Is Pain a Sign of Prostate Cancer?

Pain in the hips, back, ribs, or groin can come from a variety of sources, including many that may be completely unrelated to the prostate or to the male reproductive system. Even when this type of pain is related to the male reproductive system, it is often associated with benign prostatic hyperplasia (the non-cancerous enlargement of the prostate gland due to aging), as well as to bacterial infections or chronic pelvic pain syndrome. If this pain is in fact related to prostate cancer, it is typically indicative of advanced prostate cancer that has spread to the bones (also called bone metastases).

Pain in advanced prostate cancer

Advanced prostate cancer-related pain in the hips, back, ribs, or groin is often described as a dull, deep pain, similar to a toothache, and is much different than most other pain that comes after overuse or general soreness.

Recent research has shown that many men with advanced prostate cancer often ignore pain and pain-related symptoms, do not discuss pain with their healthcare providers and have difficulty discussing pain-related symptoms with caregivers and healthcare providers.¹¹ Men should definitely discuss any type of pain they are feeling with their healthcare provider at the first possible sign and be sure to express the degree to which it affects them so that their provider can test appropriately.

Pain in the hips, back, ribs, or groin as a result of advanced prostate cancer can often be treated, however, treatment is typically palliative in nature. Palliative care involves treating symptoms, such as bone pain, but not curing the underlying condition causing the symptom. Although the treatment regimen for an individual’s prostate cancer can be adjusted in attempts to cure the cancer, the cancer typically is incurable once it has become widespread in the bones. This is why bone pain as a result of advanced cancer is treated palliatively. The main types of treatment for bone pain as a result of prostate cancer include, medications, radiation, and surgery.^1-4

Medications

Normally, our body maintains a careful balance of building and breaking down bone to keep bones strong and healthy, as well as to release important nutrients into our bloodstream. When cancer spreads to the bones, it typically begins eating away at them, overwhelming the normal bone breakdown process, until the bone becomes destroyed. Some medications including bisphosphonates like Zometa or monoclonal antibodies like Xgeva target the healthy bone growth regulation process in our body to favor bone building and slow down bone destruction.

Corticosteroid medications, also known as steroids, are a class of drugs designed to mimic naturally occurring corticosteroids produced by the adrenal cortex above the kidneys. Corticosteroids carry out a wide range of functions in the body. Some of these functions can aid in the relief of bone pain, inflammation, and gastrointestinal distress that comes along with cancer or the treatment of cancer. Common corticosteroids used to treat bone pain as a result of prostate cancer include prednisone and dexamethasone, among many others.

Radiopharmaceuticals belong to a class of medications that are considered systemic radiation therapies. These medications contain radioactive substances that help alleviate bone pain when cancer metastasizes to the bones. The most common radiopharmaceuticals used in the treatment of prostate cancer-related bone pain are Strontium-89 (Metastron), Samarium-153 (Quadramet), and Radium-223 (Xofigo). The radioactive elements in radiopharmaceuticals are attracted to areas in the body that are experiencing rapid bone turnover, such as where cancer has metastasized to the bones and is destroying them. These agents release radiation directly into the bone lesions, relieving pain.^5-7

Radiation

Radiation therapy, including external radiation therapy, also called external beam therapy (EBT), involves focusing a beam of high-energy radiation (or X-rays) onto a specific spot on the body from the outside. The target of this type of therapy is the exact location of an active cancerous tumor. The location of the tumor is determined by imaging procedures.

Radiation therapy may be used with the intent to cure an individual’s cancer, however, external beam radiation to treat cancer that has metastasized to the bones is typically for pain relief only. Targeting a malignant tumor on a bone, including on the spine, before it does too much damage, can lead to pain relief, as well as the prevention of future fractures and instability. Preventing fractures and skeletal instability can greatly change an individual with late-stage cancer’s quality of life.^8,9

Surgery

Surgery is typically the least common method of treating bone pain, since it is the most invasive and carries the greatest amount of risk and recovery time. However, in some instances, bone destruction can lead to great instability, that can eventually lead to painful fractures. These fractures can often be much more painful than the original bone pain, which is why in some cases, it may be advantageous to increase skeletal stability via surgery. In these cases, cement, metal pins, or metal plates can be inserted into the bones to make them stronger. Surgery may be followed by radiation therapy, but also can involve a long hospital stay or recovery time, especially if it’s a surgical procedure involving the spine.¹

Other less commonly used treatment options for hip, groin, rib, or back pain include TENS therapy (transcutaneous electrical nerve stimulation) that involves electric currents, as well as nerve blocking injections.^1,10