There may be more than one cause of pain. Possible causes include:

• The cancer may have spread to the bones.
• The cancer can sometimes spread to the lymph nodes, making them swollen and uncomfortable.
• Your pain may be due to something else and not your cancer.

Lymphoedema
If the cancer spreads to the lymph nodes it may lead to a condition called lymphoedema, which is caused by a blockage in the lymphatic system. The lymphatic system is part of the body's immune system and carries fluid called lymph around the body. If the lymphatic system is blocked, the fluid may build up in the body's tissues and cause swelling (lymphoedema), usually in the legs. The blockage may be caused by the cancer itself or by some treatments. Lymphoedema is not common in prostate cancer. You may be at greater risk if you have had surgery and/or radiotherapy to lymph nodes. Lymphoedema may cause discomfort or pain but there are treatments to manage it.

Your specialist team should investigate the cause of your pain and then offer you the most appropriate treatments.

For information on other causes of pain, speak to your specialist team or call our confidential Helpline.

The most common place for prostate cancer to spread to is the bones. If prostate cancer spreads to the bones, it does not mean that you have bone cancer. It means that some of the prostate cancer cells have spread to areas of bone. It is called secondary prostate cancer. The cancer that has spread to the bone is called 'bone secondaries' or 'bone metastases'.

The growth of the cancer in the bone causes the bone tissue to break down. This weakens the bone and may cause pain. The pain may only be in one area but over time it can spread to several parts of your body. Men who have bone pain often describe it as a dull aching or stabbing that can get worse with movement.

There are several effective ways of treating pain caused by bone metastases.

Prostate cancer cells can also spread to the bones of the spine (vertebrae). This can lead to a complication called metastatic spinal cord compression (MSCC) where the cancer cells press on the spinal cord.

MSCC is rare. However if it does happen you need to get treatment as soon as possible. Speak to your specialist team for more information about your risk.

MSCC may cause any of the following symptoms:

• Pain in your lower, middle or upper back or neck that is severe or different from usual pain. The pain may get worse when you cough, sneeze, lift, strain, or go to the toilet, and it may wake you at night or stop you from sleeping.
• A narrow 'band' of pain around your stomach area or chest.
• Pain that moves down your arms or legs.
• Weakness in your arms or legs, difficulty standing or walking, or falling.
• Numbness or pins and needles in your legs, arms, buttocks, stomach area or chest, which does not go away.
• Problems emptying your bladder and/or bowel. You may be unable to empty your bladder and/or bowel, or you may have no control over emptying them.

These symptoms may also be caused by other conditions, but it is still important to get medical advice in case you do have MSCC.

MSCC is a serious condition. If you have any of the symptoms listed above, contact your specialist team straight away. Do not wait to see if it gets better and do not worry if it is an inconvenient time, such as the weekend. You should have been given information about who to contact if you have any symptoms. If you do not have any contact details, go to accident and emergency (A&E) at your local hospital and tell them that you have prostate cancer and the symptoms of MSCC.

You can read more about MSCC in our online fact sheet.

Predicting how much pain you might have is difficult as pain is a very individual experience.

How much pain you have can depend on several factors, including:

• Where the pain is and what is causing it.
• How soon you tell your specialist team about the pain.
• Finding the right pain relief for you.
• Taking the right amount of pain-relieving drugs at the right times.
• Other factors such as tiredness, how well you are feeling, if you are anxious and whether or not you feel well supported with your pain.

You should not have to accept pain as a normal part of having cancer. Let your specialist team know about any pain as soon as possible. The earlier you ask for help, the easier it will be to get your pain under control. With the right treatment, your specialist team should be able to control your pain effectively.

You can read more about pain in our online fact sheet.

Your specialist team will ask you questions about your pain to try to get as much information about it as possible.

You might find that keeping a diary to record your pain regularly helps you to describe it to your specialist team. Think about including the following information:

• Where is your pain?
• How bad is it?
• What does it feel like? For example, is it a stabbing pain, or a dull ache?
• When did the pain start? How often do you get it? How long does it last? Does it wake you at night?
• Does anything help? For example changing position or having a relaxing bath.
• Does anything make it worse? For example, moving around.
• How does your pain make you feel? For example, do you feel anxious or depressed? Does this affect the pain?

A good way of describing how much pain you are in is to rate it on a scale of zero to ten with zero being no pain and ten being the worst pain you can imagine.

Your specialist team will need to examine you to see if there are any obvious physical reasons for your pain. This will help them to decide whether you need any tests, such as blood tests or an X-ray.

The best way to manage your pain can depend on a number of things, including what is causing the pain, your general health and how you are feeling emotionally. Treating pain often involves using a few different approaches.

Pain may be a sign that your prostate cancer treatment is not working as well as it was. A different treatment may help the pain. Possible treatments include:

• Hormone therapy
• Steroids
• Chemotherapy

You may need treatment to help the pain itself such as:

• Pain-relieving drugs
• Palliative radiotherapy
• Medicines called bisphosphonates
• Other therapies, for example transcutaneous electrical nerve stimulation (TENS) machine.

There are other things which may also help. These include:

• Complementary therapies.Emotional support
• Treatments for other causes of pain, for example, antibiotic therapy can be very effective for pain caused by an infection

By using a combination of these, cancer pain can be managed well in most cases. Once treatment has started it should be regularly reviewed so that any changes can be managed as soon as they appear. If one type of treatment does not work for you, then you may be able to try something else. Tell your specialist team about any new pain.

You can read more about how pain is treated in our online fact sheet.

As well as the treatments mentioned, you may find some of these ideas helpful:

• Generally looking after yourself, for example by maintaining a good diet or taking regular gentle exercise, may help you to feel better.
• Change your position frequently to stay as comfortable as possible and prevent stiffness.
• Hot or cold packs may help to relieve some types of pain. Wrap them in a towel so that they do not hurt your skin.
• Try listening to music, reading, watching television or chatting with a friend or family member to try and take your mind off your pain.
• Try relaxation techniques such as deep breathing, relaxation tapes or a relaxing bath.

These suggestions may help you to feel more comfortable and more in control of your pain.

As well as getting medical help to treat your pain, most men find it helps to get some emotional support. Feeling more in control of your emotions can help you feel better.

You may find it helpful to speak to someone with personal experience of pain caused by prostate cancer.
• Our support volunteers are all personally affected by prostate cancer and can offer support over the telephone.
• There are also support groups throughout the country where you and your family can meet other people affected by prostate cancer.
• You can join our online community. This is for men with prostate cancer and their families to share experiences, information and support.

If you are feeling low or anxious, it may be useful to talk to a counsellor who may help you cope. You may be able to get a referral through your specialist team or GP.

You may also find that it helps to talk to your specialist team or a specialist cancer nurse such as a Macmillan or Marie Curie nurse. They can help you work through some of your concerns and they know a lot about cancer pain and how to manage it. You can ask your GP or specialist team to refer you to these nursing services.

• What is causing my pain?
• Who will assess my pain?
• What treatments are available to help manage my pain?
• Will I need to take pain-relieving drugs?
• What are the side effects of pain-relieving drugs?
• What else can I do to help with my pain?
• Who else can I talk to about my pain?

You can find a list of references used to produce this page in our online fact sheet.