Stage 4 prostate cancer is cancer that began in the prostate but has since spread to other organs. Depending on the tumor’s location, you may experience fatigue, weakness, and other symptoms.

Prostate cancer is cancer that starts in the prostate gland. Advanced prostate cancer occurs when it has spread, or metastasized, from the prostate to other areas of the body.

Cancer spreads when cells break off from the original tumor and move into nearby tissue. This is called localized metastasis. Cancer can spread directly into nearby tissues or to distant parts of the body through the lymphatic system. When this happens, it’s called “metastatic disease” or “prostate cancer with metastasis to” a certain body part or organ system.

New tumors can grow in any organ, but prostate cancer can spread to the:

  • lymph nodes outside the pelvis
  • adrenal gland
  • bones
  • liver
  • lungs

Stage 4 prostate cancer occurs when the prostate cancer has already spread to distant organs or tissues at the time of diagnosis.

Most of the time, doctors can diagnose prostate cancer at an earlier stage. It’s generally a slow-growing cancer, but it can spread or come back (recur) after treatment.

When cancer is confined to the prostate, many people have no symptoms. Others have trouble urinating or notice blood in their urine.

Metastatic cancer can cause generalized symptoms such as:

  • weakness
  • fatigue
  • weight loss

Other symptoms of advanced prostate cancer may depend on where it has spread and the size of the tumors.

  • Cancer that has metastasized to the bones can lead to bone pain and fractures.
  • Cancer that has spread to the liver may cause abdominal swelling or yellowing of the skin and eyes, known as jaundice.
  • Tumors in the lungs can cause shortness of breath or chest pain.

The exact cause of prostate cancer isn’t clear. Your risk of developing this particular cancer increases after you reach age 50.

Certain groups are more likely to develop aggressive forms of prostate cancer, including African-Americans and people who carry certain inherited genetic mutations such as:

  • BRCA1
  • BRCA2
  • HOXB13

People with prostate cancer don’t always have a family history of the disease. But having a close relative with prostate cancer more than doubles your risk.

If you’ve previously been diagnosed with prostate cancer, be sure to tell your doctor if you develop any new symptoms, even if you’ve completed treatment.

To determine if prostate cancer has returned or has spread, your doctor will likely order imaging tests, which may include:

  • X-rays
  • CT scans
  • MRI scans
  • PET scans
  • bone scans

You probably won’t need all of these tests. The doctor typically chooses tests based on your symptoms and physical exam.

If any images reveal abnormalities, it doesn’t necessarily mean that the cancer has returned or spread. You may need additional testing may be necessary. If they find a mass, a doctor will likely order a biopsy.

For a biopsy, a doctor removes samples from the suspicious area, whether through surgery or an in-office procedure, depending on the location. A pathologist then analyzes those cells under a microscope to see if they’re cancerous. The pathologist can also determine if you have an aggressive form of prostate cancer.

No matter where prostate cancer spreads, it’s still treated as prostate cancer. It’s harder to treat when it reaches an advanced stage.

Treatment for advanced prostate cancer involves targeted and systemic therapies. Most people need a combination of treatments, and they may have to be adjusted from time to time.

Hormone therapy

Hormone therapy suppresses the hormones that help prostate cancer cells to grow. A doctor may recommend any of the following hormone therapies:

  • Orchiectomy is a surgical procedure to remove the testicles, which is where the hormones are produced.
  • Luteinizing hormone-releasing hormone (LHRH) agonists are drugs that lower testosterone production in the testicles. You can receive these drugs by injection or by or by implantation under your skin.
  • LHRH antagonists are drugs that rapidly lower testosterone levels. You can receive these drugs by monthly injections under your skin.
  • Anti-androgens and androgen receptor inhibitors are available as pills you can take daily.

Side effects of hormone therapy drugs include:

  • injection site reactions
  • sexual dysfunction
  • anemia

PARP inhibitor therapy

PARP (poly (ADP‐ribose) polymerase) inhibitors can help prevent cancer cells from repairing their DNA after treatments like chemotherapy have damaged them. Doctors may recommend them for people whose cancer has specific genetic mutations known as BRCA+ mutations.

