Prostate cancer commonly metastasizes to bone with which radiographic pattern?

• A. Osteolytic lesions
• B. No lesions
• C. Mixed lesions
• D. Osteoblastic (sclerotic) lesions

Answer: (D)

Prostate cancer bone metastases typically drive new bone formation rather than bone destruction. This osteoblastic (sclerotic) activity produces dense, hardened areas on radiographs, commonly in the spine, pelvis, and proximal femora. The cancer cells and the bone microenvironment release signaling factors that stimulate osteoblasts, leading to these sclerotic lesions. While some metastases can be mixed or rarely lytic, the classic radiographic pattern is osteoblastic, making that description the best fit. Bone scans or PET often show increased uptake due to the high bone turnover from this osteoblastic activity, even if X-rays aren’t markedly abnormal.