Prostate Cancer With Bone Metastases: Answers to Your Questions

The second most common cancer among men is prostate cancer, affecting 1 in 8 men. Prostate cancer is treatable, in most cases, when the cancer remains localized to the prostate gland. But if the cancer advances to stage 4, cancer cells can break away from the original tumor and metastasize to other parts of the body.

At this advanced stage, the cancer can’t be cured, says Scott T. Tagawa, MD, a medical oncologist at NewYork-Presbyterian Hospital and professor of urology at Weill Cornell Medicine in New York City. “But with treatment, many men can live a long time. There are men I’ve been treating for advanced prostate cancer for 10 or 20 years.”

Today, even better treatments are available. For a long time, Dr. Tawaga says, men with advanced prostate cancer lived an average of three to five years. But that changed around 2012, as newer, more effective drugs were introduced. He often starts men on these drugs right away, “when they walk in the door with prostate cancer that has spread.” This has led to a longer survival time and better quality of life for many of the men he treats.

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

The cancer cells spread to the bones by breaking away from your prostate gland and escaping attack from your immune system as they travel to your bones.

There’s no cure for advanced prostate cancer, but there’s a lot that doctors can do to help with the symptoms that might develop. This includes managing pain. “A common misconception is that if there’s cancer in the bone, there must be pain,” Tagawa says. “That’s not true. Cancer can be in the bone without pain.” But if you do have pain, he says, “It can be controlled with anticancer therapies and pain medication, and a good quality of life can be maintained.”

There are treatments for hypercalcemia, as well as other complications of advanced prostate cancer. This includes bones that become weak and break or fracture and growths in the spine that can press on your spinal cord and damage nerves.

No matter what symptoms you develop, palliative care can help. This type of supportive care aims to ease any discomfort you’re experiencing and improve your overall quality of life with prostate cancer.

Promptly treating prostate cancer bone metastases with the newest medication can help change your 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 cancer specialists, who use sophisticated imaging technologies such as PET scans, have gotten very good at finding even tiny bone metastases, which is valuable in diagnosing and treating early.

The treatments your doctor recommends will depend on factors specific to you, from your overall health to how advanced the cancer was when you was first diagnosed.

In addition, your doctor may consider chemotherapy, immunotherapy, radiation treatments — like external beam radiation, which directly targets specific bone lesions — or surgery. 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 treatment equipment consolidated in one place, which can help with the coordination of care.

Achieving and maintaining a healthy weight by eating a balanced diet with plenty of fruits, vegetables, and whole grains and staying physically active can help your overall health. These lifestyle changes can also have a positive effect on bone metastases, Tagawa says. “Both diet and exercise,” he says, “are things that are under [your] direct control.”

A healthy lifestyle can also help you better manage side effects from treatment. Try setting small but realistic goals for yourself when it comes to eating a healthy diet and getting exercise.

If you’re not sure which foods to choose, ask your doctor for a referral to a dietitian. This specialist can help you develop a meal plan that includes foods that offer the best chance of slowing the cancer’s growth and keeping you as healthy as possible.

As an oncologist, Tagawa concentrates on treating the cancer itself, but he’s aware that many of the men he sees with advanced prostate cancer are older and more likely than younger men to have health problems that can benefit from diet and exercise.

“I focus on the cancer,” Tagawa says, “but I don’t want to see [these men] go through all of that and then die from a heart attack or stroke. Attention to both diet and exercise can lead to improvements in quality and quantity of life.”

When it comes to exercise, what matters is that you do it. Just keep moving your body. Swimming, bicycling, walking, and gardening all count. Aim for a certain number of steps each day, and consider using a pedometer to help stay on track. Mix things up, set goals for yourself, and try being active with a friend or group to stay motivated.

And if you’re on hormone therapy, talk to your doctor about investing in some weights or elastic resistance bands to support your bone strength, too.

Metastatic prostate cancer isn’t curable, but your doctor will most likely set up regular visits to check the cancer’s location and manage any long-term side effects from the cancer or any medication you’re taking.

The tests you’ll have and how often you’ll need them should be customized to you. Your care team will consider your overall health, medications that are safe for you to take, other health conditions you have, and at what stage the cancer was when you were diagnosed.

Dealing with a diagnosis of advanced prostate cancer can be very difficult. It’s natural to wonder if you’re 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 you’re 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. Through the American Cancer Society, you can connect with a patient navigator at a cancer treatment center who can help you with practical and emotional issues by calling 1-800-227-2345.

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

• Advanced prostate cancer is a serious condition, but improved treatments have led to longer survival times and a better quality of life for many men.
• Prostate cancer that has spread to the bones can’t be cured, but with appropriately administered therapies, many men can manage symptoms and have a good quality of life.
• While there is no definitive cure, maintaining a balanced diet and staying physically active could aid in overall health. Doctors advise it as a supplementary approach to medical treatment.
• Because symptoms may vary or remain undetected, working closely with a healthcare provider is crucial to monitoring the condition and navigating treatment options.