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Bone Complications in Prostate Cancer

Posted Aug 24 2008 1:49pm
ANNOUNCER: Prostate cancer patients sometimes face a complication with their disease when the malignant cells which have formed in the prostate, spread into the bones.

DEREK RAGHAVAN, MD, PhD: Bone metastases occur relatively commonly. I say relatively because probably 80% of people with prostate cancer don't have problems. But of the people who do, it tends to go to the lymph nodes and or bone in probably 90% of the people who happen to have metastases.

ANNOUNCER: Prostate cancer patients should check with their doctor about the possibility of bone complications.

DEREK RAGHAVAN, MD, PhD: Patients who have prostate cancer who develop metastases in bone, can either get a type called sclerotic metastases. Sclerotic essentially reflects a thickening of the bone. Less commonly there'll be a type of bone metastases called lytic metastases. And that means a hole forms in the bone.

PAUL MATHEW, MD: If there's a metastases present in a weight-bearing bone such as the femur, for example, such a bone might be more prone to fracture than others. Additionally if the cancer is present in the spine a complication know as spinal cord compression can occur and compress or press upon the adjacent spinal cord. This can result in significant disability, such as with paralysis.

ANNOUNCER: The main symptom of bone metastases is pain which can often be confused with arthritis pain in elderly patients.

DEREK RAGHAVAN, MD, PhD: As a general rule, arthritic pain is localized to a joint. So it'll be the knee, the hip, the elbow, something like that. Where mostly metastatic pain is within the actual bony tissue. It ultimately requires a relatively high level of clinical skill to identify the difference between arthritis type pain and metastasis type pain.

PAUL MATHEW, MD: Pain medications will form the centerpiece of managing any patient with malignant pain, whether it's bony or otherwise. And I think the pain can be particularly severe on occasion.

ANNOUNCER: Prostate cancer patients with bone complications do have several treatment options to discuss with their doctor.

DEREK RAGHAVAN, MD, PhD: Prostate cancer is driven by a male hormone or male chemical called testosterone. For the bone complications themselves if you effect a castration, meaning if you use any of the chemical or surgical ways of stopping testosterone production, in about 80% of patients that will cause the bone metastases to shrink and will put them into remission.

PAUL MATHEW, MD: Radiation therapy is generally reserved for patients who have painful metastases to bone that are threatening pathological fracture or a spinal cord compression.

ANNOUNCER: A more common treatment option involves drugs called bisphosphonates.

DEREK RAGHAVAN, MD, PhD: We will use those, essentially to cut down the severity of bone pain. These agents, in my experience are mostly used for lytic disease. Bisphosphonates, in addition to reducing bone pain, have been shown, particularly in breast cancer, to limit the subsequent development of bone events. The data in prostate cancer are not quite as clear.

PAUL MATHEW, MD: A recent clinical trial that will be published this fall will show a decrease in what is referred to as skeletal adverse events in patients who've been treated with a bisphosphonate called zoledronic acid or Zometa. The patients who receive this drug compared to placebo had a lower rate of pathological fractures but also spinal cord compression and bone pain. It may be that zoledronic acid will find a place in the routine treatment of patients with metastatic prostate cancer based upon this.

ANNOUNCER: Hormonal treatment of prostate cancer, where the tumor is deprived of testosterone, can cause osteoporosis; bisphosphonates can also be helpful in preventing this situation.

DEREK RAGHAVAN, MD, PhD: What actually happens is that, when you have a patient who has bone metastases, and you cause castration to occur, that is associated with an increased risk of osteoporosis. And there are some preliminary data that suggest that the bisphosphonates may overcome that risk.

ANNOUNCER: As with all medications, some patients who take bisphosphonates do experience some side effects.

PAUL MATHEW, MD: A few patients will have a flair in bone pain after initial treatment with bisphosphonates. A few will have nausea and flu-like illness, but generally speaking, they're very well-tolerated with few side effects, both short-term and long-term.

ANNOUNCER: For patients with prostate cancer who have bone metastases, there are now many treatment options. Both early detection and prevention of complications, can help preserve a person's quality of life.

PAUL MATHEW, MD: I think anybody with a diagnosis of cancer and prostate cancer in particular needs to be aware that pain is a warning sign and must be paid close attention to. I think it's important for patients to communicate such symptoms to their physicians promptly and ask their physicians about what effective measures there may be to treat this. Certainly pain relief is available for virtually every single patient. Radiation, surgery, and the use of bisphosphonates and certainly hormonal therapy at the very beginning are all important components in the multi-modality treatment of skeletal complications of prostate cancer.

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