Side effects can include:

  • fatigue
  • diarrhea
  • nausea


In external beam radiation, beams of radiation target the prostate gland or another area of the body. It can help to ease symptoms when prostate cancer has spread to the bone. Fatigue is a common side effect.

For internal radiation, your doctor will implant tiny radioactive seeds into your prostate. The seeds emit a permanent low dose or temporary high dose of radiation. Potential side effects can include:

  • sexual dysfunction
  • urinary difficulties
  • bowel problems


Chemotherapy kills cancer cells throughout the body. It may shrink existing tumors and slow or prevent the growth of new tumors. Side effects can include:

  • nausea
  • loss of appetite
  • weight loss


Sipuleucel-T (Provenge) is a vaccine doctors use to treat advanced prostate cancer, especially if it’s not responding to hormone therapy.

The vaccine is made using your own white blood cells. You receive it intravenously in three doses spaced 2 weeks apart. Side effects may include:

  • nausea
  • a headache
  • back pain
  • joint pain


While some surgery to remove tumors may be an option, a doctor is less likely to recommend it for prostate cancer that has spread to multiple areas. It may also depend on the location of the cancer and the symptoms you experience.

Be sure to talk with your doctor if your treatments impact your quality of life. They may be able to prescribe medications or other therapies to help manage side effects. You can also ask about clinical trials for prostate cancer. These trials involve newer treatments that aren’t yet in use, combinations of approved medications, or drugs that have been approved to treat another condition.

In addition to treating the cancer, your care team may be able to offer solutions for specific symptoms like pain, fatigue, and urinary problems.

No cure is available for stage 4 prostate cancer. Your healthcare team will work with you to help control the cancer for as long as possible while maintaining a good quality of life.

Your outlook may depend on many factors, including your age, overall health, how fast the cancer is spreading, and how well you respond to therapies. Additionally, treatments are continually improving over time through research, so you may have additional treatment options in the future.

With treatment, you can live for years with metastatic prostate cancer.

It’s important that you learn all you can about advanced prostate cancer so you can make informed decisions. Be open with your doctors and others on your healthcare team. Express your concerns, and feel free to advocate for yourself and your quality of life. You also can get another medical opinion if you feel it’s necessary.

Some complementary therapies may prove helpful in coping with advanced cancer. For example:

  • tai chi, yoga, or other movement therapy
  • music therapy
  • meditation, breathing exercises, or other relaxation techniques
  • massage

Various services can help you with everything from lodging while you’re undergoing treatment to getting some help around the house. Communicating with online or in-person groups provides a space to share information and lend mutual support.

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For more information about support services, contact the National Cancer Information Center by phone or live chat. Someone is available 24 hours a day, 7 days a week to answer your questions.

The following includes common questions about stage 4 prostate cancer.

How long can you live with stage 4 prostate cancer?

People with stage 4 prostate cancer can live for many years with treatment. Your individual outlook can depend on factors that include age, general health, how you respond to treatment, and where the cancer has spread.

How bad is stage 4 prostate cancer?

Stage 4 prostate cancer is cancer that began in the prostate and has spread to other organs and body systems. Treatment, such as chemotherapy, radiation, and immunotherapy, can slow or stop cancer growth. People with advanced prostate cancer can live for years with treatment.

Is prostate cancer stage 4 terminal?

While stage 4 or advanced prostate cancer is difficult to cure, people who undergo treatment may live for years after diagnosis.

What causes death from stage 4 prostate cancer?

The spread of prostate cancer to other organs can impair their functionality, which may lead to death.

Advanced prostate cancer is cancer that began in the prostate but has since metastasized to other parts of the body. Treatment typically involves chemotherapy, radiation, and immunotherapy.

A person’s outlook with advanced prostate cancer depends on many factors, including age, general health, the location where it has spread, and the response to treatment. But people with advanced prostate cancer can live for multiple years after diagnosis.