Osteolytic Lesions in Prostate Cancer

While the majority of metastases from prostate adenocarcinoma are sclerotic, about 5% can be osteolytic. Mixed osteolytic and sclerotic lesions can also be seen. The uncommon neuroendocrine tumors of the prostate also produce osteolytic lesions.

Regardless of pathology, both bone resorption and bone formation can be seen in metastatic lesions from prostate cancer, with the radiographic appearance reflecting the dominant process. Sclerotic metastases are the result of stimulation of osteoblasts or inhibition of osteoclasts or both by cancer cells, whereas lytic metastases are the result of stimulation of osteoclasts or inhibition of osteoblasts or both by cancer cells.

References

• Conti G, La Torre G, Cicalese V, Micheletti G, Ludovico MG, Vestita GD, Cottonaro G, Introini C, Cecchi M. Prostate cancer metastases to bone: observational study for the evaluation of clinical presentation, course and treatment patterns. Presentation of the METAURO protocol and of patient baseline features. Arch Ital Urol Androl. 2008 Jun;80(2):59-64.
• Guise TA, Mohammad KS, Clines G, Stebbins EG, Wong DH, Higgins LS, Vessella R, Corey E, Padalecki S, Suva L, Chirgwin JM. Basic mechanisms responsible for osteolytic and osteoblastic bone metastases. Clin Cancer Res. 2006 Oct 15;12(20 Pt 2):6213s-6216s.
• Logothetis CJ, Lin SH. Osteoblasts in prostate cancer metastasis to bone. Nat Rev Cancer. 2005 Jan;5(1):21-8.
• Roodman GD. Mechanisms of bone metastasis. N Engl J Med. 2004 Apr 15;350(16):1655-64.