Prostate Cancer

Managing Pain in Advanced Prostate Cancer

Advanced prostate cancer tends to affect vital organs and spread to multiple sites, which causes complex pain syndrome.

Prostate cancer-induced pain majorly results from cancer cells infiltrating the bones and organs around the pelvic area. Various treatments with chemotherapy, radiotherapy, and surgery can also cause injury to nerves and soft tissues.

Thus, patients with advanced prostate cancer point to pain that starts not only from cancer itself but also from treatment side effects. The presence of comorbidities like infection and osteoporosis can further exacerbate the severity of this disease’s problem.

For instance, prostate cancer patients are likely to have diabetes, causing diabetic neuropathy, subsequent nerve damage, and pain. This article looks at the incidence and mechanisms of pain in advanced prostate cancer and reviews current treatment options.

Advanced prostate cancer

Prostate cancer is a malignancy that starts in the prostate gland, a small gland located between the bladder and the penis. The disease is advanced if it has spread to other parts of the body (also called metastasis).

Prostate cancer often infiltrates the bones, lymph nodes, liver, and lungs. It rarely moves to other organs due to mechanisms that are poorly understood. The spread of prostate cancer to the bones presents several clinical challenges, including a lack of effective treatment and increased pain levels.

Do all men with advanced prostate cancer have pain?

Pain is one of the most challenging symptoms of cancer. Studies on the prevalence of pain in cancer patients report high figures that range from 20-60% in patients on active treatment (Van den Beuken-van Everdingen et al., 2007).

The rate is significantly higher in patients with advanced cancer ranging from 60-85%, including in advanced prostate cancer (Berry et al., 2006).

Not all men with advanced prostate cancer have pain, and those who do experience it at different levels. Severe pain is frequent in patients who have bone metastasis or cancer inversion of other vital organs.

More than 75% of men with advanced prostate cancer develop bone metastases, causing severe pain and increased bone fracture risk. Bone pain decreases the patient’s quality of life and predicts overall survival (Fizazi et al., 2015).

The mechanisms that drive bone pain in these circumstances are not fully understood; however, research shows that softened bone sections, abnormal bone formation, sensitization of both peripheral bone afferents and central spinal circuits drive the pain.

Infiltration of organs around the prostate gland, including the urethra, urinary bladder, and ureters, is common in advanced prostate cancer and causes pelvic pain.

What are the causes of pain in advanced prostate cancer?

Pain is one of the most common symptoms in cancer patients with advanced disease and the effect of diagnosis and treatment.

The cause of pain in advanced prostate cancer derive from multiple sources, including:

  • The presence of a tumor and its spread to distant organs – cancer spread to bones, nerves, lymph nodes, muscles, and other parts of the body damage and irritate them to cause pain.

  • The side effects of treatment – therapy to kill cancer cells often irritate or damage nearby healthy tissues.

  • Cancer and treatment-related infections.

  • Cancer and treatment-induced metabolic imbalance.

  • Mechanisms unrelated to cancer or the treatment – men with prostate cancer may also have other conditions, including prostate and non-prostate disease. Common comorbidities that increase pain in prostate cancer include:

Prostatitis including bacterial and non-bacterial prostatitis

– Chronic pelvic pain

Urinary tract infection affecting the bladder and the urethra

– Diabetic neuropathy

– Inflammation

What should you do if experiencing pain?

It will help if you inform your medical team about any pain you have. Early identification of the source and treatment is often essential for effective pain management. In the majority of cases, treatment can control prostate cancer-related pain.

In addition to conventional pharmaceutical therapies, there are things you can do to help with your bone and prostate pain. There is a range of complementary therapies that have been shown to reduce the severity of pain. The following are some of the common complementary therapies:

Behavioral pain interventions – coping skills training and emotional support can help you manage prostate cancer pain. Evidence-based pain coping skills training interventions are a recommended part of multimodal pain treatment.

The training is traditionally delivered in person, but recent studies suggest that online tools achieve a similar outcome and increase accessibility (Penedo et al., 2020). Studies have shown that cognitive-behavioral stress management interventions improve quality of life in men recovering from prostate cancer treatment (Penedo et al., 2006).

Acupuncture – is another complementary therapy used in pain management. It involves inserting thin needles into the skin at specific points on the body. For prostate-related conditions, acupuncture has been shown to reduce both bone and pelvic pain (Paley et al., 2011; Sahin et al., 2015). However, it might not be suitable if you have specific comorbidities.

Gentle massage – to specific areas of the hands, feet, and other painful regions can help you relax, relieve stress, and improve blood flow.

Aromatherapy – Different plant-based natural oils added to baths, inhaled, or used in massage may help you feel calm and relaxed. Like massage, feeling calm and relaxed can reduce the severity of prostate cancer pain.

Hypnotherapy – talking therapy to encourage positive can help you relax and relieve the feeling of pain.

How can prostate cancer pain be managed?

Because cancer pain derives from multiple sources, multimodal treatment is recommended. This approach to pain management combines various groups of medications and complementary therapies for pain relief.

In addition to the complementary therapies discussed above, the most commonly included medications include anesthetics, opioids, non-steroidal anti-inflammatory drugs (NSAIDs), and alpha-2 agonists.

