Bone metastases and skeletal-related events
Cancer spread to the bones, most common in prostate, breast, lung, kidney and thyroid cancer and myeloma. It causes pain, fractures and high calcium, and the complications are counted in trials as 'skeletal-related events'.
Overview
Skeletal-related events (fracture, need for radiotherapy or surgery to bone, spinal cord compression, hypercalcaemia) are reduced 30-40% by bone-modifying agents (zoledronic acid, denosumab). Single-fraction 8 Gy radiotherapy relieves pain as well as longer courses; SBRT gives more durable relief for spine metastases. Bone-seeking radiopharmaceuticals (radium-223, strontium-89) treat bone-predominant prostate cancer, and bone-only disease has a better prognosis than visceral spread in breast cancer. Spinal cord compression is an emergency needing steroids and urgent radiotherapy or surgery.
- Peripheral zone (most indications)
- Transition zone (BPH)
- Ducts (ductal, intraductal, neuroendocrine)
- Seminal vesicle (T3b)
- Nodes: obturator
- Nodes: internal iliac
- Nodes: external iliac
- Nodes: presacral
About three quarters of indications arise in the peripheral zone at the back of the gland, the part a finger or a biopsy needle reaches; drainage is to the obturator and iliac nodes.
- Peripheral zone (most indications)Localised: low / favourable-intermediate / unfavourable-intermediate / high risk (NCCN) · Non-metastatic castration-resistant (nmCRPC) · Metastatic hormone-sensitive (mHSPC; FDA 2026 term 'androgen pathway modulation-naive or -sensitive'), de novo vs recurrent, high vs low volume (CHAARTED) · Metastatic castration-resistant (mCRPC) · HRR-mutant (~20-25% of mCRPC; BRCA2 most actionable) · Treatment-emergent neuroendocrine prostate cancer (~15-20% of late mCRPC)
- Transition zone (BPH)
- Ducts (ductal, intraductal, neuroendocrine)Treatment-emergent neuroendocrine prostate cancer (~15-20% of late mCRPC) · Ductal and intraductal / cribriform variants (aggressive)
- Seminal vesicle (T3b)
- obturator
- internal iliac
- external iliac
- presacral
Same organ: Localised prostate cancer, high and very high risk, Biochemical recurrence of prostate cancer, Metastatic hormone-sensitive prostate cancer, Non-metastatic castration-resistant prostate cancer, Metastatic castration-resistant prostate cancer, Neuroendocrine and small-cell prostate cancer
Showing the organ this term concerns: Prostate cancer.
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