Monday, September 26, 2022

Advanced Prostate Cancer With Bone Metastases

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What Is Bone Metastasis

Bone Metastasis: Treatments, Scans & Side Effects | Ask a Prostate Expert, Mark Scholz, MD

The bone is a common site for metastasis. Bone metastasis or âbone metsâ occurs when cancer cells from the primary tumor relocate to the bone. Prostate, breast, and lung cancers are most likely to spread to the bone. However, other cancers are not excluded. Bone metastases do not begin from the bones but move there from the primary tumor site. On the other hand, primary bone cancers are rare cancers where the primary tumor actually starts in the bone. Therefore, bone cancer and bone metastases are not the same.

As an example, consider a patient with prostate cancer. Prostate cancer cells from the primary tumor can break away and get into the bloodstream. Once in the blood, the cancer cell can travel to the bone and form a new tumor. It is important to remember that this secondary tumor is made up of abnormal prostate cancer cells, not abnormal bone cells. The result of this process is referred to as prostate cancer that has metastasized to the bone or metastatic prostate cancer. This is otherwise known as bone metastasis.

When cancer cells metastasize to the bone, they can cause changes to the bone. The process by which portions of the bone are damaged is called osteolysis. Oftentimes, small holes result from osteolysis. These holes in the bone are referred to as osteolytic lesions or lytic lesions. Lytic lesions can weaken the bones and increase the risk of breakage or other problems. It is also common for bone metastasis patients to experience pain with lesions.

How Does Prostate Cancer Spread

Cancer cells sometimes break away from the original tumor and go to a blood or lymph vessel. Once there, they move through your body. The cells stop in capillaries — tiny blood vessels — at some distant location.

The cells then break through the wall of the blood vessel and attach to whatever tissue they find. They multiply and grow new blood vessels to bring nutrients to the new tumor. Prostate cancer prefers to grow in specific areas, such as lymph nodes or in the ribs, pelvic bones, and spine.

Most breakaway cancer cells form new tumors. Many others don’t survive in the bloodstream. Some die at the site of the new tissue. Others may lie inactive for years or never become active.

Symptoms Of Prostate Cancer Spread To The Bones

The most common place for prostate cancer to spread to is the bones. This can include the:

  • spine

The most common symptom if cancer has spread to the bone is bone pain. It is usually there most of the time and can wake you up at night. The pain can be a dull ache or stabbing pain.

Your bones might also become weaker and more likely to break .

When prostate cancer spreads to the spine, it can put pressure on the spinal cord and cause spinal cord compression. This stops the nerves from being able to work properly. Back pain is usually the first symptom of spinal cord compression.

Spinal cord compression is an emergency. You should contact your treatment team immediately if you are worried you might have spinal cord compression.

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What Are Next Steps

Bone metastasis have a profound effect on the long-term outlook for prostate cancer. But its important to remember that the numbers are only statistics.

The good news is that life expectancy for advanced prostate cancer continues to increase. New treatments and therapies offer both longer life and better quality of life. Speak to your doctor about your treatment options and long-term outlook.

Everyones cancer experience is different. You may find support through sharing your treatment plan with friends and family. Or you can turn to local community groups or online forums like Male Care for advice and reassurance.

The Role Of Parathyroid Hormone

Stage 4 Prostate Cancer Bone Metastasis Prognosis

Parathyroid hormone is a hormone secreted by the parathyroid gland which plays an important role in bone remodeling. It stimulates bone resorption by osteoclasts indirectly through PTH binding receptors located on osteoblasts. Upon binding of PTH on osteoblasts, the expression of OPG is downregulated whereas the expression of RANKL is upregulated . Signaling to the bone marrow-derived osteoclast precursors, high levels of RANKL consequently stimulate their fusion, differentiation, and activation. PTH causes a net bone loss through an increased resorption process when administered in a continuous fashion, but a net bone gain through an enhanced formation process when administered intermittently. To our knowledge, only a handful of evidence documented the ectopic expression of PTH by the thyroid and other non-parathyroid tumors . Specifically, studies on the ectopic expression of PTH by prostate tumors are limited .

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Where Prostate Cancer Spreads In The Body Affects Survival Time

Sarah Avery

EMBARGOED FOR RELEASE until 4 p.m. on Monday, March 7, 2016

DURHAM, N.C. â Patients with lymph-only metastasis have the longest overall survival, while those with liver involvement fare worst. Lung and bone metastasis fall in the middle.

Smaller studies had given doctors and patients indications that the site of metastasis in prostate cancer affects survival, but prevalence rates in organ sites were small, so it was difficult to provide good guidance, said Susan Halabi, Ph.D., professor of biostatistics at Duke and lead author of the study published online March 7 in the Journal of Clinical Oncology.

With the large numbers we analyzed in our study, we were able to compare all of these different sites and provide information that could be helpful in conveying prognosis to patients, Halabi said. This information could also be used to help guide treatment approaches using either hormonal therapy or chemotherapy.

Halabi and colleagues from leading U.S. and international cancer research centers pulled data from nine large, phase III clinical trials to analyze outcomes of 8,736 men with metastatic prostate cancer. The patients had all undergone standard treatment with the chemotherapy drug docetaxel.

