Bisphosphonate drugs such as zoledronic acid (Zometa®) help to: strengthen bones lower the risk of fractures reduce bone pain. You can have bisphosphonates as a drip (infusion) into a vein. You have this in the outpatient department every 3 to 4 weeks. Bisphosphonates can also reduce high levels of calcium in the blood (hypercalcaemia) caused by the cancer in the bones.

Denosumab (Xgeva®, Prolia®) is a type of targeted therapy drug that can also be used to help strengthen bones. It is given as an injection just under the skin (subcutaneously) every 4 weeks. Your doctor or nurse can give you more information.

A high level of calcium in the blood is called hypercalcaemia. Secondary cancer in the bones may cause calcium to be released from the bones into the blood. This is not common in prostate cancer. If you have high levels of calcium in the blood, it can make you: feel sick thirsty drowsy constipated. Tell your doctor or nurse if you have these symptoms. It is important hypercalcaemia is diagnosed and treated quickly. Your nurse or doctor will give you a drip (infusion) of fluids. This is to help to flush out the extra calcium from your body. They also give you bisphosphonates as a drip to lower the calcium levels. Your symptoms should go away within a few days.

Strengthening a weakened bone

If there is a risk of a bone breaking, your doctor may advise surgery to strengthen or repair the bone. This is done under a general anaesthetic. The surgeon puts a metal rod down the middle of the bone, or fixes a metal plate on the outside of the bone. This holds the bone so that it will not break. The rods or plates stay in permanently. This is mainly used to treat the long bones in the legs. You may have surgery to the spine. Or you may have a hip joint replaced that has been damaged by the cancer. You may have radiotherapy before or after surgery. This can help repair the bone, or try to destroy any cancer cells.

Malignant spinal cord compression

Malignant spinal cord compression (MSCC) happens when cancer cells grow in, or near to, the spine and press on the spinal cord and nerves. Symptoms of MSCC include: back or neck pain – the first symptom is often severe pain that comes on slowly numbness or pins and needles in your toes, fingers or buttocks feeling unsteady on your feet bladder or bowel problems.

Living with advanced prostate cancer | Macmillan Cancer Support

Managing symptoms of advanced prostate cancer

Advanced prostate cancer may cause symptoms that are difficult to cope with. But there are different ways to manage or control them. Treatments for the cancer can also improve symptoms. But they sometimes take a few weeks to work.

Different members of your cancer team can support you. You may see a doctor or nurse who specialises in pain and symptom control. They are sometimes called palliative care specialists.

A physiotherapist can advise you if you have problems walking. They can plan an exercise programme and help you build your muscle strength. Occupational therapists can also help with equipment that makes it easier and safer to manage at home.

Tiredness

You may feel extremely tired (fatigued). This can be because of the cancer and treatment side effects. There are things you can do to help manage tiredness:

Pace your everyday activities and save energy for things you want to do.
Accept offers of help from others, or ask for help when you need it.
Try to be more physically active to improve your energy levels – for example, by going for regular short walks.
Eat healthily to give you more energy and help you feel better.
Try some complementary therapies such as relaxation techniques, which may help you to feel less anxious and tired.

If you are having problems getting around, ask to see a physiotherapist or occupational therapist. Using a walking aid may allow you to move more easily.

Tell your doctor or nurse if you are very tired. They can test your blood to make sure you do not have anaemia (a low level of red blood cells). This can make you feel tired and sometimes breathless. You may need a blood transfusion to improve this.

Pain

Always tell your doctor or nurse if you have pain. There are different painkillers that work in different ways. You can take painkillers:

by mouth
as injections under the skin
as patches on the skin.

If pain is a problem, try to take your painkillers regularly. Even if you are not in pain when the next dose is due, taking regular painkillers can stop pain coming back. If your painkillers are not working well, tell your doctor. They can increase the dose or change the painkiller to one that works better for you.

There are special NHS pain clinics run by doctors and nurses who are experts in treating pain. If there are problems controlling your pain, you can ask your doctor to refer you to a clinic.

Treating bone pain

The most common place for advanced prostate cancer to spread to is the bones. There are different ways bone pain can be controlled. You may be given:

drugs called non-steroidal anti-inflammatory drugs (NSAIDs)
bone-strengthening drugs called bisphosphonates
1 or 2 sessions of radiotherapy.

Radiotherapy is effective at helping with bone pain but can take a few weeks to work. Take your painkillers regularly until the radiotherapy works.

Bisphosphonates
Bisphosphonate drugs such as zoledronic acid (Zometa^®) help to:

strengthen bones

lower the risk of fractures

reduce bone pain.

You can have bisphosphonates as a drip (infusion) into a vein. You have this in the outpatient department every 3 to 4 weeks. Bisphosphonates can also reduce high levels of calcium in the blood (hypercalcaemia) caused by the cancer in the bones.
Denosumab

Denosumab (Xgeva^®, Prolia^®) is a type of targeted therapy drug that can also be used to help strengthen bones. It is given as an injection just under the skin (subcutaneously) every 4 weeks. Your doctor or nurse can give you more information.

Treating bone problems

For some people, secondary cancer in the bones may cause problems that need treatment. There are ways of managing these.

