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Bone metastases in advanced prostate cancer: Clinical manifestations and diagnosis

A Oliver Sartor, MD
Steven J DiBiase, MD
Section Editors
Nicholas Vogelzang, MD
W Robert Lee, MD, MS, MEd
Jerome P Richie, MD, FACS
Deputy Editor
Michael E Ross, MD


The spectrum of clinical manifestations of prostate cancer has changed substantially since the introduction of prostate specific antigen (PSA) screening, with a higher percentage of men now having localized disease at presentation. However, metastatic prostate cancer remains an important clinical problem, both in terms of the number of affected men and its impact on quality of life.

The bones of the axial skeleton are the predominant site of metastasis in most men with metastatic prostate cancer (image 1), and these lesions can cause pain, debility, and/or functional impairment. The clinical manifestations and diagnostic assessment of bone metastases in men with prostate cancer are reviewed here.

An overview of bone metastases is presented separately, as is a discussion of the management of prostate cancer bone metastases. (See "Overview of the epidemiology, clinical presentation, diagnosis, and management of adult patients with bone metastasis" and "Bone metastases in advanced prostate cancer: Management".)


Malignant cells are widely disseminated in men with advanced prostate cancer. However, metastases preferentially develop in the bones of the axial skeleton, where red marrow is most abundant. The reasons for this pattern of metastasis are unclear, but the leading hypothesis focuses on symbiotic interactions between prostate cancer cells and bone stromal cells, such as osteoblasts, osteoclasts, and fibroblasts.

The bone metastases in men with prostate cancer are usually osteoblastic (ie, characterized by new bone formation). However, increases in bone resorption have been consistently demonstrated histologically and biochemically. Bone destruction is an important factor in the etiology of pain and other complications due to bone metastases, although it is unclear if such bone destruction precedes the development of osteoblastic metastases or is a consequence of increased bone formation.


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Literature review current through: Sep 2016. | This topic last updated: Mar 18, 2016.
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