Site of metastases was categorized into four groups: lung, liver , lymph nodes only, bone with or without lymph nodes and no other organ metastases.

Halabi said more research is needed to understand how and why prostate cancer spreads to different organs.

Treatments To Help Manage Symptoms

Advanced prostate cancer can cause symptoms, such as bone pain. Speak to your doctor or nurse if you have symptoms there are treatments available to help manage them. The treatments above may help to delay or relieve some symptoms. There are also specific treatments to help manage symptoms you may hear these called palliative treatments. They include:

This is the team of health professionals involved in your care. It is likely to include:

  • a specialist nurse
  • a chemotherapy nurse
  • a urologist
  • an oncologist
  • a diagnostic radiographer
  • a therapeutic radiographer
  • a radiologist
  • other health professionals, such as a dietitian or physiotherapist.

Your MDT will meet to discuss your diagnosis and treatment options. You might not meet all the health professionals straight away.

Your main point of contact might be called your key worker. This is usually your clinical nurse specialist , but might be someone else. The key worker will co-ordinate your care and help you get information and support. You may also have close contact with your GP and the practice nurses at your GP surgery.

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General Statement On Bone Metastases

Bone metastasis is a devastating condition that has wide-ranging negative impacts on the lives of patients with advanced cancer . To date, no large-scale etiological studies on the prevalence or incidence of bone metastasis have been conducted worldwide . However, the current 5-year survival rate for prostate cancer is> 95% across numerous countries , and an increase in survival time may increase the incidence of bone metastasis.

Irrespective of the primary malignant location, bone metastases are commonly found in the spine, pelvis, shoulder, and distal femur . These bone lesions can cause serious complications, such as spinal cord and nerve root compression, pathological fracture, and hypercalcemia . Bone metastases most commonly affect the axial skeleton. In adults, the axial skeleton contains red marrow, which suggests that the properties of the circulation, cells and extracellular matrix within this region assist in the formation of bone metastasis . Batson showed that venous blood from the breast and pelvis flowed not only into the vena cava but also into the vertebral venous plexus, which extends from the pelvis to throughout the epidural and peri-vertebral veins . Blood drainage to the skeleton via the vertebral venous plexus may, at least in part, explain the tendency of breast and prostate cancers to produce metastases in the axial skeleton and limb girdles .

Fig. 1

Batsons venous plexus. Cited from Diseases of the Spine and Spinal Cord

Fig. 2

Ethics Approval And Consent To Participate

Stories of Advanced Prostate Cancer Survivors | Ask a Prostate Expert, Mark Scholz, MD

As the data used was extracted from SEER dataset , Ethics approval and Consent to participate could be checked in SEER. We were permitted to have Internet access after our signed data-use agreement was approved by the SEER administration . The date collected from the Second Affiliated Hospital of Zhejiang University School of Medicine was approved by the Ethics Committee of Zhejiang University .

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The Stages Of Prostate Cancer: What You Need To Know

After a prostate cancer diagnosis, your oncologist will refer to the stage of your cancer. All cancers are categorized into four distinct stages, each of which identifies the progress of the growth of cancerous cells within clinically defined standards. These stages help doctors determine the most appropriate care for each patient based on his or her condition, and can also provide easy-to-understand context for your diagnosis. Learn more about the stages of prostate cancer, how each stage will affect your treatment plan and the survival rates for each stage, then contact Regional Cancer Care Associates to schedule a consultation.

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Ccl20 Blocking Antibody Treatment

C57BL6/J male mice received an intraperitoneal injection of 45g anti-CCL20 blocking antibody or rat IgG isotype control antibody 1 day prior to intracardiac injection of RM1-BoM3 prostate cancer bone metastasis cells. The administration of blocking antibody and isotype control then continued on a twice-weekly basis until the end of the experiment.

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Is It Time To Let A Dog With Cancer Go

Our canine companions are a member of our family, making a cancer diagnosis extremely devastating. Not only is it difficult to hear the words, but many owners struggle with understanding the process of their disease and when its actually time to let them go. In this article we will help you understand the diagnosis of cancer in dogs.

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Surgery And Advanced Prostate Cancer

Frontiers

An indication for immediate bilateral orchiectomy is spinal cord compression. Surgical intervention is mandatory for pathologic fractures involving weight-bearing bones.

In patients with clinical stage T3 prostate cancer at initial presentation, radical prostatectomy has not historically been considered beneficial, because of the increased probability of incomplete resection of the cancer, likelihood of micrometastatic disease, and increased morbidity.

However, a retrospective review of approximately 840 men with stage cT3 prostate cancer who underwent RP at the Mayo Clinic reported outcomes similar to those with organ-confined disease during the same period at this institution. Pathologic stage, Gleason grade, positive surgical margin, and nondiploid chromatin were found to be independently associated with increased progression of disease.

In another Mayo Clinic study, in which the long-term survival of patients with high-risk prostate cancer was compared after RP and after external beam radiation therapy , RP alone and EBRT plus ADT provided similar long-term cancer control. However, the risk of all-cause mortality was greater after EBRT plus ADT than after RP.

