If PC migrates to the spine, are there warnings, symptoms or pain? I had recurrance after surgery, did hormone therapy. I am androgen independent now but keeping my PSA from running amuck by adding megace to my treatment. How do I know, or what PSA level can warn me of progression to the spine? I have had backaches for 2 years now. My PSA is 2 and rising slowly.
I hope this post helps more than worries.
There are no absolute levels at which cancer is expected to have metastasized.
In general, if the PSA reaches 20, then a bone scan is ordered to see if there are metastases. If you have back pain – then it is best you are evaluated even if your PSA is pretty low. Pain in the bone is a function of how much the surface is destroyed (only the surface lining of the bone actually feels pain). The evaluation would usually consist of a bone scan.
There are some practical considerations here as well, that is what will be done if the result is positive or not?
If there is no known spread, you can discuss the option of radiotherapy to the prostate area if you are candidate.
If it has spread to the bone, and if it is in an area where you feel the back pain, you may be advised to undergo radiation for that site. If it is present in an area without pain, and if it is a high-risk site (such as the spine, because a fracture may mean paralysis) a decision is made whether treatment with radiation to the area (this is not yet standard practice, there is some evidence that it may help, though the evidence is not very robust). Another issue is the use of bisphosphonates (these drugs counter bone loss) and may be started regularly. It is possible that you were given a bisphosphonate during the time when you were on hormones, every 3 to 4 months. This was to inhibit bone thinning due to the hormones. If there is metastasis to bone, the bisphosphonates must work harder and may be used monthly.
There are other causes of bone pain and in your case, it may be due to bone loss. You are predisposed to thinning of bones (osteoporosis) as a side effect of androgen deprivation. Back aches may also be due to age-related degenerative changes, such as arthritis on the back.
Stay positive, and discuss things with your doctor.
Thanks for your comments. I have been on weekly Fosamax, 50,000 IU of D monthly for 4 years, along with eating 2 carmel flavored calcium chews daily, taking a little sun for natural D, and a personal trainer that the gym 3 times per week.
After my recurrance of cancer 4 years ago, I demanded a full analysis of every little problem that may be wrong with me. I wanted to know why this came back at the age of 50, only 1 year after surgery. I pushed my HMO, and finally got the referrals I needed to the right doctors. My endrocrinologist found low vitamin D and osteoperosis with fractures that had probably developed to that stage at least 5 years before I got cancer. This is now resolved with the Fosamax which I am still taking. I started hormone treatments for the cancer 9 months later, which worked for about 18 months before failing. I am on megace now. Current PSA is 2 and rising. My bone, CT, and MRI scans were negative, but the MRI did say mild degeneration of the lumbar spine. I am due for a new set of scans in February 2008. I did outside opinions at UCLA and that doctor said I was at higer risk for spreading cancer to the bone because of my prior osteperosis. I hope that my Fosamax treatments did its job before the primary hormone thereapy failed.
I really appreciate your comments. Other people, please post and share your experiences and knowledge. What does bone pain feel like?
There is no unique pain that will ensure that the pain is really due to bone pain.
The general features would include, no apparent relationship with work or body position, tends to be worse at night, more likely will involve the shafts (as opposed to arthritis which involves joints) it may begin with intermittent bouts of pain, then gradually becomes more frequent to constant.
If the involved bone is on the extremity (an arm or a leg), the pain tends to be more localized (you can pinpoint positions where the pain seems to emanate). This is likely a function of the arm and leg being more discretely innervated as they are used to feel things around you. The pain in the spine tends to be dull and poorly localized. Some may feel the pain over some area away from the spine (areas of similar innervation/supplying nerves). Some patients may even sustain a fracture even before the pain becomes marked.
Try to evaluate yourself as well as to how tolerant you are of pain, because ultimately, the experience is really a function of the individual case as well.
Stay positive. My best to you and Merry Christmas.
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