What Is Bone Metastasis
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.
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:
- chemotherapy with hormone therapy
- clinical trials.
Research has found that having radiotherapy 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.
If you live in Scotland, you may also be offered a type of hormone therapy called abiraterone acetate together with standard hormone therapy. In the rest of the UK, abiraterone is currently only given to men with advanced prostate cancer that has stopped responding to other types of hormone therapy. The National Institute for Health and Care Excellence is currently deciding whether to make it available for men who have just been diagnosed 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.
If you have any questions, speak to our Specialist Nurses.
Hormone Therapy In Older Patients
The backbone of prostate cancer treatment is hormonal therapy, which aims to limit the activation of the androgen receptor with testosterone. This limitation of AR activation may occur through agents that decrease circulating testosterone, such as gonadotropin-releasing hormone agonists or antagonists. The use of these agents also decreases testosterone precursors and other off-target effects of testosterone. Agents such as nonsteroidal anti-androgens block AR activation and yet preserve circulating testosterone levels.
Providers must carefully consider the toxicities of androgen deprivation therapy in a physiologically older population. These patients have less reserve to absorb additional imbalances or conditions that will impact their current steady state. In general, agents that result in a hypogonadal state can lead to toxicities within the following domains: metabolic and body composition sexual health and mood and central nervous system symptoms .
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Prostate Cancer Is Common With Aging
After skin cancer, prostate cancer is the most common cancer in men. About 1 in 7 men will be diagnosed with prostate cancer in their lifetime. And these are just the men who are diagnosed. Among very elderly men dying of other causes, a surprising two-thirds may have prostate cancer that was never diagnosed.
Only 1 in 36 men, though, actually dies from prostate cancer. That’s because most prostate cancers are diagnosed in older men in whom the disease is more likely to be slow-growing and non-aggressive. The majority of these men eventually pass away from heart disease, stroke, or other causes — not their prostate cancer.
Improvements In Life Expectancy
A decade ago, a man with metastatic prostate cancer would typically have a life expectancy of two to three years. Today, life expectancy for men with the same advanced disease is likely to be five to six years. In the UK the survival rate for men with stage 4 prostate cancer is approximately 50%, meaning that 50 out of every 100 men will survive their cancer for 5 years or more after they are diagnosed with stage 4 prostate cancer*. There is now a much broader range of chemotherapy drugs available for men with advanced disease with greater efficacy . We also have better treatments to control the symptoms of advanced prostate cancer, such as pain from metastases. In this section, we consider in more detail the different treatments that are available and evidence for their effectiveness.
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How To Make The Right Treatment Decision
Current expert guidelines for treatment of localized prostate carcinoma recommend potentially curative therapy for patients whose life expectancy is at least 10 years., Patients with limited life expectancy are more likely to die from health conditions other than prostate cancer. Men with a life expectancy of more than 10 years are more likely to die from progressive prostate cancer. This 10-year rule enjoys broad acceptance among urologists and radiation oncologists.,
Conservative management proved to be an acceptable treatment option for men with low-grade Gleason scores, clinically localized disease, and life expectancies of less than 10 years. Increasing age was described as a risk factor for receiving inadequate treatment for prostate cancer. Thus, older men have been shown to receive potentially curative therapy less often than younger men., Radical prostatectomy is preferred treatment in men younger than 70 years, whereas radiation therapy is applied predominantly in patients older than 70 years. Conservative therapy such as watchful waiting or androgen deprivation by luteinizing hormone-releasing hormone analogs is preferentially applied in men older than 80 years. Watchful waiting or hormonal therapy is used to treat 82% of men older than 80 years.
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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?
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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.
What Are The Symptoms Of Metastatic Cancer
Some people will have minimal or no symptoms of metastatic cancer. If symptoms are present, theyre based on the location of the metastasis.
Bone metastasis
Bone metastasis may or may not cause pain. The first sign of bone metastasis is bone breakage after a minor injury or no injury. Severe back pain accompanied by leg numbness or difficulty with bowel or bladder control must be evaluated immediately.