In the study, RP was used in 1238 men, EBRT plus ADT was used in 344 men, and 265 received EBRT alone. The 10-year cancer-specific survival rates in the study were 92% in patients treated with RP or EBRT plus ADT, and 88% in those receiving EBRT alone, with a median follow-up of 6-10 years.

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Prostate Cancer Survival Rates Are Favorable Overall

Thinking about survival rates for prostate cancer takes a little mental stretching. Keep in mind that most men are around 70 when diagnosed with prostate cancer. Over, say, five years, many of these men will die from other medical problems unrelated to prostate cancer.

To determine the prostate cancer survival rate, these men are subtracted out of the calculations. Counting only the men who are left provides whatâs called the relative survival rate for prostate cancer.

Taking that into consideration, the relative survival rates for most kinds of prostate cancer are actually pretty good. Remember, weâre not counting men with prostate cancer who die of other causes:

  • 92% of all prostate cancers are found when they are in the early stage, called local or regional. Almost 100% of men who have local or regional prostate cancer will survive more than five years after diagnosis.
  • Fewer men have more advanced prostate cancer at the time of diagnosis. Once prostate cancer has spread beyond the prostate, survival rates fall. For men with distant spread of prostate cancer, about one-third will survive for five years after diagnosis.

Many men with prostate cancer actually will live much longer than five years after diagnosis. What about longer-term survival rates? According to the American Society of Clinical Oncology, for men with local or regional prostate cancer:

  • the relative 10-year survival rate is 98%
  • the relative 15-year survival rate is 96%

What Bone Pain Might Feel Like

Bone pain from metastatic prostate cancer generally doesnt go away on its own. It can be near constant, in fact. Some men may even wake up throughout the night from the pain, which can be a dull ache or a stabbing sensation.

Not all men with cancer in their bones will experience bone pain, but those who do liken it to a throbbing in the bones, like a terrible toothache. Affected areas can be tender to touch or make it difficult to move, particularly if the cancer has spread to the spine.

Pain can sometimes begin in one area and eventually spread to other parts of the body.

Bone metastases can also cause your bones to become weaker, which can result in bones that are easier to break, making fractures common.

These fractures of the vertebra can cause compression. In addition, metastatic tumor deposits can also cause spinal cord compression, which is when a mass like a tumor or bone fragment puts pressure on the spinal cord.

Some symptoms of spinal cord compression are:

  • severe pain and weakness in the legs
  • severe numbness in the back of the legs and inner thighs
  • a loss of bowel and bladder control

Motor skills and coordination may be affected as well.

For people with prostate cancer, spinal cord compression occurs when cancer that has spread to the spine puts pressure on the spinal cord, preventing nerves from being able to work properly. Back pain generally occurs.

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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.

Early Versus Delayed Treatment

Impact of Bone Metastases in mCRPC

In the years following the introduction by Huggins and Hodges of hormone therapy for prostate cancer, early institution of such treatment was recommended based on comparison with historical controls.

Later, the Veterans Administration Cooperative Urology Research Group studies reversed the recommendation of early hormone therapy instead, hormone therapy was deferred until symptomatic progression. In addition, prolongation of survival was believed to be secondary to the alteration of the nature of metastatic lesions, thereby creating earlier androgen resistance, rather than a result of early hormone manipulation.

In more recent years, the old controversy of appropriate androgen-deprivation therapy timing has gained new and stronger popularity because of the advent of less-toxic and well-tolerated pharmaceutical agents, such as luteinizing hormone-releasing hormone agonists and antiandrogens. Laboratory studies have demonstrated that early hormone therapy does not confer early resistance. An update of the VACURG study by Byar and Corle determined that disease progression from stage C to stage D was decreased from 50% to 10% with diethylstilbestrol therapy. Crawford and associates also showed a benefit of early hormone therapy in patients with distant metastases.

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Advanced Prostate Cancer And Bone Metastases

Most all prostate cancer patients worry about metastases. Metastases used to signal that death was near. Most prostate cancer metastases take place in bones. New treatments such as Xofigo have helped thousands of men delay health while maintaining a pain free high quality of life. Bone metastases are tumors that have spread from the prostate to your bones. Usually bone metastases occur in the pelvis, spine, thighs and ribs. But, they can develop in any bone anywhere in your body. Bone metastases can become extremely painful. Which is why it is reasonable and very human to fear bone metastases. So, if you are feeling anything that you imagine to be bone pain, talk to your doctor right away.

Diagnosing Bone Metastases

Bone metastases symptoms are sometimes confused with arthritis. The symptoms such as pain seem to be the same. So, if you are already diagnosed with prostate cancer, you must talk to your doctor about anything at all that you imagine to be pain in your bones. X-rays can diagnose bone metastases best, but bone scans, CT scans, PET scans, MRIs and blood tests are also used for diagnosis.

Untreated bone metastases in a man with castrate resistant prostate cancer could cause fractures and other skeletal problems none of which are pleasant.

Early detection of bone metastases allows more effective treatment to delay bone pain and other complications.

Preventing and Treating Bone Metastases

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