Anticipating Complications

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.

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. Vigilant monitoring for fractures is common; less commonly, surgery might be considered to stabilize bones at risk. This procedure can improve the chances of not fracturing the bones, and therefore help to stave off other complications down the road.

The most significant complication from bone metastases is spinal cord compression. A weakening of a vertebra by a prostate cancer bone metastasis can result in the bones of the spinal column collapsing one on top of the other, compressing the spinal cord housed within the bones as well as 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, additional medications, such as steroids, might be used for men at high risk for a spinal cord compression, and surgery to stabilize the weakened bones might be considered. MRI scans can also be used to better visualize the health of the spinal column and to detect early any problems that might occur.

The symptoms of spinal cord compression are often 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. It is therefore important to recognize and address any symptoms as soon as possible. The earlier new fractures or a spinal cord compression is detected, the easier it is to treat.

Additional Reading:

Chapter 8: Managing Bone Metastases and Pain