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Prostate Cancer That Spread To Bones

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Outlook For Advanced Prostate Cancer

Prostate Cancer and Bone Metastasis

Even though a cure for advanced prostate cancer doesnt exist today, significant research regarding treatment is constantly occurring as scientists study how combined therapies may improve prognosis, how to identify cancers that are resistant to certain treatments, and how new technologies such as artificial intelligence can provide better information about prostate cancer cells.

How Is A Recurrence Detected

After prostate cancer treatment, you will go for medical check-ups every few months as determined by your doctor. At each follow-up appointment, your doctor will order a blood test to measure PSA levels. This test helps your doctor detect a cancer recurrence. You will also be examined. New symptoms should be reported to the doctor, as these may prompt other testing.

When PSA test results suggest that the cancer has come back or continued to spread, X-rays or other imaging tests may be done, depending on your situation and symptoms. Your doctor may use a radioactive tracer called Axumin with a PET scan to help detect and localize any recurrent cancer so that it could be biopsied or treated.

Your doctor may also use a new drug called Ga 68 PSMA-11 in the scan which binds to PSMA-positive prostate cancer lesions in the tissues of the body so they can be targeted for treatment.

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.

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Where Can I Find Support

It can be very difficult to deal with a diagnosis of advanced prostate cancer. Its natural to wonder if youre doing all you can to fight the cancer and how to handle guilt, intimacy with a partner, and concerns about masculinity. And finding and paying for the best care can, of course, be a challenge.

But emotional and practical support can help you move forward. An important thing to remember is that youre not alone. There are many kinds of help available, and the right cancer resources can make a world of difference.

Ask your doctor for resources you can contact, including social workers and support systems in your community. The Patient Navigator Program of the ACS can be reached at 1-800-227-2345 youll be connected to a patient navigator at a cancer treatment center who can help you with practical and emotional issues.

The Prostate Cancer Foundation has links to in-person and online support groups around the country, and the ACS lists nationwide support programs as well. The PCF also offers resources ranging from help with housing during cancer treatment to finding ways you can look good and feel better while living with cancer.

Can Prostate Cancer Spread

When prostate cancer spreads, it most often spreads to the bone.

Simple cases of prostate cancer can develop into metastatic ones. This type of cancer appears when cancer cells are starting to spread outside their ground zero areas, the prostate gland.

Once they reach other parts of the body, cancer cells are beginning to grow there. Even though the new development reacts as bone cancer or lung cancer, doctors are always naming the type of cancer according to the organ from which it first originated.

Hypothetically, prostate cancer can spread anywhere in the body. However, prostate cancer metastasis is usually attacking lymph nodes first. Once they are connected to the lymphatic system, they can easily travel to other parts of the body:

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Can I Survive Advanced Prostate Cancer Whats The Prognosis

Prostate cancer is the second leading cause of death from cancer in men, according to the National Cancer Institute. While theres no cure, men can live with it for years if they get the right treatment. Each man with advanced prostate cancer is different, of course. You and your cancer have unique qualities that your doctor takes into consideration when planning the best treatment strategy for you.

According to Harvard Medical School, the prognosis for men with advanced prostate cancer is improving because of newer medications that help them get past a resistance to androgen-deprivation therapy that typically develops after a few years of treatment. With these medications, many men are living longer, and a number of men diagnosed with advanced prostate cancer are dying with the cancer, not from it.

Promptly treating prostate cancer bone metastases with the newest medication can help change a mans prognosis dramatically, Tagawa says. There are men who do well for decades, he says. Some men can even stop treatment, go on to live many years, and actually die of something unrelated.

Tagawa says that cancer specialists who use sophisticated imaging technologies, like positron-emission tomography scans, have gotten very good at finding even tiny bone metastases, which is valuable in diagnosing and removing early stage metastases.

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.

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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 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.

Survival Rates And Outlook

Metastatic Bone Cancer: Bone Pain When Breast & Prostate Cancer Spreads

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 31% . Therefore, people with this stage of prostate cancer are about 31% as likely as those without the condition to live for at least 5 years after diagnosis.

However, survival rates are only estimates, and everyone is different. The following factors are among those that can affect a personâs outlook:

  • 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.

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Symptoms Of Prostate Cancer Spread To The Lymph Nodes

Lymph nodes are part of a system of tubes and glands in the body that filters body fluid and fights infection.

There are lots of lymph nodes in the groin area, which is close to the prostate gland. Prostate cancer can spread to the lymph nodes in the groin area, or to other parts of the body. The most common symptoms are swelling and pain around the area where the cancer has spread.

