Wednesday, June 15, 2022

How To Treat Prostate Cancer That Has Spread To Bones

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Symptoms Of Advanced Prostate Cancer

If you are worried about prostate cancer, we have more information about the .

Symptoms of prostate cancer may not develop for many years. The symptoms of advanced prostate cancer may be caused by an enlarged prostate. Or symptoms may be a sign of secondary cancer, where the cancer has spread to another part of the body.

See also

Outlook Once Cancer Has Spread To The Bones

The research on cancer metastasis is rapidly growing. As researchers better understand the mechanisms of bone metastasis, new drugs and other treatments are being developed. These target particular processes in cells involved in how the cancer cells invade and grow in bones.

The use of nanoparticles to deliver drugs is very encouraging. These tiny particles are able to deliver drugs to the bone with minimal toxicity to the person with cancer.

Rapidly treating bone metastasis can lead to a

Cancer That Clearly Has Spread

If the cancer has spread outside the prostate, it will most likely go to nearby lymph nodes first, and then to bones. Much less often the cancer will spread to the liver or other organs.

When prostate cancer has spread to other parts of the body , hormone therapy is probably the most effective treatment. But it isnt likely to cure the cancer, and at some point it might stop working. Usually the first treatment is a luteinizing hormone-releasing hormone agonist, LHRH antagonist, or orchiectomy, sometimes along with an anti-androgen drug or abiraterone. Another option might be to get along with the hormone therapy. Other treatments aimed at bone metastases might be used as well.

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.

Destroying Bone Mets With Mrgfus

Prostate Cancer Spread Metastatic to Bones Life Expectancy ...

If pain medication becomes ineffective, the patients medical team may recommend an intervention aimed at the bone lesion itself. Traditionally, surgery or radiation therapy were the only available methods to remove or try to destroy the lesion. However, surgery is invasive, and radiation therapy takes several weeks to take effect if at all while exposing patients to the effects of ionizing radiation.

Now there is a remarkable new approach to destroying prostate cancer bone mets and relieving the pain they cause. It is called MR-guided Focused Ultrasound .

Within 3-7 days, most patients have significant pain reduction in many cases, almost none.

How Will My Cancer Be Monitored

Your doctor will talk to you about how often you should have check-ups. At some hospitals, you may not have many appointments at the hospital itself. Instead, you may talk to your doctor or nurse over the telephone. You might hear this called self-management.

You will have regular PSA tests. This is often a useful way to check how well your treatment is working. Youll also have regular blood tests to see whether your cancer is affecting other parts of your body, such as your liver, kidneys or bones.

You might have more scans to see how your cancer is responding to treatment and whether your cancer is spreading.

Your doctor or nurse will also ask you how youre feeling and if you have any symptoms, such as pain or tiredness. This will help them understand how youre responding to treatment and how to manage any symptoms. Let them know if you have any side effects from your treatment. There are usually ways to manage these.

Drugs To Strengthen The Bones

Treatment for bone pain is usually reserved for men with advanced prostate cancer. IF you have advanced prostate cancer, its likely youre already receiving cancer drugs to treat the cancer directly. For bone pain specifically, Filson says bisphosphonates are the usual course of treatment. Cancer drugs that lower testosterone can weaken bones, and doctors prescribe bisphosphonates to help reverse the process.

How Fast And Where Does Prostate Cancer Spread

Endi Prayi, B.S

Like other cancers, prostate cancer can spread from the site of where it first started to other sites of the body. Once it spreads, the disease may still respond to the treatment, but typically it is now no longer to be cured. Bones, liver, and lungs are the most common sites for prostate cancer metastasis. How do you know that it has spread? And how fast this metastasis?

Since the early detection of the disease is very crucial for the prognosis and outlook of patients , its very important to diagnose the disease as early as possible.

In the U.S, the number of men diagnosed with the disease at later stages decreases drastically due to the implementation of PSA screening test .

Men with many risk factors of prostate cancer should start discussing the test with their doctor earlier. Visit this section for more information about this!

The PSA test is also recommended in other countries . However whether this test is necessary for all men is debatable.

For those who eventually dont have prostate cancer in their life, the choice to take the test may put them at high risk of getting over-diagnosis, making anxiety more likely.

Therefore, some experts agree that the screening prostate cancer test is more recommended for those who have some /many risk factors of the disease. For more advice, consult more with your GP!

How prostate cancer is diagnosed?

PSA screening test
Rectal examinations
Biopsy procedure
IVU or IVP Intravenous urogram
    Imaging tests

    Cancer That Is Thought To Still Be In Or Around The Prostate

    If the cancer is still thought to be just in the area of the prostate, a second attempt to cure it might be possible.

