Managing bone pain in metastatic prostate cancer involves tracking symptoms and working with healthcare teams to utilize treatments like bisphosphonates and radiation therapy to help protect bones.
In Plain English: The Clinical Takeaway
- Mechanism of Action: Bone-protecting agents like bisphosphonates block the cellular activity that breaks down bone tissue, reducing fracture risks.
- Symptom Tracking: Keeping a daily pain diary detailing severity on a 1-to-10 scale helps physicians adjust medical interventions effectively.
- Safe Mobility: Oncology-trained physical therapists design tailored movement plans to preserve function without stressing vulnerable skeletal areas.
Describing Pain to Healthcare Team
Pain is a very individual experience, which means that only you can describe what you’re feeling. For your healthcare team to help you, they need to have an accurate description of your pain.
Your team will ask questions about the pain and use certain tools to help you describe it. But it’s important for you to keep track of it.
“Note where the pain is, how severe it is on a scale of 1 to 10, when it occurs, and what it feels like, such as burning, stabbing, and aching. Also mention what makes it better or worse.”
said Heath.
Your healthcare provider can gain a clearer understanding if you maintain a log detailing your pain’s specifics, triggers, aggravating and soothing factors, and frequency of pain medication usage. Your pain record can also include how you rate your pain at the time you used a pain relief medicine, your rating 1 to 2 hours after using it, and the length of time that your medicine provides relief.
It’s also important to speak to your doctor about pain early on.
“Don’t wait until the pain becomes severe to mention it. Changes in pain are also very important.”
said Heath.
If pain is new or suddenly becomes worse, notify your cancer care team. Other symptoms along with the pain, such as weakness, numbness, and changes in bowel and bladder control, require urgent evaluation.
Bone-Protecting Agents and Targeted Treatments
When prostate cancer has spread beyond the prostate gland, it is referred to as metastatic prostate cancer. Bone is almost invariably the initial destination when the malignancy begins to disseminate, frequently resulting in discomfort.
“Cancer cells growing in the bone can disrupt the normal process of breaking down and rebuilding bone. This can irritate the bone and nearby nerves and may weaken the bone, leading to pain.”
said Elisabeth I. Heath, MD, chair of the department of oncology at Mayo Clinic in Rochester, Minnesota.
Individuals dealing with metastatic prostate cancer have access to two categories of drugs that mitigate pain and stop bone deterioration. Bisphosphonates help prevent the breakdown of bone while at the same time encouraging the creation of new bone. Targeted antibodies help slow the cells that break down bone.
| Medication Class | Primary Mechanism | Key Benefits | Medication Class | Primary Mechanism | Key Benefits |
|---|---|---|---|---|---|
| Bisphosphonates | Help prevent the breakdown of bone while encouraging the creation of new bone | Help prevent the breakdown of bone and reduce complications such as fractures | |||
| Targeted antibodies | Slow the cells that break down bone | Help reduce complications such as fractures and other problems caused by weakened bones |
Bone-strengthening medicines can be an important part of care for some patients with metastatic prostate cancer.
“Bisphosphonates, such as zoledronic acid, and targeted antibodies, such as denosumab, slow the cells that break down bone.”
said Heath.
According to her, these therapies can lower the likelihood of fractures and additional complications stemming from fragile bones in select patients. Although these agents are not conventional painkillers, safeguarding skeletal integrity and minimizing skeletal-related events makes them a vital component of a comprehensive care strategy.
Radiation and Integrative Interventions
Conventional cancer therapies like chemotherapy and hormone treatments can effectively manage or alleviate bone pain caused by metastatic prostate cancer. Radiation therapy, particularly external beam radiation therapy (EBRT), can help with bone pain especially if the pain is limited to one or only a few areas of bone.
Systemic radiation therapy medications circulate through the bloodstream to locate disseminated cancer cells, subsequently emitting localized radiation to destroy them once they arrive at the target sites.
Several complementary and integrative interventions may help people with prostate cancer manage pain.
“Depending on the individual, these can include gentle stretching and…”
said Heath.
Massage therapy may help relieve pain, though patients should check with their doctor and ask therapists to use light pressure rather than deep massage.
Physical Therapy for Better Mobility
General wellness guidelines issued by the International Bone Metastases Exercise Working Group advise patients living with bone metastases to maintain regular physical activity. However, it is important to weigh the possible risks of skeletal complications against potential health benefits.
“An oncology-trained physical therapist can be an important part of a patient’s care team, especially for people whose bones may be weakened by cancer, treatment, osteoporosis, or bone metastases.”
said Arturo Rodriguez, DPT, physical therapist at City of Hope Orange County in Irvine, California.
Endurance, muscular strength, physical functioning, fatigue levels, and general well-being can all benefit from a well-rounded routine that blends aerobic exercises like walking and cycling with resistance training.
Discussing Therapy Risks with Team
Patients must exercise caution when considering certain therapies. Patients must consult their oncology care providers to weigh the individual benefits and drawbacks of bone-strengthening pharmaceuticals, given their potential adverse effects like calcium fluctuations and dental or jaw complications.
Integrative therapies also require medical clearance.
“It’s important to check with the care team before starting a new therapy. For example, deep massage, forceful stretching and other certain exercises may not be appropriate over bones weakened by cancer. The safest approach is one tailored to where the cancer is located and the patient’s individual fracture risk.”
said Heath.
Certain physical activities could increase the risk of injury. Activities like downhill skiing can increase the risk of falls.
Any fitness regimen should be preceded by a professional assessment for patients experiencing severe exhaustion, lymphedema, osteoporosis, bone metastases, balance issues, or specific cardiopulmonary disorders.
References
- Mayo Clinic
- Prostate Cancer UK
- American Cancer Society
- Canadian Cancer Society
Consult a qualified healthcare professional for personalized evaluation and treatment of metastatic prostate cancer.
