Bone metastases

The bone is the most common metastasis site of prostate cancer, accounting for 50-75% of all metastases. The median survival time in men with bone metastases was 21 months in recent studies. The most common sites of bone metastases are the spine, femur, and pelvic bones.

The tumor metastasizes via the bloodstream (hematogenic) and forms osteoblastic metastases. Osteoblastic means that the metastases stimulate bone formation. The bone metastases cause severe pain and an increased risk of pathological fractures, i.e. fractures that occur without adequate trauma.

In addition to the general treatment options for metastatic prostate cancer mentioned above, there are also options that specifically address the bone metastases and their symptoms. The most important therapeutic option is pain management. Here, drugs from the opioid class are used.

In some cases, surgical stabilization of the affected bones can also reduce pain. Furthermore, bone metastases can be irradiated.This also leads to a reduction in pain and also has the additional effect that the bone becomes more stable again and fractures can be prevented. The irradiation of the bone can take place from the outside or by means of implanted radionuclides, which release their radiation over a period of two to four months through radioactive decay on site.

Another therapeutic option is the drug group of bisphosphonates. These intervene in bone metabolism and cells responsible for bone resorption. This results in more stable bone tissue and the reduction of bone fractures.

Spinal column metastases

The most common form of metastases in prostate cancer is bone metastases. Approximately 60% of bone metastases affect the spinal column and especially the lumbar spine. Spinal column metastases cause pain in the area of the back.

This pulling pain is caused by constriction of a nerve root. It can also lead to neurological symptoms and even to cross-sectional symptoms. Therapeutically, spinal column metastases are treated like other bone metastases.

This consists of irradiation either from the outside or from the inside using radionuclides. Irradiation leads to a reduction in pain and the bone becomes more stable again. In this way bone fractures can be prevented.

Drug therapy with bisphosphonates is also possible for spinal metastases. This group of drugs interferes with bone metabolism and can prevent remodelling processes in the bone and thus also bone fractures. The most important therapeutic option for spinal column metastases is pain therapy. The metastases often cause very severe pain. These should be treated with opioids such as morphine.