Download Advanced prostate cancer: managing cancer that has

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
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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
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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