Table of Contents

Chapter 8: Managing Bone Metastases and Pain

a. Detecting Bone Metastases

Because the prostate is sitting in pelvic region, that’s often the first area to which the cells will travel: the pelvic bone, the lower spine, and the upper thighs. For many men, pain in this region is often the first sign that the cancer might have spread to the bone or that there might be a complication from a bone metastasis. Some might experience constant pain localized to a particular area, while others might experience bursts of pain in a number of different areas that wax and wane over time.

If your doctor suspects that the pain might be due to a bone metastasis, or if your doctor feels that you are at high risk of developing a metastasis, you will likely undergo one or more tests to determine the size and location of the metastasis. The "gold standard" test, or the one that is considered the best, is the bone scan, or bone scintigraphy. A radioactive substance that acts like a dye is injected into your vein, and images of your entire skeleton are taken.When prostate cancer cells settle in the bones, they don’t just sit there. They interact with the bone cells, causing new bone cells to grow and causing the bone tissue to break down. The dye-like material that’s injected highlights areas of bone metabolism or activity—areas where bone tissue is changing more rapidly than it normally would in a healthy adult male.

Bone scans are very sensitive, meaning that they can detect even small amounts of increased bone metabolism. But they’re not very specific, meaning that the changes they detect might not be caused by prostate cancer bone metastases. In fact, the dye might be detecting changes in the bone due to a previous fracture, infection, arthritis, or even bone loss that can result from the use of hormone therapy.

This is another reason it’s important that all of your doctors have a complete record of your medical history. Treatments for bone metastases can be very effective, but they’re not appropriate for other diseases or disorders that can damage your bones and joints. Knowing your complete medical history can help your doctors better assess the results of your bone scan and therefore determine the treatment approach that’s right for you.

Also, keep in mind that even if your treatment is effective at controlling the growth of bone metastases, you might not see a change on a new bone scan. Your doctors might use other types of scans, such as x-rays, CT scans, MRIs, and PET scans, to monitor the effects of the metastases over time and to determine whether any new changes on a bone scan are caused by bone metastases.