Cancer cells can stop lymph fluid from draining away. This might lead to swelling in the legs due to fluid build up in that area. The swelling is called lymphoedema.

Animal Models Of Prostate Cancer: Metastasis To Bone

To fully understand the mechanisms by which prostate cancer cells metastasize, models that closely resemble the pathology and sequential order of human prostate metastatic disease are necessary. While there are several good animal models of primary prostate cancers that mimic the pathology of human disease, at present there is no model that sufficiently recapitulates human prostate cancer as it metastasizes mostly to the bone. There are several prostate cancer cell lines that form primary tumors, but will not metastasize to bone following orthotopic transplantation into the prostate. Some widely used models of metastatic prostate cancer produce metastases that primarily localize to the lymph nodes or lung and only produce sporadic bone metastases. Moreover, injection of human prostate cells into immunocompromised animals has the inherent limitation of downplaying potential interactions between prostate cancer cells and immune cells. This interaction might be important for site-specific lodging of prostate cancer cells in bone, and should be considered in these studies. An overview of selected in vivo models is described below and in Table 1.

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How Doctors Find Metastatic Prostate Cancer

When you are diagnosed with prostate cancer, your doctor will order tests such as:

These tests may focus on your skeleton and in your belly and pelvic areas. That way doctors can check for signs that the cancer has spread.

If you have symptoms such as bone pain and broken bones for no reason, your doctor may order a bone scan. It can show if you have signs of cancer spread in your bones.

Your doctor will also ask for blood tests, including a check of PSA levels, to look for other signs that the cancer is spreading.

PSA is a protein made by the prostate gland. A rise in PSA is one of the first signs your cancer may be growing. But PSA levels can also be high without there being cancer, such as if you have an enlarged prostate a prostate infection, trauma to the perineum, or sexual activity can also cause PSA level to be high.

If youâve been treated, especially if a surgeon removed your prostate, your PSA levels should start to go down. Doctors usually wait seve,ral weeks after surgery before checking PSA levels. A rise in PSA after treatment may suggest the possibility cancer is back or spreading. In that case, your doctor may order the same tests used to diagnose the original cancer, including a CT scan, MRI, or bone scan. The radiotracer Axumin could be used along with a PET scan to help detect and localize any recurrent cancer.

Though very rare, itâs possible to have metastatic prostate cancer without a higher-than-normal PSA level.

What Is Bone Metastasis

Where Does Prostate Cancer Spread To Bones

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.

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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.

Developmental History Of Wb

Reports comparing BS with MRI for the detection of bone metastases have been available since the last century . However, our research has indicated that the oldest reports that included the term whole-body MRI date back to 1997 . Since the beginning in the twenty-first century, various devices have been developed to enable a whole-body scan in a single session without the need to change the directions of the body, which include multichannel coil and table-top extenders .

In 2004, Takahara et al. used DWI with background body signal suppression . Until the development of this method, DWI was predominantly used for investigations of the central nervous system, especially in cases of acute stroke . However, several researchers have reported that various malignancies in the body show similar high signal intensities .

To date, many therapeutic agents have been developed , such as radium-223 dichloride for castration-resistant prostate cancer , which has a high occurrence of bone metastases . With the increase in the number of treatment options and improvements in patient survival, the use of WB-MRI for providing accurate diagnosis and therapy monitoring has become crucial.

Since the mid-2010s, research has focused on the standardization and therapy monitoring of WB-MRI .

Fig. 4

MET-RADS-P template . The MET-RADS-P template form allocates the presence of unequivocally identified disease to 14 predefined regions of the body

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The Long Bones As A Superior Metastatic Niche

In prostate cancer, disseminated tumor cells circulate through the bloodstream and ultimately localize to the long bones, where they develop into metastatic lesions. The long bones are generally defined as the set of bones that are longer than they are wide, such as the femurs and ribs. The long bones are primarily comprised of a mineralized matrix of type 1 collagen, which is organized into a dense outer layer of cortical bone that provides structural rigidity and protection to the interior trabecular bone. In contrast to cortical bone, trabecular bone is highly vascularized and contains the bone marrow, which is metabolically active and contains a variety of cell types central to hematopoiesis and the lymphatic system . A number of physical features likely combine to make the long bones a comparatively permissive environment for disseminated prostate tumor cells, and contributes to the high rate of skeletal metastases in prostate cancer.

What Happens If You Stop Hormone Therapy For Prostate Cancer

Advanced prostate cancer: Bones at risk!

If you stop your hormone therapy, your testosterone levels will gradually rise again and some side effects will reduce. Your side effects won’t stop as soon as you finish hormone therapy it may take several months. Surgery to remove the testicles can’t be reversed, so the side effects are permanent.

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