Coordination Between Myeloid And Lymphoid Compartments
The observed deficiencies of cytotoxicity in the proximity of the tumor may arise through repressive actions by other immune populations . For instance, we find that the Treg cells, which typically act to suppress immune response , showed increased activity signatures at the site of the metastasis . The complex patterns of immune signaling are also likely to involve the myeloid compartment. Indeed, considering variation of TAM and TIM abundance among patients we find that increased proportion of TAMs at the site of metastasis is correlated with CTL-2 exhaustion . Similarly, increased abundance of TIMs coincides with a reduction in the CTL-2 cytotoxicity signature . While these associations suggest that TIM or TAM populations may be directly affecting T lymphocyte state, identifying a specific signaling channel through which communication takes place is challenging.
What Is Bone Metastasis
The bone is a common site for metastasis. Bone metastasis or “bone mets” 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.
Treatments For Prostate Cancer Spread To Bones
If prostate cancer spreads to other parts of the body, it nearly always goes to the bones first. Bone metastasis can be painful and can cause other problems, such as fractures , spinal cord compression ,;or high blood calcium levels, which can be dangerous or even life threatening.
If the cancer has grown outside the prostate, preventing or slowing the spread of the cancer to the bones is a major goal of treatment. If the cancer has already reached the bones, controlling or relieving pain and other complications is also a very important part of treatment.
Treatments such as hormone therapy, chemotherapy, and vaccines may help with this, but other treatments specifically target bone metastasis and the problems it may cause.
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Managing Bone Pain And Weakness
Symptoms like nausea, hot flashes, and pain can usually be relieved with medication. Some people find that complimentary treatments like acupuncture or massage help manage side effects.
Your doctor may also recommend orthopedic surgery to stabilize your bones, relieve pain, and help prevent bone fractures.
Pain In The Back Or Hips
Many times, prostate cancer pain occurs around the lower spinal cord and hips. This a result of the prostate being in close proximity to these regions.
Cancer in the hips will cause bones to become brittle and weak. The result is consistent soreness, especially when bending over or exercising.
Prostate cancer can also put pressure on the spine. The compression of the nerves causes a dull pain that can become stabbing as the cancer grows.
If youve been experiencing severe pain in the back or hips even without engaging in rigorous activities during the day, its best if you get yourself checked. Aside from being one of the most common signs of prostate cancer, severe pain in the back and hips can take a toll on your daily activities, and prevent you from becoming productive during the day. Pain in the back and hips can also adversely affect your mobility, making it very challenging for you to move.
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Preservation Of Bone Health In Pca Patients Treated With Adt
Medically induced hypogonadism leads to bone loss and increased risk of fractures. All patients on long-term ADT should therefore be screened for bone mineral density and vitamin D levels should be measured. Daily supplementation of calcium and vitamin D is strongly suggested. Patients should be encouraged to eliminate risk factors for osteoporosis such as smoking and alcohol abuse and to exercise regularly for prevention of bone loss. A phase III trial demonstrated that the use of denosumab significantly increased bone mineral density and reduced the risk of fractures in men under ADT . Similar effects have been shown for the bisphosphonates zoledronate, pamidronate and alendronate, albeit in smaller trials.
Drugs To Treat Cancer Spread To Bone
If prostate cancer spreads to other parts of the body, it almost always goes to the bones first. These areas of cancer spread can cause pain and weak bones that might break. Medicines that can help strengthen the bones and lower the chance of fracture are bisphosphonates and denosumab. Sometimes, radiation, radiopharmaceuticals, or pain medicines are given for pain control.
Side effects of bone medicines
A serious side effect of bisphosphonates and denosumab is damage to the jaw, also called osteonecrosis of the jaw . Most people will need to get approval from their dentist before starting one of these drugs.
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Is It Prostate Cancer Bone Mets Or Primary Bone Cancer
A recent article by a Duke Cancer Institute oncologist, Dr. Daniel George, raised an interesting point. He opened with his own experience of meeting with an advanced prostate cancer patient who says he has bone cancer. Dr. George writes, In the past, I would smile politely and correct them by saying, actually what you have is prostate cancer that has spread to your bones. But, what if they are right?
