Many men with metastatic prostate cancer (mPC) have back pain associated with nonmalignant etiologies at sites of metastases. These findings were published in JCO Oncology Practice.
For patients with mPC, the spine is the most common site of metastasis and can be a source of pain. These patients often receive tumor-directed therapies; however, nonmalignant etiologies of back pain would not be responsive to these interventions. To better understand back pain in mPC, data were sourced from the Memorial Sloan Kettering Cancer Center patient registry, collected between 2013 and 2017. Fifty-three men with mPC who reported pain in an area of metastastic disease were retrospectively reviewed for trends in back pain.
The patients were median age 72 years (range, 52 to 90), 66% had castration-resistant disease, 64% had a precancer history of back pain, 72% had abnormal posture, 68% had reduced spinal range of motion, and 51% had gait abnormalities.
Patients were stratified into malignant pain (20), nonmalignant pain (12), and mixed pain (21) subgroups.
Of the 20 patients in the malignant pain group, 14 (70%) reported a precancer history of back pain, 7 of whom required surgical intervention. Pain was caused by either malignancy (55%) or metastasis-associated vertebral compression fracture. These patients used the most analgesics and narcotics.
The 12 patients with nonmalignant pain were the oldest cohort and most (67%) had a precancer history of back pain. The back pain in this cohort was commonly caused by activity (58%).
The 21 men in the mixed pain group were found to have both cancer and noncancer causes for their pain. A precancer history of back pain was reported by 57% of patients in this group, with activity-related pain reported in nearly half of cases (48%).
This study was limited by its small sample size and may have included referral bias.
The investigators concluded that noncancer-related back pain was common among men with mPC. They recommend patients with mPC receive multidisciplinary care to address nonmalignant etiologies contributing to their pain.
Disclosure: Multiple authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.
Ruppert LM, Cohn ED, Keegan NM, et al. Spine pain and metastatic prostate cancer: defining the contribution of nonmalignant etiologies. JCO Oncol Pract. Published online February 17, 2022. doi:10.1200/OP.21.00816