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When men have advanced prostate cancer, it's common for the cancer to spread to bones. The most commonly affected bones are:

  • Spine
  • Pelvis
  • Ribs
  • Upper femur (thighbone)

Some problems seen when prostate cancer spreads to bones include:

Pain. The pain may be dull and aching or sharp and stabbing. It may feel worse at night.

Anemia. Cancer can affect your bone marrow, which normally makes red blood cells and other cells in your blood. If you develop anemia due to lack of red blood cells, you may feel:

  • Tired and weak
  • Dizzy
  • Short of breath

Fractures and bone loss. The cancer itself can weaken the bones. In addition, removing the male hormone testosterone through androgen deprivation therapy (ADT), a treatment for advanced prostate cancer, can lead to bone loss and fractures.

Pressure on the spinal cord. There can be pressure on the spine due to cancer in the spine. It can cause bladder and bowel problems, trouble walking, and weakness or numbness in the legs. This is an emergency and requires immediate treatment.

How to Prevent Bone Problems

Doctors can offer many strategies to treat or prevent bone-related problems if you have prostate cancer. These include:

Radiation. Targeted radiation therapy can provide pain relief if cancer has spread to your bones. It does this by shrinking tumors in the bones as well as strengthening the bone itself. Your doctor may direct a focused beam of radiation at a certain spot on a bone. Or they may inject a radioactive substance into your vein that provides radiation to tumors in more than one bone. This substance is highly absorbed by prostate cancer cells. 

Also, one drug, Xofigo, is approved for use in men who have advanced prostate cancer that has spread only to the bones. Candidates should have also received therapy designed to lower testosterone. Xofigo, given by injection once a month, works by binding to minerals within bones to deliver radiation directly to bone tumors. A study of 809 men showed that those taking Xofigo lived an average of 3 months longer than those taking a placebo.     

Surgery. Surgeons can strengthen your bones if they have become weak or fractured. The surgeon may remove the tumor, then repair the bone with bone cement, pins, screws, plates, rods, or other equipment.

Surgery may also be needed to strengthen a damaged area of bone before treating it with radiation.

Bisphosphonates. Different kinds of cells in your bones are constantly breaking down old bone and creating new material. Drugs called bisphosphonates reduce the process of bone breakdown and thus strengthen the bones.

Research has found that a type of bisphosphonate called Zometa (zoledronic acid) can lessen pain and fractures in certain men with prostate cancer. It can also protect men's bones while they're using androgen deprivation therapy.

Denosumab. This drug -- also called Prolia and Xgeva -- can reduce bone loss in certain men with prostate cancer. It may also help protect men's bones when they're taking androgen deprivation therapy. 

Pain-relieving medications. Different types of drugs can help manage the pain from prostate cancer that has spread to bones:

  • Prednisone may help lessen pain by reducing swelling around cancer in bones.
  • Nonsteroidal anti-inflammatory drugs (NSAIDs) or acetaminophen can reduce mild pain.
  • Opioids, such as long-acting morphine or fentanyl patches, may be needed for more severe pain.

Lifestyle changes. If you're using ADT for your prostate cancer, you can help preserve your bone health by taking these steps:

  • Stop smoking.
  • Limit alcohol and caffeine use.
  • Exercise regularly, especially with weights.
  • Take calcium and vitamin D supplements.