working, and slow down the spread of cancer that has not yet reached the bones.
Doctors inject the denosumab under the person’s skin every 4 weeks.
Radiation therapy uses a machine to aim an external radiation beam at the cancer cells in a person’s body. This treatment can:
- reduce bone pain
- shrink tumors on the spine to relieve pressure
- shrink tumors in other areas of the body to alleviate symptoms
Doctors can also inject medications called radiopharmaceuticals to treat people with bone metastases. Once inside the body, these drugs move to the bones and release radiation that can kill cancer cells.
Radiopharmaceuticals treat all the affected bones at the same time rather than just targeting one area.
Radiopharmaceuticals that doctors use for prostate cancer that has spread to bones include:
- strontium-89 chloride (Metastron)
- samarium-153 lexidronam (Quadramet)
- radium-223 (Xofigo)
All of these drugs can help relieve bone pain. According to the
Treatment for bone metastasis can cause side effects in some people:
Bisphosphonates and denosumab
Bisphosphonates and denosumab can cause similar side effects, including:
- flu-like symptoms
- bone or joint pain
People taking bisphosphonates or denosumab may need to take calcium and vitamin D supplements to prevent their calcium levels from becoming too low.
Bisphosphonates can also cause kidney problems, so doctors may not recommend these drugs for people with reduced kidney function.
Rarely, taking bisphosphonates or denosumab can cause osteonecrosis of the jaw (ONJ). This is a serious condition where the bone tissue in the jaw dies due to the blood supply being cut off. It can lead to:
- pain and swelling in the mouth
- tooth loss
- gum infections
Before taking bisphosphonates or denosumab, it is essential to make a doctor aware of any dental issues. Doctors often advise people to speak with a dentist to address any dental issues before starting these medications. Practicing good oral hygiene, such as brushing correctly and flossing daily, may help prevent ONJ.
External radiation therapy can cause some side effects, including:
- Bowel problems: These issues include diarrhea, bloody stools, and rectal leakage. Some people may need to follow a special diet to help reduce these side effects.
- Fatigue: This may continue for a time after treatment stops.
- Lymphedema: This can cause fluid to build up in certain parts of the body, such as the legs and groin. Physical therapy can help reduce pain and swelling.
- Erectile dysfunction: Doctors can prescribe medications to help with erection problems.
- Urination difficulties: Include pain while urinating, accidental leakage, and loss of control. Many treatments are available for urination problems, including catheters, medications, exercises, and surgery.
Radiopharmaceutical treatment can lead to a decrease in blood cells. A low blood cell count can increase a person’s risk of infection and bleeding.
People taking radiopharmaceuticals should consult their doctor about the symptoms that may indicate a low blood cell count and the precautions they can take to prevent this.
Pain medication can be very effective in relieving the pain of prostate cancer and bone metastases.
A person should talk with a doctor about any pain they are experiencing. The doctor can prescribe appropriate pain relief and work with the individual to develop a pain control plan.
Different types of pain relievers
Doctors can also offer advice and treatment for any other symptoms or side effects that a person may have.
There is currently no cure for advanced prostate cancer, but advances in treatments are extending life expectancy and improving quality of life.
The ACS states that the 5-year relative survival rate for individuals with prostate cancer that has spread to distant lymph nodes, organs, or the bones is
However, survival rates are only estimates, and everyone is different. The following factors are among those that can affect a person’s outlook:
- general health
- how cancer responds to treatment
- how far cancer has spread
Ongoing cancer research is also facilitating the development of more effective treatments and leading to improved survival rates.
Here are some answers to questions people often ask about prostate cancer moving to the bones.
What is the life expectancy when prostate cancer moves to the bones?
When prostate cancer moves to the bones, doctors call this advanced or distant prostate cancer. For people with advanced prostate cancer, there is a
What happens when prostate cancer moves to the bones?
In over 60% of people with advanced prostate cancer, cancer will spread to the bones. This happens as cancer cells spread throughout the body and most commonly affects the hips, spine, and ribs. Symptoms include pain and a higher likelihood of fractures.
Is there any treatment for prostate cancer that has spread to the bones?
Various drugs can help manage symptoms or slow the progression of prostate cancer in the bones. They
Prostate cancer can spread to other organs in the body. When the disease spreads to the bones, this is known as bone metastasis.
Although there is currently no cure for prostate cancer that has spread to the bones, treatment can help relieve pain, improve quality of life, and extend life expectancy.
A doctor will work closely with a person to develop a treatment plan. Many people also find it beneficial to join a support group and connect with others who understand how they may be feeling. The Prostate Cancer Foundation provides information to help people find a local support group.