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Over half of patients with advanced prostate cancer ignore or underreport symptoms that their disease has spread to the bone (bone metastases or bone mets). This can create a dilemma for the physician: is it better to
- Not ask about symptoms if the patient doesn’t volunteer the information?
- Ask questions at the risk of seeming pushy?
- Ask questions and take the patient’s answer at face value?
It is commonly accepted that men have been brought up to be strong and brave. This may partially explain why they don’t come forward about their symptoms with their doctors.
It’s also possible that if no one has clearly spelled out for patients what the symptoms are, they may not connect occasional aches, unusual fatigue, or poor appetite with prostate cancer that has spread to the bones.
While pain in the lower back is often the first warning sign of prostate cancer bone mets, other symptoms can evolve and change over time. These can include
- General sense of weakness or tiredness
- Difficulty with normal daily activities
- Poor sleep
- Poor appetite
- Less ability to move or get around
- Change in bladder or bowel function
- Spinal cord compression due to fractures of the backbone
- Breaks in bone that happen without undue stress or accidents
3 ways to monitor bone mets
Doctors whose patients have been diagnosed with advanced prostate cancer (cancer that has left the prostate gland at the time of diagnosis or primary treatment) should continue to inform patients regarding signs of early bone mets or increased bone mets activity. Here are the three main ways to monitor bone mets:
- Symptom identification and assessment – Encouraging patients to be self-aware and to report any pain, fatigue or other symptom occurrence can elicit much-needed information.
- PSA testing – Many patients are not aware that when prostate cancer spreads to the bone or other organs, the growing tumor releases Prostate Specific Antigen (PSA) because the cancer originated from mutated prostate cells that still shed their biomarker proteins into the bloodstream. Even if the prostate gland was surgically removed, a rising PSA means that prostate cancer tumors have taken hold somewhere else and are actively growing.
- Radiologic imaging – Today, there are several types of very precise, high resolution imaging that can detect and even characterize bone mets. Imaging such as bone scintigraphy and PET-CT scans relies on radioactive agents called radiotracers to highlight even very small bone mets. MRI is another type of imaging that does not involve exposure to radiation, and can utilize different imaging sequences to portray even very small bone mets lesions.
Combining all three monitoring methods gives doctors – and their patients – the most comprehensive and up-to-date portrait of any bone metastasis that may be present. As with all cancers, early detection and early intervention offers the greatest chance of effective treatment to control the further activity of bone mets.
For patients with painful bone mets that do not respond to drugs or other treatment, the Sperling Medical Group offers MRI-guided Focused Ultrasound (MRgFUS). This outpatient treatment does not involve surgery, medication or radiation. For more information, contact the Sperling Medical Group.
Copyright by Dan Sperling, MD. Reprint permission courtesy of Sperling Prostate Center (New York, Florida), the leading U.S. center for multiparametric detection, diagnosis and image-guided focal treatment of prostate cancer. The Sperling Medical Group offers noninvasive MRI guided Focused Ultrasound (MRgFUS) to treat a variety of conditions, including painful bone mets.
Read more in our Prostate Cancer Health Center.