Despite the very small number of primary bone cancer cases, Dr. George is implying that before administering a systemic treatment for metastatic prostate cancer, further diagnostic tests should be done to identify exactly what is growing in the bone. If it turns out to be primary bone cancer, there are several different types. Each one requires its own type of chemotherapy. And if its prostate cancer bone mets, which is far more prevalent than primary bone cancer, it must be treated as prostate cancer, even though its in the bone.
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 theyre 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.
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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.
A Potential Method To Prevent Prostate Cancer From Spreading In The Future
Recent studies have detected a transcription factor known as STAT3 as a promoter of prostate cancer metastasis. It has been proposed as a potential target to inhibit metastasis.;
A study published in 2021 showed for the first time how a STAT3 inhibitor could obstruct the progression of prostate cancer. In other words, it wont allow prostate cancer to spread to the bone .
However, we should note that the latter is the first study performed in animal models. It should be replicated and tested several times in clinical trials before finding an application in humans.
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Do You Live In Fear Of Prostate Cancer Every Time Your Hip Bone Area Begins Aching As You Imagine That This Is A Metastasis From A Tumor In Your Prostate
Every prostate cancer is unique, says Michael Herman, MD, Director of Urologic Oncology at South Nassau Communities Hospital in Oceanside, NY.
Occasionally, there are aggressive prostate cancers that spread to the bones early , but the majority of prostate cancers take years to spread to the bones, if in fact they ever do, continues Dr. Herman.
In most cases of these metastases, the first area is actually the bones including the hip.
Luckily, many prostate cancers are not aggressive, and if men are diagnosed with these types of prostate cancer, they typically die with the disease, not because of the disease.
The important thing is to distinguish between these non-aggressive, or indolent, prostate cancers, and the more aggressive types.
As of now, the only way to know whether or not you have an aggressive or indolent prostate cancer is to go to a urologist and get screened for prostate cancer.
If it turns out that you are at risk for aggressive prostate cancer, a prostate biopsy may be necessary.
If youre having hip pain but have not been diagnosed with prostate cancer, chances are exceedingly high that your hurting hip is musculoskeletal in origin or reacting to pressure applied to it such as from a tight seatbelt.
Dr. Hermans interests include reducing the over-diagnosis and over-treatment of prostate cancer by utilizing the latest biomarkers and imaging techniques. He is at the forefront of treatment and research of urologic cancers.
What Is My Outlook
If youre diagnosed with advanced prostate cancer, you may want to know how well your treatment is likely to control your cancer and for how long it will control it. This is sometimes called your outlook or prognosis. But not all men will want to know this.
While it isnt possible to cure advanced prostate cancer, treatments can help keep it under control, often for several years. Treatments will also help manage any symptoms, such as pain.
No one can tell you exactly what your outlook will be, as it will depend on many things such as where the cancer has spread to, how quickly it has spread, and how well you respond to treatment. Some men may not respond well to one treatment, but may respond better to another. And when your first treatment stops working, there are other treatments available to help keep the cancer under control for longer. Speak to your doctor about your own situation and any questions or concerns you have.
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Questions To Ask Your Doctor Or Nurse
- What type of hormone therapy are you offering me and why?
- Are there other treatments I can have?
- What are the advantages and disadvantages of my treatment?
- What treatments and support are available to help manage side effects?
- Are there any lifestyle changes that might help me manage my cancer, symptoms, or side effects?
- How often will I have check-ups and what will this involve?
- How will we know if my cancer starts to grow again?
- What other treatments are available if that happens?
- Can I join any clinical trials?
- If I have any questions or get any new symptoms, who should I contact?
Gleason Score For Grading Prostate Cancer
Prostate cancer is also given a grade called a Gleason score. This score is based on how much the cancer looks like healthy tissue when viewed under a microscope. Less aggressive tumors generally look more like healthy tissue. Tumors that are more aggressive are likely to grow and spread to other parts of the body. They look less like healthy tissue.
