Not all men with advanced prostate cancer experience pain, but many will, particularly if the cancer has spread to the bones.
While oncologists focus on medical treatments for advanced prostate cancer, they are also increasingly concerned with treating this pain.
“The good news is, I really think we’re doing much, much better preventing and controlling pain in prostate cancer,” says Timothy Gilligan, MD, an oncologist at Cleveland Clinic. As of 20 years ago, he explains, there were fewer treatments for prostate cancer and the pain it can cause.
“Intractable pain used to be expected for a significant proportion of men,” says Dr. Gilligan. “Now we have better treatments for the cancer and for the pain.”
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Bone metastases can cause pain in these areas and weaken the bones, leaving people vulnerable to fractures from a fall or other accident. These fractures can cause pain directly, but metastatic cancer can also put pressure on nerves — particularly if it spreads to the spine — which can cause more pain. If the tumor compresses the nerves in the spine, it can cause symptoms such as numbness, tingling, and pain in your arms, legs, or back.
Strategies for Relieving Pain
Pain from advanced prostate cancer can be chronic and may interfere with your ability to do the things you want or need to do. But there are steps you can take to control or relieve pain. Try these tips:
1. Follow Your Treatment Plan
Standard treatments for preventing or slowing the growth of prostate cancer may also help relieve symptoms such as pain. These include hormone therapy (blocking testosterone, which can fuel tumor growth); chemotherapy, which directly attacks the tumor; and surgery.
Additionally, there are treatments that can target bone metastases more specifically. Options include drugs called bisphosphonates, which help strengthen bones and prevent fractures; external radiation therapy; ablation; corticosteroids; and pain medications.
Men with advanced prostate cancer should stick closely to their treatment protocol, Gilligan says, because “We have abundant evidence that [the treatments] reduce pain.”
2. Take Steps to Reduce Stress
“How we experience pain is strongly influenced by our mental state,” says Gilligan. Work with family members, including your spouse or partner, to reduce stress, which may help reduce pain. You can’t avoid stress completely, but getting plenty of sleep, eating well, staying active, and practicing relaxation techniques such as deep breathing and meditation can help keep your stress levels in check.
3. Stay Active
Another proven way to manage stress and pain is through exercise, according to the National Institutes of Health. The Centers for Disease Control and Prevention recommends at least 30 minutes a day, 5 days a week. What’s more, regular exercise can also help strengthen bones, reducing the risk of fracture.
Some research shows that regular exercise improves bone density — a measure of bone strength — in the spine and hips of men with advanced prostate cancer and reduces the risk of pain-causing fractures.
If you’re already active, be sure to talk to your doctor about any exercise modifications you should make to avoid irritating areas where the cancer has metastasized. Your doctor may advise you to avoid activities such as lifting heavy weights, bending and twisting, and high-impact exercises, Gilligan says.
Men with advanced prostate cancer should get medical clearance from the doctor before embarking on an exercise program. Start slowly. Go for a short daily walk, for example, and gradually build from there, increasing your time and incorporating other types of exercise. You can work with a personal trainer or physical therapist to develop an exercise plan that’s safe for you.
4. Get a Massage
Massage may help relieve stress and pain in people with cancer. Just be sure to tell your massage therapist that you have prostate cancer, says Gilligan — especially if there’s a lot of cancer in your bones — because your bones might be weak. The massage therapist can then adjust the strength of the massage accordingly. You may also want to get a doctor’s letter to assure the therapist that massage is safe for you.
5. Pay Attention to Aches and Pains — Especially in the Bones
When cancer weakens bones, they can become painful. It may hurt to stand up. If you experience such pain and difficulty, it’s important to report these symptoms to your doctor. If some part of a bone has been damaged by tumors, a surgeon may be able to affix a rod to help strengthen that bone.
6. Work With a Palliative Care Specialist to Manage Symptoms
While your oncologist works with you to treat the cancer directly, palliative care specialists — doctors, nurses, and other healthcare professionals — are trained to help you find ways to improve your symptoms and quality of life. These specialists focus on relieving pain, as well as helping you manage other symptoms and stress.
“You want aggressive [cancer] treatments,” says Gilligan, “but you don’t want side effects from those treatments.” Studies have shown that people who receive palliative care have less severe symptoms, experience less pain, and have a better overall quality of life than those who don’t opt for palliative care.
Palliative care specialists “work in conjunction with us,” says Gilligan, “but oncologists are slow to get them involved sometimes.” Be your own advocate and ask your doctor for a palliative care referral.
It’s also important to be aware that palliative care is not the same as hospice (or “end of life”) care. You can receive palliative care anytime after the cancer diagnosis to help get your symptoms under control and yourself feeling better.
The Takeaway
When prostate cancer spreads to the bones, the tumors can compress the nerves in the spine, causing pain.
Finding ways to lower your stress levels, such as by exercising or getting a massage, can also help ease pain.
Your cancer doctors can help you find other ways to manage pain, such as by affixing a rod to a damaged bone or referring you to a palliative care team.
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Snijders RAH et al. Update on Prevalence of Pain in Patients With Cancer 2022: A Systematic Literature Rview and Meta-Analysis. Cancers. January 18, 2023.
Campbell BJ. Exercise and Bone Health. OrthoInfo. July 2020.
Kim TJ et al. Pathophysiology of Bone Loss in Patients With Prostate Cancer Receiving Androgen-Deprivation Therapy and Lifestyle Modifications for the Management of Bone Health: A Comprehensive Review. Cancers. June 2020.
Cagliari M et al. Feasibility and Safety of Physical Exercise to Preserve Bone Health in Men With Prostate Cancer Receiving Androgen Deprivation Therapy: A Systematic Review. Physical Therapy & Rehabilitation Journal. March 2022.
Daniel Landau, MD, is a distinguished board-certified hematologist-oncologist with a career that has spanned two eminent institutions: the Orlando Health Cancer Institute and the Medical University of South Carolina. With a specialized interest in genitourinary oncology and hematology, he has been at the forefront of managing both benign and malignant conditions.
Dr. Landau is a pioneering figure in integrating advanced technology into oncology, having served as a director of telemedicine services. Under his leadership, multiple innovative systems have been designed and piloted, all with a singular focus: enhancing the patient experience.
Beyond his clinical and technological endeavors, Landau is deeply committed to medical education. He has dedicated significant time and expertise to nurturing the skills of medical students, residents, and fellows, ensuring that the flame of knowledge and compassion burns bright in the next generation of oncologists.
Paul Raeburn is a journalist and blogger, and the author of five books, including, most recently, The Game Theorist’s Guide to Parenting, in 2016, and Do Fathers Matter?, in 2014, both published by Scientific American/FSG.
He is the author of more than 150 freelance articles for Discover, The Huffington Post, The New York Times Magazine, Scientific American, National Public Radio, and Psychology Today, among many others. He is a past president of the National Association of Science Writers. In addition, he was a media critic for the Knight Science Journalism Tracker from 2009 to 2012 and the chief media critic from 2012 to 2014.
Raeburn was the science editor and chief science correspondent at the Associated Press from 1981 to 1996, and a senior editor and writer at BusinessWeek for seven years after that. From 2008 to 2009, he was the creator, executive producer, and host of Innovations in Medicine and The Washington Health Report on XM satellite radio.