Brain metastasis
If a tumor has metastasized to the brain, symptoms may include headache, dizziness, visual problems, speech problems, nausea, difficulty walking or confusion.
Lung metastasis
Cancer symptoms of lung metastasis are usually very vague. This is because they can be similar to symptoms of other health conditions. Warning signs may include a cough , coughing up blood, chest pain or shortness of breath.
Liver metastasis
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What Can Affect My Outlook
No one can tell you exactly what will happen. How prostate cancer affects you will depend on many things.
- Your stage Whether your cancer is localised, locally advanced, or advanced.
- Your Gleason score or grade group The higher your Gleason score, the more aggressive the cancer, and the more likely it is to spread.
- Your treatment options You may be able to have treatment aimed at getting rid of the cancer. Or you may be able to have treatment to keep the cancer under control. Read more about choosing your treatment.
- Your health If you have other health problems, you may have fewer treatment options. And you may be more likely to die from another condition, such as heart disease.
- Your PSA level After youve been diagnosed, PSA tests are a good way of monitoring your prostate cancer and seeing how youre responding to treatment.
- How successful your treatment is Your treatment may be successful at getting rid of your cancer or keeping it under control. But for some men, treatment may not work as well as expected.
Types Of Imaging Studies
If your doctor suspects your cancer might be spreading, they will likely order more imaging tests. A common imaging workup may include a bone scan and a CT scan of the abdomen and pelvis. An MRI might be done as well. Some research centers are also using magnetic MRIs or PET scans to further refine the staging of prostate cancer.
Prostate Cancer Doctor Discussion Guide
Get our printable guide for your next doctorâs appointment to help you ask the right questions.
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What Are Risk Factors For Prostate Cancer
The main cause of prostate cancer is unknown. However, several factors may increase the risk of developing the disease:
- Age: As you become older, your chances of acquiring prostate cancer increase. Most of the prostate cancer cases are observed in men over the age of 50 years.
- Ethnicity: Prostate cancer is more common in Black men and less common in Asian men for unknown reasons.
- Genetics: Men who have a parent or sibling who has had prostate cancer are at a slightly higher risk of developing prostate cancer.
- Obesity: Studies have revealed that obesity may potentially raise the risk of prostate cancer.
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.
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Life Expectancy Of Stage 4 Liver Cancer
Life Expectancy of Stage 4 Liver Cancer is not very impressing at all. The stage is concerned as one of the most critical Liver Cancer. The impact of the Liver Cancer Stage 4 is very bad, and the condition gets worse with time. On average patient may survive for 6 months. However, if the complexity of Liver is less then, people may survive for even couple of years. However, the life expectancy of Stage 4 depends upon the condition of the people.
Understanding Prostate Cancers Progression
To determine the appropriate treatment, doctors need to know how far the cancer has progressed, or its stage. A pathologist, the doctor trained in analyzing cells taken during a prostate biopsy, will provide two starting pointsthe cancers grade and Gleason score.
- Cancer grade: When the pathologist looks at prostate cancer cells, the most common type of cells will get a grade of 3 to 5. The area of cancer cells in the prostate will also be graded. The higher the grade, the more abnormal the cells.
- Gleason score: The two grades will be added together to get a Gleason score. This score tells doctors how likely the cancer is to grow and spread.
After a biopsy confirms prostate cancer, the patient may undergo additional tests to see whether it has spread through the blood or lymph nodes to other parts of the body. These tests are usually imaging studies and may include a bone scan, positron emission tomography scan or computed tomography scan.
Prostate cancer treatment: The care you need is one call away
Your multidisciplinary team will work with you to develop a personalized plan to treat your prostate cancer in a way that fits your individual needs and goals.
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Andrews Final Week At Home
It was a very busy and happy house in the final week. Friends and family visited every morning and evening. Andrew and I rested in between.
It was a very busy and happy house in the final week.
