Hi, I’m Dr. Scholz. Let’s talk about prostate
cancer. Our topic today is pain and this question
comes up all the time when the word ‘cancer’ comes up. One of the frightening things
about cancer is the thought of a progressive disease, unremitting pain leading to early
mortality. This is the horrors of prostate cancer and I’m gonna put that right up front
because thankfully with prostate cancer we don’t deal with this problem very much and
when I’m giving this talk today I’m drawing more on my experience when I did general oncology
20 years ago and in rare cases with prostate cancer patients. But that doesn’t mean that
the issue or the questions surrounding pain don’t come up all the time in my practice.
What happens is that once a person’s been diagnosed with cancer every symptom, every
pain seems to take on heightened significance. So I get questioned every day, “Is this pain
I have… Or, is this pain from the prostate cancer?” And that is a natural question once
someone has been diagnosed it’s always on their minds. Thankfully, not only is the pain
almost never due to prostate cancer—the average patient with prostate cancer is in
his 70s and has aches and pains from all kinds of things—but also, we can give a reassuring
message and diagnose what the pain is coming from and help them solve it, which is just
part of being a physician. So let’s talk first about the type of pain
that is from cancer. New prostate cancer patients that are walking around with undetectable
PSAs, it’s essentially impossible for you to have pain from prostate cancer. The two
just don’t go together. The pain, if you’re having pain, must be coming from something
else. But if your PSA is above 5 or 10, or maybe it’s quite high, maybe it’s 50, and
you’re having a new pain, how do you make a distinction between something from prostate
cancer from, say, arthritis, kidney stone, or something of that nature? Well, cancer-related
pain from prostate cancer is almost always related to an issue in the bones, and I’m
not talking about the joints. The joints, the elbows, the shoulders, those are probably
arthritic pains because prostate cancer doesn’t spread to the joints. Pain that is outside
the elbows and below the knees is almost never from prostate cancer because there’s no red
marrow in those areas and the cancer doesn’t spread there. So pains in the bone that are
enduring, progressive could possibly be from prostate cancer and the next step is usually
to get a scan—a bone scan or an MRI—and determine if there is actually a spot in the
area where the pain is occurring and that’s how it can be confirmed that the pain is indeed
from prostate cancer. Once a site of pain is detected it’s actually fairly easy to treat
because radiation therapy to that spot will almost always eliminate the pain completely.
A problem, of course, can arise if people have multiple sites and it could then, therefore,
be dangerous to give radiation to multiple sites as it could have an immunosuppressive
effect. There are injectible types of radiation such as Xofigo which circulates through the
blood and concentrates in the areas where the cancer is occurring and that can also
relieve pain. But let me backtrack a minute and talk about
this issue with treating pain for prostate cancer. The best treatment, of course, is
to simply treat the disease with whatever the best available therapy is, and in our
previous videos we’ve gone through the Royal category and talked about using Lupron, Xtandi,
Taxotere, [and] other agents to try and control the disease, and if the disease is controlled,
the pain will be controlled. In fact, one of the earliest signs of an effective therapy
is the elimination of pain, if pain was occurring at the time the treatment was started. But
what about confusing situations where there may be a spot on the bones, maybe its sort
of close to this area where it’s hurting, but people aren’t quite sure? A careful history
[and] communication with your doctor is what will help clarify the situation. Cancer pains,
when they come, don’t go away without treatment so they’re persistent. They tend to be progressive.
So pains that seem to be occurring in the morning and going away in the afternoon or
are relieved by certain activities are probably not related to cancer. So cancer paints tend
to be very consistent and progressive and that is the character that the doctor is going
to be trying to determine when questioning you. There are a couple of other tricks that we’ve
learned over the years to help people bridge through a time when they’re going on a new
therapy. Oftentimes in Royal, someone may have a rising PSA and develop some pain in
a bone perhaps and during the time that the doctors are waiting for the new therapy to
take hold and eliminate the pain, it’s logical to use different types of analgesics. Non-steroidals
such as Motrin, Aleve, Celebrex, these types of things can be quite effective actually
and they’re relatively safe. If those less potent analgesics aren’t effective, narcotic
medications are also a good choice and they come in short-acting and long-acting, and
these medicines can be used to bridge through the time until the new treatment starts working
and then the analgesics can be stopped. Another trick that doctors can use during
this bridge period is cortisone. Prednisone in doses of 20-30mg has a rather remarkable
analgesic effect. It also improves energy temporarily and if we could use cortisone
on a long-term basis it would solve a lot of our problems. That’s not safe. But taking
it for a few weeks is very safe actually and often times quite effective. So with prostate cancer, thankfully, we’re
not dealing with pain issues on a common day-to-day basis. For those exceptional cases and in
the men that have very advanced prostate cancer the issue can arise and thankfully there’s
a sequential logical way to pursue a solution. If you are encountering problems finding a
solution with your physician, consider asking for a referral to a pain specialist. There
are doctors out there. Oftentimes they’re trained as anesthesiologists who sub-specialized
simply in pain management and they have developed the art to a very high level and they have
other additional methods and tricks that they can use to try and help when people are experiencing
difficulty in this area.

2 thoughts on “Pain and Advanced Prostate Cancer Treatment (Royal Stage) | Prostate Cancer Staging Guide”

  1. All my tumors in my bones showed up real well on both the bone scan and the MRI. (PSA at time of diagnosis was 3,280)

Leave a Reply

Your email address will not be published. Required fields are marked *