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1 How are bones affected by prostate cancer? 4 Where can I find more information? Advanced prostate cancer is prostate cancer that has spread beyond the prostate gland to other parts of the body. This can occur in newly diagnosed men or in men who have been previously treated for prostate cancer. The most common place for prostate cancer to spread is to the bones (bone metastasis). Canadian Urological Association – Patient information www.cua.org Our bones stay healthy through an ongoing process where old bone is broken down and new bone is formed. When prostate cancer spreads to the bone, this balance is changed. Bones can become weak and may eventually fracture (break). The most common bones affected are the spine, thigh bone, ribs, hips (pelvis), and skull. Canadian Cancer Society – Bone metastases www.cancer.ca/en/cancer-information/ cancer-type/metastatic-cancer/ Advanced prostate cancer: managing cancer that has spread to bones Prostate Cancer Canada – Drugs to treat bone metastasis www.prostatecancer.ca/Prostate-Cancer/ Treatment/ Advanced prostate cancer can spread to bones. This is called bone metastasis. For men with advanced prostate cancer, it is important to keep bones healthy and strong. Diet, exercise, and medical therapies can help men maintain their daily activities and prevent problems such as bone fracture (breaks). Men may feel a dull, aching pain at the site of the bone metastasis. However, many men will have back pain that is not caused by their prostate cancer. It is important to tell you doctor about any changes in your pain. Sometimes prostate cancer in the bones can also cause numbness or tingling, and can limit movement. This may happen if the spread of cancer affects the spine and nerves in the spinal cord. If you have numbness or weakness you need to go immediately to the closest emergency department, so doctors can check your spine for any problems. The development and production of this material was made possible through an educational grant provided by Amgen Canada Inc. and Astellas Pharma Canada, Inc. The information in the publication is not intended to convey medical advice or to substitute for direct consultation with a qualified medical practitioner. The Canadian Urological Association disclaims all liability and legal responsibility howsoever caused, including negligence, for the information contained in or referenced by this brochure. © 2014 Canadian Urological Association. All Rights Reserved. cua.org BCPC-10-14 Prostate cancer that has spread to the bones may also cause the bones to release calcium into the bloodstream. Your doctor will order blood tests to monitor your calcium levels. cua.org 2 What are the treatment options for bone metastases? B. Radiation therapy with Radium-223 Description D. Other treatments for bone pain or fractures due to cancer Your doctor may suggest other options such as: • This medicine is injected under the skin every 4 weeks • It delays and reduces the risk of fractures to bones and severe bone pain • A radioactive medicine is injected into the blood (intravenous, IV) every 4 weeks for a total of 6 treatments • Radium-223 goes to where the cancer has spread in the bone; it gives off radiation in the areas where the cancer is causing damage • Radium-223 can improve patient survival and can also delay and reduce the risk of fractures and severe bone pain • Currently, Radium-223 is not widely available in Canada; it may be available to men who join a clinical trial Common side effects Common side effects • Choose calcium-rich foods and beverages • Dairy – milk, cheese, yoghurt • Vegetables – collards, spinach, kale, broccoli • Fruit – oranges • Nuts – almonds, sesame seeds • Fish – salmon, sardines, mackerel A. Therapies that prevent or delay fractures and bone pain caused by cancer I. Denosumab Description • Fatigue, weakness • Low phosphate level in the blood • Nausea Other important side effects • Low calcium level in the blood • Jaw bone problems • Skin infections • Unusual thigh bone fractures II. Zoledronic acid Description • This drug is injected into the blood (intravenous, IV) every 3 to 4 weeks • It delays and reduces the risk of fractures to bones and severe bone pain Common side effects • Flu-like symptoms (fever, fatigue, weakness) • Bone, joint and/or muscle pain, joint stiffness Other important side effects • Kidney problems • Eye problems (pain, swelling, poor vision) • Jaw bone problems • More bruising or bleeding than usual • Diarrhea, nausea, and vomiting • Increase in risk for infections • Pain, redness, or swelling at the injection site Important notes • Your healthcare team will give you instructions on personal cleanliness to minimize exposure of household members and caregivers to radiation from body fluids (eg, urine) C. Prostate cancer medicines Examples: hormone therapy, abiraterone, enzalutamide, docetaxel and cabazitaxel • The goals of cancer therapies are to control prostate cancer and improve symptoms • These medicines can shrink or slow bone metastases and help lessen bone pain • You and your doctor will discuss the best treatment options for controlling your prostate cancer, how the treatment is given, and the possible side effects • Pain-relieving drugs • Other types of radiation therapy • Surgery to support bones 3 What can I do to keep my bones healthy? Men with advanced prostate cancer can make some lifestyle changes that may help keep their bones healthier. • Use vitamin supplements (ask your doctor about the right dose for you) • Calcium (eg, 1000 mg per day) • Vitamin D (eg, 800-1200 IU per day) • Make healthy lifestyle choices • Stop smoking • Drink fewer alcoholic beverages • Limit caffeine (coffee, tea) • Exercise regularly • Walking, stair climbing, stationary bike riding • Arm and leg strengthening • You may want to get advice on a routine that’s effective and safe from a physiotherapist or certified fitness instructor • Keep appointments • Get your blood tests and scans as ordered by your doctor • Go for bone scans or other types of X-rays to monitor the status of your bones • Discuss symptoms like pain, numbness, and weakness with your doctor