The Gleason scoring system is the most common prostate cancer grading system used. The pathologist looks at how the cancer cells are arranged in the prostate and assigns a score on a scale of 3 to 5 from 2 different locations. Cancer cells that look similar to healthy cells receive a low score. Cancer cells that look less like healthy cells or look more aggressive receive a higher score. To assign the numbers, the pathologist determines the main pattern of cell growth, which is the area where the cancer is most obvious, and then looks for another area of growth. The doctor then gives each area a score from 3 to 5. The scores are added together to come up with an overall score between 6 and 10.
Gleason scores of 5 or lower are not used. The lowest Gleason score is 6, which is a low-grade cancer. A Gleason score of 7 is a medium-grade cancer, and a score of 8, 9, or 10 is a high-grade cancer. A lower-grade cancer grows more slowly and is less likely to spread than a high-grade cancer.
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When To Talk With A Doctor
Prostate cancer is the most common type of cancer among men in the United States and should therefore be a subject that men learn about and address with their doctors once they reach adulthood.
Because prostate cancer is slow growing, regular prostate screenings can often catch the disease in its early stages. The American Cancer Society recommends the following timeframe for initial prostate screenings:
- age 40 for men with more than one first-degree relative who had prostate cancer at an early age
- age 45 for men at high risk of developing prostate cancer, including African Americans and anyone with a first-degree relative who was diagnosed with cancer younger than 65 years of age
- age 55 to 69 for men who are of average risk of prostate cancer
The issue of prostate cancer screenings is a somewhat controversial one, so talk with a primary care physician or urologist about the pros and cons of getting a screening at your age.
Questions To Ask The Doctor
- What treatment do you think is best for me?
- Whats the goal of this treatment? Do you think it could cure the cancer?
- Will treatment include surgery? If so, who will do the surgery?
- What will the surgery be like?
- Will I need other types of treatment, too?
- Whats the goal of these treatments?
- What side effects could I have from these treatments?
- What can I do about side effects that I might have?
- Is there a clinical trial that might be right for me?
- What about special vitamins or diets that friends tell me about? How will I know if they are safe?
- How soon do I need to start treatment?
- What should I do to be ready for treatment?
- Is there anything I can do to help the treatment work better?
- Whats the next step?
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What Is Brachytherapy For Prostate Cancer
Brachytherapy is a form of radiation treatment. During brachytherapy, doctors take small particles or seeds that contain a source of radiation and place them inside the body in or near a tumor.
The radioactive material only affects the tissue very close to it, so it tackles the tumor but doesnt harm the rest of the body.
According to the American College of Surgeons , healthcare professionals may recommend brachytherapy as a stand-alone treatment if you have very low- or low-risk prostate cancer or favorable intermediate-risk prostate cancer.
If you have a higher-risk case, healthcare professionals might use brachytherapy in addition to external beam radiation therapy .
Symptoms Of Advanced Prostate Cancer
The symptoms of advanced prostate cancer depend on where the cancer has spread to. Find out about the possible symptoms and when to see your doctor.;
Advanced prostate cancer means that a cancer that began in the prostate gland has spread to another part of the body. If your cancer has spread you might:
- have bone pain
- have weight loss for no known reason
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Can Prostate Cancer Spread
Medically Reviewed by: Dr. BautistaUpdated on: November 18, 2019
Like other cancers, prostate cancer can spread if the cancer cells grow out of control. At ITC, we treat all different types of cancer and know that patients often have a lot of questions surrounding their diagnosis.;
We often are asked what is prostate cancer? Can prostate cancer spread? How is it diagnosed? And more. At Immunity Therapy Center, we know that each diagnosis is unique and every patient is different which is why we focus on a holistic approach to prostate cancer. And we believe that when patients have the knowledge, theyre more likely to take control of their health.
To give you the knowledge to prepare, lets take a closer look at prostate cancer, what symptoms to look for, and how it can spread.
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