The best combination for you will depend on several things, including the diagnosed source of the pain, your general health, and your daily activities.

Treatment options

Cancer growth and spread in the bone is one of the leading causes of pain in prostate cancer. A range of treatment options is available to help management, including:

  • Pain-relieving radiotherapy –Radiation therapy can shrink the bones’ cancer cells, stopping them from damaging the nerves and causing pain. Further, slowing cancer growth in the bone allows the bones to repair and strengthen. Studies have shown that men who receive pain-relieving radiotherapy experience improved control of their pain (Gardner et al., 2019).

  • Bisphosphonates -are a class of drugs that treat bone damage or prevent further damage caused by cancer cells. They bind to damaged bones and can help reduce further loss of bone density and relieve pain. Bisphosphonates are often used with other pain treatments, such as opioids, radiation, and behavioral training.

  • Surgery -to support damaged bone is another bone-specific therapy. Though rarely used, a metal pin or plate can be inserted into the bone to strengthen and stabilize the area affected by cancer. This type of surgery can reduce the risk of bone fracture. When supported with bisphosphonates and complementary therapy, surgery can be an effective pain management strategy in prostate cancer.
  • Transcutaneous electrical stimulation (TENS) – is another clinical intervention whereby electrical currents are sent to nerves in the body. This signal serves to interfere with the pain signals caused by cancer. Studies have shown that TENS is beneficial to men with bone pain.

  • Nerve blocker -Like TENS, agents that block nerve activity can be injected into a particular part of the body to block the pain signal. This type of treatment is useful for men who only have pain in one or two define areas. It is also useful when other treatment options stop working or pose a risk of severe side effects.

  • Other treatment – Infections like underlying bacterial prostatitis may worsen the extent of prostate cancer pain. Thus, antibiotic treatment may be included in multimodal therapy to eliminate the infection and further reduce pain.

Conclusion 

Cancer pain is a significant issue in the treatment of advanced prostate cancer. Multimodal therapy with medications, surgery, and complementary therapies is recommended for effective treatment.

Complementary therapies, including behavioral training, acupuncture, and other psychological interventions, have shown utility in reducing pain. Advanced prostate cancer is often associated with bone metastasis, which damages bones to cause pain.

A range of therapy, including radiotherapy, surgery, and medication, is essential to reduce further damage and reduce pain. Targeted bone pain management improves a patient’s quality of life.

Pain might also indicate that your prostate cancer is not responding to treatment, requiring a different treatment. Thus, it is vital to inform your doctor about any pain to ensure early intervention.

Sources

  1. Berry, D.L., Moinpour, C.M., Jiang, C.S., Ankerst, D.P., Petrylak, D.P., Vinson, L.V., Lara, P.N., Jones, S., Taplin, M.E., Burch, P.A., 2006. Quality of life and pain in advanced stage prostate cancer: results of a Southwest Oncology Group randomized trial comparing docetaxel and estramustine to mitoxantrone and prednisone. J. Clin. Oncol. 24, 2828–2835.
  2. Fizazi, K., Massard, C., Smith, M., Rader, M., Brown, J., Milecki, P., Shore, N., Oudard, S., Karsh, L., Carducci, M., 2015. Bone-related parameters are the main prognostic factors for overall survival in men with bone metastases from castration-resistant prostate cancer. Eur. Urol. 68, 42–50.
  3. Gardner, K., Laird, B.J., Fallon, M.T., Sande, T.A., 2019. A systematic review examining clinical markers and biomarkers of analgesic response to radiotherapy for cancer-induced bone pain. Crit. Rev. Oncol. Hematol. 133, 33–44.
  4. Paley, C.A., Bennett, M.I., Johnson, M.I., 2011. Acupuncture for cancer-induced bone pain? Evid. Based Complement. Alternat. Med. 2011.
  5. Penedo, F.J., Fox, R.S., Oswald, L.B., Moreno, P.I., Boland, C.L., Estabrook, R., McGinty, H.L., Mohr, D.C., Begale, M.J., Dahn, J.R., 2020. Technology-based psychosocial intervention to improve quality of life and reduce symptom burden in men with advanced prostate cancer: Results from a randomized controlled trial. Int. J. Behav. Med. 1–16.
  6. Penedo, F.J., Molton, I., Dahn, J.R., Shen, B.-J., Kinsinger, D., Traeger, L., Siegel, S., Schneiderman, N., Antoni, M., 2006. A randomized clinical trial of group-based cognitive-behavioral stress management in localized prostate cancer: development of stress management skills improves quality of life and benefit finding. Ann. Behav. Med. 31, 261–270.
  7. Sahin, S., Bicer, M., Eren, G., Tas, S., Tugcu, V., Tasci, A., Cek, M., 2015. Acupuncture relieves symptoms in chronic prostatitis/chronic pelvic pain syndrome: a randomized, sham-controlled trial. Prostate Cancer Prostatic Dis. 18, 249–254.
  8. Van den Beuken-van Everdingen, M., De Rijke, J., Kessels, A., Schouten, H., Van Kleef, M., Patijn, J., 2007. Prevalence of pain in patients with cancer

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