    After surgery: If youve had a radical prostatectomy, radiation therapy might be an option, sometimes along with hormone therapy.

    After radiation therapy: If your first treatment was radiation, treatment options might include or radical prostatectomy, but when these treatments are done after radiation, they carry a higher risk for side effects such as . Having radiation therapy again is usually not an option because of the increased potential for serious side effects, although in some cases may be an option as a second treatment after external radiation.

    Sometimes it might not be clear exactly where the remaining cancer is in the body. If the only sign of cancer recurrence is a rising PSA level , another option for some men might be active surveillance instead of active treatment. Prostate cancer often grows slowly, so even if it does come back, it might not cause problems for many years, at which time further treatment could then be considered.

    Factors such as how quickly the PSA is going up and the original Gleason score of the cancer can help predict how soon the cancer might show up in distant parts of the body and cause problems. If the PSA is going up very quickly, some doctors might recommend that you start treatment even before the cancer can be seen on tests or causes .

    Faqs About Prostate Cancer That Has Spread To The Bones

    Learn what this diagnosis means for your health and your future, and what you can do to feel strong and well supported.

    Andrea PeirceRosalyn Carson-DeWitt, MDThinkstock

    The is a gland the size of a golf ball that sits below the bladder and in front of the rectum. Its responsible for making the fluid that forms semen. Many men develop cancer of the prostate gland; its 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, its considered advanced, according to the American Cancer Society . When it spreads, its 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 cant be cured, says Scott T. Tagawa, MD, a medical 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 Ive been treating for advanced prostate cancer for 10 or 20 years.

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

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    What Is Metastatic Cancer

    In metastasis, cancer cells break away from where they first formed , travel through the blood or lymph system, and form new tumors in other parts of the body. The metastatic tumor is the same type of cancer as the primary tumor.

    Cancer that spreads from where it started to a distant part of the body is called cancer. For many types of cancer, it is also called stage IV cancer. The process by which cancer cells spread to other parts of the body is called .

    When observed under a  and tested in other ways, metastatic cancer cells have features like that of the primary cancer and not like the cells in the place where the metastatic cancer is found. This is how doctors can tell that it is cancer that has spread from another part of the body.

    Metastatic cancer has the same name as the primary cancer. For example, breast cancer that spreads to the lung is called metastatic breast cancer, not lung cancer. It is treated as stage IV breast cancer, not as lung cancer.

    Sometimes when people are with metastatic cancer, doctors cannot tell where it started. This type of cancer is called cancer of unknown primary origin, or . See the Carcinoma of Unknown Primary page for more information.

    Treatment For Advanced Prostate Cancer

    Metastatic prostate cancer

    Although advanced prostate cancer cannot be cured, it can be controlled with treatment, sometimes for several years. Treatments can also help relieve symptoms and improve your quality of life.

    A multidisciplinary team  will meet to discuss the best possible treatment for you. This will depend on different factors, like your general health. Your cancer doctor will talk to you about the advantages and disadvantages of these treatments.

    The main treatments are:

    • Hormonal therapy

      Hormonal therapies reduce the amount of testosterone in the body. This may slow the growth of the cancer or stop it growing for a while.

    • Chemotherapy

      uses anti-cancer drugs to destroy cancer cells. You may have it with hormonal therapy when you are first diagnosed with advanced prostate cancer. Or, it can be given when hormonal therapy is no longer controlling the cancer.

    • Radiotherapy

      is most often used to shrink cancer that has spread to the bones. External beam radiotherapy uses high energy rays to destroy cancer cells. Its given using a large machine. Radioisotope therapy is a type of internal radiotherapy given as an injection.

    • Surgery

      to remove the prostate is not suitable for advanced prostate cancer. Surgery may be used to help control symptoms or to help stabilise a bone that is at risk of breaking.

    Your doctor or nurse will usually ask you to sign a form giving your permission for them to give you the treatment. They cannot give treatment without your consent.

    See also

    The Top 7 Signs Of Advanced Prostate Cancer

    Elaine K. Luo, M.D.Rena Goldman

    In the early stages, you may not notice any symptoms related to prostate cancer. This is why screenings are important. Symptoms can sometimes be noticed for the first time when the cancer advances.

    Advanced prostate cancer, also called metastatic cancer, means the cancer has spread to other areas of your body beyond your prostate gland. The most common areas for prostate cancer to spread are your bladder, rectum, and bones. It can also spread to your lymph nodes, liver, lungs, and other body tissues.

    Whether youve just been diagnosed or youre in treatment, its also important to know the signs of advanced cancer. Cancer can behave differently depending on your genetics, so not every person will experience the same symptoms in the same way.

    Read on to learn more about the seven top symptoms of advanced prostate cancer and how to spot them.

