If bone metastasis is found in a prostate cancer patient, what are the next steps?

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BruceRothMD (Physician - Oncology - Hematology/Oncology (Verified) ) - 01 / 28 / 2013

First, one must determine the extent of bony metastatic disease. A patient who presents with rib pain might have x-rays that prove there is metastatic disease there, but they might also have more dangerous lesions (in the spine or hip, for example) that are not yet symptomatic, but need to be addressed quickly. So, in general, radionuclide bone scans are utilized as they image all the bones in the body at once. Bones that appear to take up the radioactive tracer can then be imaged with some technique with greater specificity, like plain x-rays, MRI, etc. The next step is to determine whether a localized treatment, such as external beam radiotherapy should be used for specific bone lesions because of severe pain, or because that particular bone (usually a weight-bearing bone) is at risk for fracture. If there are a number of lesions that have appeared, the treating physician might consider a change in systemic therapy (e.g. addition of another hormonal therapy, chemotherapy, etc) to treat the progressive disease. Finally, several medications are available which attempt to decrease the risk of fractures of weakened bones and one of which may be prescribed by the treating physician. These include a class of drugs called bisphosphonates (the one approved in this setting is zoledronic acid, or Zometa®), and a class of drugs called RANK-ligand inhibitors (denosumab, Xgeva®). A full discussion of the side effects of these drugs is warranted before starting therapy.
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