Prostate cancer is one of the most common cancers in the United States. In its early stages, many people do not experience symptoms. If prostate cancer spreads to other parts of the body — most commonly to the bones — this is called metastatic prostate cancer. Some people with metastatic prostate cancer may experience bone pain, often in the hip, back, or other bones.

This article explains how prostate cancer can cause back, hip, and bone pain, as well as what signs to watch out for and how to manage these symptoms effectively.

How Does Prostate Cancer Spread to Bones?

When prostate cancer becomes advanced, it may spread to other areas in a process called metastasis. Cancer cells can leave the prostate, travel through the blood or the lymph system, and settle in other parts of the body. These cells most often reach the bones (called bone metastasis), including the:

• Upper and lower back
• Hips
• Legs
• Ribs

Bones are constantly being rebuilt by two types of bone cells — osteoblasts (which build bone) and osteoclasts (which break down bone). When cancer cells reach the bones, they upset this balance. Osteoblasts may create too much new bone, leading to abnormal bone growth, while osteoclasts may break down bone faster than normal, causing bones to be weak and fragile. When prostate cancer cells form bone metastases, they’re usually called “osteogenic” or “osteoblastic,” meaning the cancer causes osteoblasts to make extra bone cells.

Why Does Bone Metastasis Cause Pain?

Bone metastasis can cause pain in several ways, such as:

• Pain inside bones — Cancer cells in the bone can lead to a dull ache or, at times, sharp pain.
• Pressure on nerves — Cancer that spreads to the spine can press on nerve roots or the spinal cord, causing back pain, numbness, or weakness in the legs.
• Weakness or fractures — Fragile bones break more easily, causing sudden sharp pain.

Bone pain feels different for everyone. It may worsen during movement or if the affected area is touched. The severity and frequency of pain may depend on where the cancer is located.

What Types of Pain Are Warning Signs of Prostate Cancer?

Following are some common signs that prostate cancer may have spread to the bones.

Persistent Back or Hip Pain

Pain in the lower back, pelvis, or hips that doesn’t go away and may even wake you up at night could be a sign that prostate cancer is in the bones. You may feel a deep ache or a sharp pain that gets worse when you move. The pain may be mild at first and worsen over time.

Easy Fractures

Bones weakened by metastasis can break even after a minor injury, causing sudden sharp pain and loss of function.

Nerve-Related Symptoms

When prostate cancer reaches the bones’ outer layer, it can cause neuropathic (nerve) pain. Nerve pain may lead to numbness or tingling in the legs, feet, buttocks, or lower back and make it hard to move.

Abnormal bone growths in the spine can pinch nerves in the spinal cord, causing weakness in the arms, chest, or legs and affecting bladder control.

Other Symptoms

Bone metastasis can cause tiredness and fatigue. Hypercalcemia (high blood calcium levels) can lead to nausea, confusion, constipation, and changes in appetite.

When Should You See a Doctor?

Not all back or hip pain results from cancer. Other causes include arthritis, muscle strains, and disc problems. However, if you have been diagnosed with or at higher risk of prostate cancer, it’s important to pay attention to back, hip, or bone pain that:

• Lasts more than a few weeks
• Doesn’t get better with rest
• Feels severe
• Interferes with daily activities
• Comes with numbness or weakness
• Happens along with unexpected weight loss

If you notice any of these symptoms, tell your doctor. Get emergency care right away if you fall and have severe pain, see exposed bone, or have a fever.

How Is Bone Metastasis Diagnosed?

If you have pain, your doctor will start by asking questions to help find the source. You may need to describe when and where you feel pain, what it feels like, and if it wakes you up at night. It may help to keep a journal or diary about your pain and review it with your doctor.

Your healthcare provider may order urine and blood tests to check for signs of bone damage. They may also examine your bones using imaging tests such as:

• Bone scans
• X-rays
• Computed tomography (CT) scans
• Positron emission tomography (PET) scans
• Magnetic resonance imaging (MRI) scans

Which Treatments Help Manage Back, Hip, and Bone Pain?

Managing bone metastasis involves treating both the cancer and the pain. Many options are available, so be sure to work with your healthcare team to find what’s best for you.

Cancer-Fighting Treatments

Some prostate cancer treatments may also help relieve bone pain, including the following options:

• Hormone therapy (also called androgen deprivation therapy) — Lowers testosterone to slow cancer growth
• Chemotherapy — Uses anticancer drugs to destroy cancer cells and keep them from spreading
• Immunotherapy — Helps the immune system recognize and attack cancerous cells

Bone-Strengthening Drugs

Drugs like bisphosphonates (zoledronic acid) and denosumab work by slowing the breakdown of bones, which helps relieve pain, prevent fractures, and strengthen bones — especially during hormone therapy. You may also need to take calcium and vitamin D supplements to avoid low calcium levels during treatment.

Radiation Therapy

Radiation therapy (also called radiotherapy) targets specific bone tumors to reduce pain. This option may be especially helpful for pain in the spine caused by tumors, but it can be used for pain anywhere in the body.

Radiopharmaceuticals

Radiopharmaceuticals contain radioactive elements that are injected into a vein and travel to the bones affected by cancer. There, they release radiation to destroy cancer cells and help with pain in many bones at once.

Surgery

Surgery is less common but may be needed to support weak or broken bones. A doctor may insert metal plates or pins to stabilize affected bones and decrease the risk of breaks. If the cancer is near the spine, kyphoplasty may be performed. This procedure involves putting a mixture similar to cement into the bone to strengthen it.

Pain Medications

Pain medications can help with mild to moderate pain, especially when taken regularly as prescribed. Your doctor may suggest over-the-counter pain relievers, like acetaminophen or nonsteroidal anti-inflammatory drugs (NSAIDs). Always check with your healthcare team before using these medications — some may interfere with cancer treatments or cause side effects.

For more severe pain, your doctor may prescribe opioids or steroids. Antidepressants or anti-seizure drugs are sometimes used to reduce nerve pain.

Physical Therapy

Physical therapy can help strengthen surrounding muscles and improve movement. A physical therapist can show you exercises and stretches to increase stability and provide pain relief. They may also recommend assistive devices like a walker or brace. Always follow your therapist’s instructions and limits.

Lifestyle Changes

Healthy habits may help improve bone pain. Before making any changes, ask your doctor or healthcare team if you should make any lifestyle changes. They may suggest that you:

• Eat a well-balanced diet and stay hydrated to help keep your bones healthy. Ask your doctor or a dietitian if you’re getting enough vitamin D, calcium, and protein.
• Exercise regularly to help strengthen bones and prevent bone loss. Good options may include walking, swimming, dancing, or yoga, but always get your doctor’s approval before trying a new activity or routine.
• Practice relaxation techniques, such as meditation or deep breathing, to help manage pain and improve your overall well-being.

Finding Relief From Prostate Cancer Pain

Prostate cancer can cause back, hip, and bone pain, but advances in treatment make it possible to manage symptoms and protect your quality of life. Work closely with your healthcare team, report new symptoms promptly, and ask questions about all your treatment options.

Pain doesn’t have to take over your daily life. With a mix of treatments, pain management strategies, and lifestyle changes, many people are able to find relief. Remember, everyone’s experience is different, so what helps one person may not work for another.

Join the Conversation

On MyProstateCancerTeam, people share their experiences with prostate cancer, get advice, and find support from others who understand.

What strategies have helped you manage back, hip, and bone pain caused by prostate cancer? Let others know in the comments below.