Prostate cancer is a malignant disease that happens when the cells in the prostate grow out of control. The prostate gland is located below the bladder, near the rectum and surrounding the urethra. When it is affected by cancer, both the reproductive and urinary systems also suffer.

Patients often experience such symptoms such as a slow or weak urinary stream; the need to urinate more often, especially at night; blood in the urine; erectile dysfunction; pain in the hips, back, chest, or other areas from cancer that has spread to bones; and weakness or numbness in the limbs.

There are treatment options, depending on factors like the patient’s age and expected lifespan; other severe health conditions; the stage and grade of the cancer; the patient’s and physician’s feelings and opinions about the need to treat the cancer right away; and potential side effects.

Treatment options to address prostate cancer include expectant watchful waiting or active surveillance; surgery; radiation therapy; cryotherapy; hormone therapy; chemotherapy; vaccine treatment; and bone-directed treatment.

Bone-directed treatment for prostate cancer

“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 (breaks) or high blood calcium levels, which can be dangerous or even life-threatening,” according to the American Cancer Society.

When cancer spreads outside the prostate, it is important to prevent or slow the metastasis. When it reaches the bones, the treatment goal is to control or relieve pain and other complications. It may be achieved with hormone therapy, chemotherapy, and vaccines, but there are bone-directed treatment options specifically focused on targeting bone metastasis and the problems it may cause.

The options of bone-directed treatment include bisphosphonates, which are drugs that slow down the bone cells’ osteoclasts. The most commonly used bisphosphonate is called Zometa (zoledronic acid); it is used to relieve pain and reduce high calcium levels caused by cancer that has spread to the bones; slow the growth of cancer that has spread to the bones and delay or prevent fractures; and help strengthen bones in men who are getting hormone therapy.

Similar to biphosphonates is the drug Prolia (denosumab), which also targets osteoclast cells, but it is used to prevent or delay problems like fractures in men whose cancer has already spread to the bones, and to slow the spread of the cancer to the bones in men with no obvious cancer spread but with rising PSA levels despite hormone therapy.

Corticosteroid drugs like prednisone and dexamethasone are also used to relieve bone pain in some men as well as lower PSA levels. Other options include external radiation therapy, which is expected to kill cancer cells but is also effective in reducing bone pain, especially if it is limited to one or only a few areas of the bone.

 Radiopharmaceuticals, like Metastron (strontium-89), Quadramet (samarium-153), and Xofigo (radium-223) are drugs with radioactive elements that are injected into the vein and settle in areas of damaged bones to kill cancer cells.

In addition, bone cancer patients experiencing pain use medications ranging from over-the-counter ibuprofen or acetaminophen to stronger prescription medicines such as morphine.

Benefits and risks of bone-directed treatment

Maintaining bone health in men who have advanced prostate cancer is an important goal of therapy, according to the authors of the study “Bone-directed treatments for prostate cancer.”

“Low bone mass is prevalent in men who have prostate cancer, and long-term androgen deprivation therapy causes additional significant decreases in bone mineral density. The adverse effects of the disease and current treatment modalities on bone health are further compounded when patients develop bone metastases, which cause clinically significant skeletal morbidity,” the study’s authors wrote.

“Treatment with bone-directed therapies, including intravenous bisphosphonates, radio-nuclides, and endothelin-1 antagonists, can provide palliative and therapeutic benefits for patients who have established bone metastases, and treatment with intravenous bisphosphonates may prevent the development of bone metastases,” they wrote.

The risks and side effects of bone-directed treatment depend on the choice of treatment. The most common side effects of bisphosphonates and similar medicines are flu-like symptoms and bone or joint pain, while patients with poor kidney function may also experience additional kidney problems. External radiation therapy and radiopharmaceuticals may cause discomfort and sickness, bowel and urinary problems, erectile dysfunction, and a decrease in blood cell counts, which could increase risks for infections or bleeding, especially if the levels are already low.

Major problems related to pain medications are drowsiness, constipation, and the risk of addiction, but this is uncommon if these drugs are used as directed to treat cancer pain.

Note: Prostate Cancer News Today is strictly a news and information website about the disease. It does not provide medical advice, diagnosis, or treatment. This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website.