    Dealing With Pain And Prostate Cancer

    Until your pain is under control it may be very difficult to think clearly or believe that the pain will go away. Coping with any type of pain, whether it is constant or comes and goes, can be tiring and frightening. Pain can affect your daily activities, your relationships with other people, your sleep, and your ability to enjoy life.

    Pain can also affect your thoughts and feelings. Theres no right way that youre supposed to feel and everyone reacts in their own way. You might feel scared, worried, stressed, helpless or even angry. Some people with pain say they feel angry or depressed. And some men worry that their pain is a sign that their cancer is getting worse.

    Your feelings can also affect your pain anxiety can make it worse, and feeling low can make you more aware of your pain. It might be useful to get some extra help if youre feeling down, for example by talking to a counsellor.

    Tiredness can also be a big problem if youre living with pain. If youre feeling very tired, speak to your GP or your doctor or nurse at the hospital. They can give you advice and support. Read more about extreme tiredness  or find out about our fatigue support service.

    There are things you can do to help yourself and people who can help.

    Who can help?

    Your medical team

    Getting help at night or at the weekend , or in an emergency

    Support from hospices

    Surgically Removing The Prostate Gland

    A radical prostatectomy is the surgical removal of your prostate gland. This treatment is an option for curing prostate cancer that has not spread beyond the prostate or has not spread very far.

    Like any operation, this surgery carries some risks.

    A recent trial showed possible long-term side effects of radical prostatectomy may include an inability to get an erection and urinary incontinence.

    Before having any treatment, 67% of men said they could get erections firm enough for intercourse.

    When the men who had a radical prostatectomy were asked again after 6 months, this had decreased to 12%. When asked again after 6 years, it had slightly improved to 17%.

    For urinary incontinence, 1% of men said they used absorbent pads before having any treatment.

    When the men who had a radical prostatectomy were asked again after 6 months, this had increased to 46%. After 6 years, this had improved to 17%.

    Out of the men who were actively monitored instead, 4% were using absorbent pads at 6 months and 8% after 6 years.

    In extremely rare cases, problems arising after surgery can be fatal.

    It’s possible that prostate cancer can come back again after treatment. Your doctor should be able to explain the risk of your cancer coming back after treatment, based on things like your PSA level and the stage of your cancer.

    After a radical prostatectomy, you’ll no longer ejaculate during sex. This means you will not be able to have a child through sexual intercourse.

    Causes Of Advanced Prostate Cancer

    Prostate cancer is the most common cancer in men in the UK. It is more common over the age 65. Although it can happen at a younger age it is uncommon under 50. People who have a prostate include men, transwomen and people assigned male at birth. If you are a trans woman and have had genital gender affirming surgery as part of your transition, you still have a prostate. Trans men do not have a prostate. It is important to talk to your GP or nurse if you are worried about prostate cancer or have symptoms.

    We have more information about the risk factors of prostate cancer.

    The Role Of Parathyroid Hormone

    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 .

    The Underlying Molecular Mechanisms In Prostate Cancer Bone Metastases

    Various types of prostate cancer cell lines, including LuCaP 23.1, LNCaP, C4-2, and IGR-CaP1, were utilized as prostate cancer models. The LuCaP 23.1 and LNCaP cells are highly sensitive to androgen . The C4-2 cell lines showed features of reduced androgen sensitivity and increased metastatic capability . In the androgen-sensitive prostate cancer cell lines, the downregulation in androgen receptor expression reduced AR-mediated transcription and cell growth. Meanwhile, the knockdown of AR expression had a marked effect on AR-mediated transcription and cell growth in the androgen-insensitive prostate cancer cell lines . The expression of AR is an important regulator of prostate cancer cell growth and development at the early stage. However, prostate cancer progresses to castration-resistant prostate cancer at the later stage. Thus, possible correlation between AR expression and the signaling molecules involved in prostate cancer bone metastasis could be considered. On the other hand, the IGR-CaP1 cell line represents a unique model recapitulating widespread bone metastasis with mixed osteoblastic and osteolytic bone lesions that resemble the conditions observed in patients .

    Managing Symptoms Of Advanced Prostate Cancer

    Symptoms can often be improved by treating the cancer, but there are other ways to control symptoms. Tell your doctor or specialist nurse if you have new symptoms or symptoms get worse.

    You may see a doctor or nurse who specialises in pain and symptom control. They are sometimes called palliative care specialists.

    Some people find complementary therapies such as relaxation, gentle massage, or aromatherapy help you feel better and more in control.

