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Bone metastases in advanced prostate cancer: Management

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 clinical manifestations of prostate cancer at diagnosis have changed substantially since the introduction of prostate-specific antigen (PSA) screening. Although a higher percentage of men have localized disease at presentation, metastatic prostate cancer remains an important clinical problem in terms of the number of men with advanced disease and its impact on quality of life, and as a cause of mortality.

Osteoblastic lesions in bone are the most common site of metastasis. These frequently are symptomatic and can cause pain, debility, and functional impairment. The treatment of bone metastases in men with prostate cancer is palliative. The goals of treatment are to improve survival, relieve pain, improve mobility, and prevent complications (eg, pathologic fractures, epidural spinal cord compression).

The management of bone metastases in men with advanced prostate cancer is reviewed here. Treatment can include treatments directed specifically against the cancer-involving bone, osteoclast inhibition to prevent complications from osseous involvement, and systemic therapy directed against the cancer.

The clinical presentation and evaluation of bone metastases and the overall approach to the management of men with advanced prostate cancer are discussed separately. (See "Overview of the epidemiology, clinical presentation, diagnosis, and management of adult patients with bone metastasis" and "Bone metastases in advanced prostate cancer: Clinical manifestations and diagnosis" and "Overview of the treatment of disseminated castration-sensitive prostate cancer".)


External beam radiation therapy — External beam radiation therapy (RT) is the treatment of choice for men with castration-resistant prostate cancer and bone pain that is limited to one or a limited number of sites. External beam RT is discussed separately. (See "Radiation therapy for the management of painful bone metastases".)

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Literature review current through: Nov 2017. | This topic last updated: Dec 06, 2017.
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