Hypercalcaemia
A high level of calcium in the blood is called hypercalcaemia. Secondary cancer in the bones may cause calcium to be released from the bones into the blood. This is not common in prostate cancer.

If you have high levels of calcium in the blood, it can make you:

feel sick

thirsty

drowsy

constipated.

Tell your doctor or nurse if you have these symptoms. It is important hypercalcaemia is diagnosed and treated quickly.

Your nurse or doctor will give you a drip (infusion) of fluids. This is to help to flush out the extra calcium from your body. They also give you bisphosphonates as a drip to lower the calcium levels. Your symptoms should go away within a few days.
Strengthening a weakened bone

If there is a risk of a bone breaking, your doctor may advise surgery to strengthen or repair the bone. This is done under a general anaesthetic.

The surgeon puts a metal rod down the middle of the bone, or fixes a metal plate on the outside of the bone. This holds the bone so that it will not break. The rods or plates stay in permanently. This is mainly used to treat the long bones in the legs.

You may have surgery to the spine. Or you may have a hip joint replaced that has been damaged by the cancer.

You may have radiotherapy before or after surgery. This can help repair the bone, or try to destroy any cancer cells.
Malignant spinal cord compression
Malignant spinal cord compression (MSCC) happens when cancer cells grow in, or near to, the spine and press on the spinal cord and nerves.

Symptoms of MSCC include:

back or neck pain – the first symptom is often severe pain that comes on slowly

numbness or pins and needles in your toes, fingers or buttocks

feeling unsteady on your feet

bladder or bowel problems.

If you notice any of these symptoms, contact your cancer doctor, nurse or GP straight away so they can do some tests. The earlier treatment starts, the more likely it is to be effective. Steroids, radiotherapy and surgery may all be used, depending on your situation. Your doctor will talk to you about any possible risks first.

Bladder or bowel problems

If you have bladder problems, such as needing to pass urine (pee) urgently or leakage, your nurse can advise you, or put you in touch with a continence service. There are different pads you can use and treatments that may help. The Bladder and Bowel Community has useful information.

If you have pelvic radiotherapy you may develop bowel problems, such as diarrhoea, much later. There are different ways to manage the late effects of pelvic radiotherapy. Your doctor can give you drugs to help control diarrhoea.

You may also have constipation. This can be caused by:

certain painkillers
being less active than usual
not eating enough high-fibre foods.

There are things you can do to help, including:

having more fibre in your diet
drinking plenty of fluids
going for regular short walks.

Your doctor may need to give you medicine (a laxative) to make your bowels work.

Get a toilet card

Macmillan has a free toilet card you can use. It may help you access a toilet more quickly when you are out. You can use it in places such as shops and pubs. The card says you have a medical condition that means you need urgent access to a toilet.

Eating difficulties

If you have eating difficulties or are worried about losing weight or gaining weight, there is lots of information to help you. You can ask your nurse or a dietitian for advice.

If you have lost weight, food supplements can provide more protein and energy, and help improve your weight. If your appetite is not good, try eating small meals often and sipping nutritional drinks. You can get some of these on prescription.

Weight gain can be a side effect of hormonal therapy. Eating healthily and cutting down on foods that are high in fat or sugar can help manage your weight. Try to only eat as much as you need. Combine this with regular exercise, such as short walks.

Booklets and resources

Complementary therapies

You may find that complementary therapies help you to feel better and more in control. These can be:

relaxation techniques
gentle massage
aromatherapy.

They may reduce symptoms of anxiety or help with pain. Tell your doctor or nurse if you plan to use any complementary therapies. They can advise you if a complementary therapy is suitable for your situation. It is also important to use a qualified therapist and tell them about your diagnosis.

About our information

References

Below is a sample of the sources used in our advanced prostate cancer information. If you would like more information about the sources we use, please contact us at cancerinformationteam@macmillan.org.uk

The National Institute for Health and Care Excellence (NICE) Prostate cancer: diagnosis and management. NICE guidelines. May 2019. Available at www.nice.org.uk/guidance/ng131

Horwich A et al. ESMO Consensus Guidelines: Prostate cancer. Annals of Oncology. 2012.

Reviewers

This information has been written, revised and edited by Macmillan Cancer Support’s Cancer Information Development team. It has been reviewed by expert medical and health professionals and people living with cancer. It has been approved by Senior Medical Editor, Dr Lisa Pickering, Consultant Medical Oncologist.

Our cancer information has been awarded the PIF TICK. Created by the Patient Information Forum, this quality mark shows we meet PIF’s 10 criteria for trustworthy health information.

We want everyone affected by cancer to feel our information is written for them.

We want our information to be as clear as possible. To do this, we try to:

use plain English
explain medical words
use short sentences
use illustrations to explain text
structure the information clearly
make sure important points are clear.

We use gender-inclusive language and talk to our readers as ‘you’ so that everyone feels included. Where clinically necessary we use the terms ‘men’ and ‘women’ or ‘male’ and ‘female’. For example, we do so when talking about parts of the body or mentioning statistics or research about who is affected.

You can read more about how we produce our information here.