    The Role Of Bone Morphogenetic Protein

    Prostate cancer

    Bone morphogenetic protein belongs to the TGF- superfamily, which functionally stimulates the replication and differentiation of normal cells in the osteoblast lineage. It also plays a crucial role during the process of mesoderm induction, neural tissue differentiation, and morphogenesis of various tissues . Interestingly, BMPs are not only synthesized by osteoblasts but also secreted by prostate cancers. The unusual expression of BMPs in prostate cancer has been implicated in the progression of the disease.

    Taken together, BMP expressions are detectable in either normal prostate tissue or prostate cancer cells. The pattern of BMP expression has a close relationship with the progression of prostate cancer and contributes to the onset of bone lesions. It is clear that BMPs play a role in the vicious cycle of metastatic bone formation from prostate cancer. BMPs produced by prostate cancer will induce osteoblastic activities and promote osteoblastic lesions. On the other hand, BMPs synthesized by osteoblasts subsequently enhance the growth of prostate cancer cells allowing further production of BMPs from prostate cancer.

    The Role Of Inflammation

    Acute inflammation is a biological response triggered by harmful stimuli such as infection, trauma, and tissue injury to eliminate the source of damage . The tumor microenvironment is unequivocally linked with inflammation, whether the infiltration of immune cells engages with tumor cells causing inflammation or chronic inflammation promotes the malignant transformation of cells and carcinogenesis .

    In an experiment performed by Morrissey et al., it was found that IL-6 was highly expressed in prostate cancer bone metastases. PC-3 cells inhibited osteoblast activity and induced osteoblast to produce IL-6 that promoted osteoclastogenesis . In addition, a recent study by Roca et al. observed that macrophage-driven efferocytosis induced the expression of pro-inflammatory cytokines, such as C-X-C motif chemokine ligand 5 by activating the signal transducer and activator of transcription 3 and the nuclear factor kappa-light-chain-enhancer of activated B cells signaling. CXCL5-deficient mice had reduced tumor progression. These findings suggested that the myeloid phagocytic clearance of apoptotic cancer cells accelerated CXCL5-mediated inflammation and tumor growth in bone . In summary, findings from available evidence suggest the alleviation of chronic inflammation as a potential therapeutic approach for prostate cancer bone metastases.

    Remission And The Chance Of Recurrence

    A remission is when cancer cannot be detected in the body and there are no symptoms. This may also be called having no evidence of disease or NED.

    A remission can be temporary or permanent. This uncertainty causes many people to worry that the cancer will come back. Although there are treatments to help prevent a recurrence, such as hormonal therapy and radiation therapy, it is important to talk with your doctor about the possibility of the cancer returning. There are tools your doctor can use, called nomograms, to estimate someone’s risk of recurrence. Understanding your risk of recurrence and the treatment options may help you feel more prepared if the cancer does return. Learn more about .

    In general, following surgery or radiation therapy, the PSA level in the blood usually drops. If the PSA level starts to rise again, it may be a sign that the cancer has come back. If the cancer returns after the original treatment, it is called recurrent cancer.

    When this occurs, a new cycle of testing will begin again to learn as much as possible about the recurrence, including where the recurrence is located. The cancer may come back in the prostate , in the tissues or lymph nodes near the prostate , or in another part of the body, such as the bones, lungs, or liver . Sometimes the doctor cannot find a tumor even though the PSA level has increased. This is known as a PSA-only or biochemical recurrence.

    Symptoms Of Metastatic Cancer

    Metastatic cancer does not always cause symptoms. When symptoms do occur, what they are like and how often you have them will depend on the size and location of the metastatic tumors. Some common signs of metastatic cancer include:

    • pain and fractures, when cancer has spread to the bone
    • headache, , or dizziness, when cancer has spread to the brain
    • shortness of breath, when cancer has spread to the lung
    • or swelling in the belly, when cancer has spread to the liver

    What Treatments Are Available

    If you have advanced prostate cancer, treatment wont cure your cancer. But it can help keep it under control and manage any symptoms.

    If youve just been diagnosed with advanced prostate cancer, you may be offered the following treatments:

    Research has found that having  together with one of the main treatments listed above can help some men with advanced prostate cancer to live longer. But radiotherapy isnt suitable for all men with advanced prostate cancer.

    Before you start treatment

    Before you start any treatment, make sure you have all the information you need. Its important to think about how you would cope with the possible side effects. Speak to your doctor or nurse about this.

    It can help to write down any questions you want to ask at your next appointment. It may also help to take someone with you, such as your partner, a family member or friend.

    It can also help to write down or record whats said to help you remember it. You have the right to record your appointment because its your personal data. You could use your phone or another recording device to do this. Let your doctor or nurse know why you are doing this, as not everyone is comfortable being recorded.

    If you have any questions, speak to our Specialist Nurses.

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