A 65-year-old man with known prostate cancer presents with severe back pain and an X-ray showing a sclerotic lesion in the L3 vertebral body. Bone scan shows multiple hot spots in the spine and pelvis. Which statement about metastatic bone disease is correct?

• A Prostate carcinoma produces purely lytic metastases; the skull is the most commonly affected site
• B Sclerotic metastases indicate healing and carry a better prognosis than lytic lesions
• C Prostate carcinoma typically produces osteosclerotic metastases; the most common site is the vertebral column ✓
• D Bone scan is less sensitive than plain X-ray for early metastatic lesions

Explanation

Prostate and breast carcinomas are the two cancers most associated with osteosclerotic (osteoblastic) metastases, though mixed patterns also occur. The vertebral column (thoracolumbar spine) is the most common site for skeletal metastases from any primary, as tumour cells reach it via Batson's venous plexus. Bone scan detects lesions earlier than plain X-ray (requires 30–50% mineral loss) and is the standard screening tool for osseous metastases.

Reference: Maheshwari Essential Orthopaedics, 6th ed.

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Written and medically reviewed by the StethoPrep medical team.