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- Sun Jul 25, 2010 6:17 pm
my dad had prostate cancer 9 years ago, he currently is being treated with
luprin. His psa was 300 6 months ago and was just tested again and was
714.Recent MRI. They have been searching for WHERE it had spread and just found
it on his 4 and 5 lumbar and spread down to his sacrum. He was told inopperable
and advanced stages but possible radiation. He's in good health otherwise. My
question is; can you estimate how long before he succumbs to the cancer? How
fast does it spread? What progression can we anticipate? Paralization? Extreme
pain? Any info would be helpful.
| Dr.M.jagesh kamath
- Tue Aug 31, 2010 11:20 am
Hello,Bone metastasis significantly reduce the life expectancy and quality of life which ultimately lead to pathological fractures,reduced motility,pain,and bone marrow failure.The main area of seeding is the red marrow,and spread to multiple areas.Radiopharmaceutical drugs when given, lead to significant pain relief.Since the cancer cell interact with the bone tissue and take part in a paracrine way stimulating bone growth at the same time growing more,the cancer spreads.The more high grade the cancer is faster the spread.Also the use of endocrine therapy,the duration and intensity will have bearing on the severity of skeletal metastasis.
| Dr.M.Aroon kamath
- Tue Aug 31, 2010 11:53 am
Dr.Jagesh has already concisely explained the complications due to the bony mets.
The following two studies may address your concerns regarding the prediction of prognosis.
Soloway et al, suggested a semiquantitative grading system based upon the extent of disease observed on the bone scintigram, namely that patients with fewer than six metastatic deposits had a significantly better 2-year survival rate than those with more extensive metastases. Patients with a superscan or its equivalent, which means bone metastases in >75% of the ribs, vertebrae and pelvic bones, had a significantly poorer 2-year survival rate than those with fewer metastatic sites.
[Soloway MS, Hardeman SW, Hickey D, Raymond J, Todd B, Soloway S, et al. Stratification of patients with metastatic prostate cancer based on extent of disease on initial bone scan. Cancer (1988) 61:195–202].
Others have not found this grading system reliable. No correlation between the survival time after the detection of bone metastases and the number of lesions at the time of detection was found. Kazuo Ohmori et al conclude thus:
“we think that the prediction of the prognosis cannot be made at the time of the detection of bone metastases, because the response to therapies for bone metastases, such as chemotherapy, radiation or hormone therapy, differs with the type of cancers and with the individual”.
[Kazuo Ohmori et al. Japanese Journal of Clinical Oncology 27:263-267 (1997)].
There are a few reports suggesting that serial bone scintigrams are valuable in predicting the prognosis in patients with metastatic breast and prostate cancers. It appears the the "rate of increase" in the number of bone metastases on serial bone scintigrams is useful for estimation of the prognosis in patients with metastatic prostate cancer.