Stage IV Prostate Cancer – Bone Metastasis Treatment and Prognosis

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I have been around quite a bit in my time and I cannot say with any level of confidence that I have seen prostate cancer ever get worse than stage 4 of disease. Ordinarily, prostate cancer progresses slowly and produces no symptoms in its initial stages, but the warning signs may usually develop to include difficult or painful urination; frequent urination, especially at night; and blood in the urine or semen in stages two and three of the disorder. Pain in the lower back, pelvis, or upper thighs often are the signals that prostate cancer cells have spread to the ribs, pelvis, and other bones, the beginning of stage 4.

Metastatic prostate cancer in the bones is the embodiment of late stage advanced prostate cancer. Having had the chance to grow due to negligence on the part of the patient; uncharacteristic aggressiveness of the disease; or misdiagnosis or mis-staging, leading the administration of inadequate interventions for the condition, about one in every ten prostate cancer cases ends up at this point. The tumor would have infiltrated the bloodstream and lymphatic system, and would be all over the bones at various distant locations across the body.

There are two parts to stage 4 prostate cancer. Stage 4 D1 has the tumor spreading to the lymph nodes and obstructing the urethras from the kidneys to the bladder; and stage 4 D2 is worse, having metastasized outside the prostate area to the other distant parts of the body. Even with the best treatments available for the disease today, such a condition is extremely difficult to cure, which is why many oncologists tend to offer the patient palliative care for the rest of their lives with the intention of managing the symptoms and prolonging life.

A combination of external beam radiation therapy and hormone therapy often works in some regard for prostate cancer stage 4 D1. The hormonal treatments suppress the secretion of testosterone, thereby slowing the progression of the carcinoma. Radiation therapy aims to kill the cancer cells, but all it does at this time is that it mostly just slows them down.

For treatment of metastatic stage IV D2 prostate cancer in which the option of cure is off the table with current standard therapies, hormonal therapy also works for the very same reasons as in the previous instance. Of course there are bone complications, resulting in hot and cold spots as seen in bone scans, and eventual fracturing of the bones.

For this, bisphosphonate drugs or radiation therapy will work incredibly well. The bisphosphonate drugs, such as FDA approved Zometa® (zoledronic acid) and Aredia® (pamidronate), effectively prevent bone loss, reducing the risk of fractures and decreasing pain associated with bone metastasis. Radiation therapy is also meant to relieve pain, often using radioisotopes like strontium-89, given intravenously to accumulate in the bones and kill the cancer cells by delivering small amounts of radiation.

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