Table of Contents

Chapter 8: Managing Bone Metastases and Pain

c. Anticipating Complications From Bone Metastases

As we noted earlier, treatment for prostate cancer bone metastases has three goals: to slow disease progression, to relieve pain, and, perhaps most importantly, to avoid the complications that stem from the weakened bone caused by the metastases.

Pathologic fractures are bone fractures that are caused by disease. Bone that is weakened by metastases is more prone to fracture, and because the metastases often grow around the lower back and upper legs, hip fractures tend to be most common. If you already have some bone loss from hormone therapy or from other causes, your doctors will likely be vigilant about monitoring for fractures, so be sure to report any falls that might precipitate a pathologic fracture. Also, your doctor might discuss with you the possibility of undergoing surgery to stabilize the bones at risk. This can improve your chances of not fracturing the bones, and therefore help to stave off other complications down the road.

By far, the most significant complication from bone metastases is spinal cord compression. The delicate spinal cord runs from the base of your brain down your spine deep inside the vertebrae, the bones that comprise the spinal column. The spinal cord houses most of the nerves that control movement and activity in your body, and damage to your spinal cord can result in permanent disability. Therefore, the vertebrae (singular is vertebra) have to stay very strong in order to protect the spinal cord.

The vertebrae are stacked one on top of the other. A weakening of a vertebra by a prostate cancer bone metastasis can result in the bones collapsing one on top of the other, compressing the spinal cord and the nerves that run out from it.

Cord compression associated with metastatic prostate cancer can cause severe nerve damage, and possibly paralysis, if not managed immediately. Therefore, if your doctor feels that you are at high risk for a spinal cord compression, you might be placed on additional medications, such as steroids, to counteract the effects that might occur should it happen, or you might be considered for a surgical procedure to stabilize the weakened bones.You also might be sent for MRI scans to better visualize the health of your spinal column and to detect early any problems that might occur.

Note that the symptoms of spinal cord compression can be subtle, and might be similar to those seen with many other medical problems. For example, because bone metastases typically occur around the lower back and upper legs, compression of the spinal cord at that point can cause back pain, leg pain or weakness, or loss of bladder or bowel control.

Since you’re the only one who really knows your own body, you’re the only one who can know when something’s not right. Don’t assume that any pain that you’re having is normal, or that any change in your bowel or bladder habits are "just another side effect." They can be signs of a more serious problem, so be sure to tell your doctors about any changes you see. The earlier you can detect any new fractures or a spinal cord compression, the easier it is to treat.