While oncologists focus on medical treatments for advanced prostate cancer, they are also increasingly concerned with treating this pain. “The good news is, I really think we’re doing much, much better preventing and controlling pain in prostate cancer,” says Timothy Gilligan, MD, an oncologist at the Cleveland Clinic. “When I trained in medical school, and finished in 2001, we used to say people with prostate cancer had a good life until the last six months.” The reason? At that time, doctors had fewer treatments for prostate cancer and the pain it can cause. “Intractable pain used to be expected for a significant proportion of men,” Dr. Gilligan says. “Now we have better treatments for the cancer and for the pain, so intractable pain is much less common.”
When Prostate Cancer Spreads to the Bones
When prostate cancer metastasizes, it most often spreads to the bones, such as the spine, hips, and pelvis, according to the American Cancer Society (ACS). Bone metastases can cause pain in these areas and weaken the bones, leaving men vulnerable to fractures from a fall or other accident. These fractures can cause pain directly, but metastatic cancer can also put pressure on nerves, particularly if it spreads to the spine, which in turn can cause more pain, according to Prostate Cancer UK. If the tumor compresses the nerves in the spine, it can cause symptoms like numbness, tingling, and pain in your arms, legs or back, Prostate Cancer UK says.
1. Follow your treatment plan.
Standard treatments used to prevent or slow the growth of prostate cancer may also help relieve symptoms such as pain. These include hormonal therapy (blocking testosterone, which can fuel tumor growth); chemotherapy, which directly attacks the tumor; and surgery, according to ACS. Additionally, there are treatments that can target bone metastases more specifically; options include drugs called bisphosphonates, which help strengthen bones and prevent fractures; external radiation therapy; ablation techniques; corticosteroids; and pain medications. Men with advanced prostate cancer should stick closely to their treatment protocol, says Gilligan, because “we have abundant evidence that [the treatments] reduce pain.”
2. Take steps to reduce stress.
“How we experience pain is strongly influenced by our mental state,” says Gilligan. Work with family members and your spouse or partner to reduce stress — less stress may help reduce pain. While you can’t avoid stress completely, getting plenty of sleep, eating well, staying active, and practicing relaxation techniques like deep breathing and meditation can help keep your stress level in check, according to the National Institutes of Health (NIH).
3. Stay active.
Another proven way to manage stress and pain is through exercise, according to the NIH. The agency recommends at least 30 minutes a day to boost your mood and reduce stress. What’s more, regular exercise can also help strengthen bones, reducing the risk of fracture, according to the American Academy of Orthopedic Surgeons. A review published in June 2020 by the journal Cancers found that regular exercise in men with advanced prostate cancer improves bone density — a measure of bone strength — in the spine and hips and reduces their risk for pain-causing fractures. If you’re already active, be sure to talk to your doctor about any exercise modifications you should make to avoid irritating areas where the cancer has metastasized — your doctor may recommend avoiding activities like lifting heavy weights, bending and twisting, and high-impact exercises, Gilligan advises. Men with advanced prostate cancer should get medical clearance from their doctor before embarking on an exercise program. Start slowly — go for a short daily walk, for example, and gradually build from there, gradually incorporating other types of exercises, according to the ACS. You can work with a personal trainer or physical therapist to develop an exercise plan that’s safe for you.
4. Get a massage.
Massage may help relieve stress and pain in people with cancer, according to the ACS. Just be sure to tell your massage therapist that you have prostate cancer, says Gilligan, because your bones might be weak. If you have a lot of cancer in your bones, the massage therapist should know, so they can adjust the strength of the massage technique accordingly. You may also want to get a doctor’s letter to assure your therapist that massage is safe for you.
5. Pay attention to aches and pains — especially in the bones.
When cancer weakens bones, they can become painful and it can hurt to stand up. If you experience such pain and difficulty, it’s important to report these symptoms to your doctor, according to the ACS. If some part of a bone has been damaged by tumors, a surgeon may be able to affix a rod to help strengthen it.
6. Work with a palliative care specialist to manage symptoms.
While your oncologist works with you to treat the cancer directly, palliative care specialists are doctors, nurses, and other healthcare professionals who are trained to help you find ways to improve the symptoms you’re experiencing and improve your quality of life, according to CancerCare, Inc., a nonprofit advocacy organization. These specialists focus on relieving pain, as well as helping you manage symptoms and stress. “You want aggressive [cancer] treatments,” says Gilligan, “but you don’t want side effects from those treatments. Studies have shown that people who receive palliative care have less severe symptoms, experience less pain, and have better overall quality of life than those who don’t. Palliative care specialists “work in conjunction with us,” says Gilligan, “but oncologists are slow to get them involved sometimes.” Be your own advocate and ask your doctor for a referral to a palliative care specialist. It’s also important to be aware that palliative care is not the same as hospice, or “end of life,” care. You can receive palliative care at any time after your cancer diagnosis to help get your symptoms under control and feel better.