Andrew was paralysed from his spinal cord compression, so his needs were quite complicated. We had carers come in four times a day to clean and move Andrew. And every afternoon, the district nurses would come in. They would check on Andrew and see how he was doing. And they would sit and talk to me and see how I was.
The district nurses left a box of drugs in our house. They explained to us that they would give Andrew these drugs if his current drugs werent able to control his pain. It made me realise that he would actually die soon. But it also reassured me that the nurses were prepared and knew what they were doing.
Andrew turned to me one day and said, Im not frightened of dying, I just dont want to leave you.
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Proactive Steps You Can Take
Diet and Exercise
According to the Prostate Cancer Foundation, a few minor changes to eating habits can be helpful for those dealing with the effects of prostate cancer. The organization recommends incorporating vegetables into many of your meals and minimizing fat intake from red meat and dairy products. The group also recommends getting vitamins from food sources like whole grains and vegetables as opposed to vitamin supplements. It is particularly important to get calcium from food sources, namely dark green leafy vegetables and low-fat dairy foods.
Coping and support
If you or a loved one has prostate cancer, its important to remember that you are not alone: More than 150,000 men are diagnosed with prostate cancer every year, according to the Prostate Cancer Foundation.
Still, it is normal for men diagnosed with prostate cancer to feel alone, uncertain or fearful. Support groups are an excellent resource for men with prostate cancer, providing a community with whom to share encouragement, information and emotional support. These groups range from online communities with people who can help answer questions to groups of men diagnosed with prostate cancer or family members of those diagnosed. They are sometimes facilitated by mental health professionals and experts in the field of prostate cancer.
Palliative care
Palliative care can include any of the following:
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What Are The Treatment Options For Prostate Cancer
Treatment for prostate cancer is determined based on the size of the tumor and extent of metastasis and may include the following:
Hormone therapy
Hormone treatment deprives the body of the male hormones needed for prostate cancer growth. Orchiectomy or luteinizing hormone-releasing hormone analogs are used alone or in conjunction with an anti-androgen.
Newer hormonal drugs that decrease androgen production and block androgen receptor signaling have been approved by the FDA for the treatment of metastatic prostate cancer following chemotherapy, and they are being studied for early usage in the disease.
Abiraterone
Abiraterone is an oral targeted medication that inhibits androgen synthesis not only in the testes but also in the adrenal glands and the tumor itself. When used with prednisone, abiraterone has been demonstrated to improve quality of life and decrease pain progression in patients with hormone-refractory prostate cancer .
Although this drug is normally well tolerated, adverse effects such as tiredness, elevated blood pressure, and electrolyte or liver problems are possible, and patients must be checked on a regular basis.
Enzalutamide
Enzalutamide interferes with molecular processes that enable prostate cancer growth by targeting various stages in the androgen-receptor-signaling cascade. Furthermore, the medicine does not cause the typical adverse effects of chemotherapy, such as nausea and hair loss.
Chemotherapy
Targeted therapy
Immunotherapy
Sipuleucel-T
Stage 4 Prostate Cancer Clinical Trials
Clinical trials provide cancer patients with life-extending and curative new medicines. Clinical drug trials are critical in getting new medicines to patients who need them the most, as well as securing data so that regulatory clearances may be secured, and new drugs can enter broad clinical practice. Patients who take part in clinical trials benefit both treatment science and their fellow patients.
There are currently 100 Phase III drug trials and more than 500 Phase I/II trials related to prostate cancer treatment in progress in the United States alone. Those that are approved will join the 12 new drugs that have been approved for men with advanced/metastatic disease since 2010 and further improve outcomes for patients:
Using our AI-powered approach, Massive Bio leads patients through the most extensive clinical trial matching process available.
We can assist you if you have been diagnosed with any of the following prostate cancer subtypes:
- Transitional Cell Carcinoma
- Small Cell Carcinoma
If you do not know which type of prostate cancer you have, that is okay. Additional testing can help you determine your exact diagnosis.
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