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 invade nearby tissue. This is called localized metastasis. Cancer can spread directly into nearby tissues or through the lymphatic system to distant parts of the body. 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 is most likely to spread to the:
- adrenal gland
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 diagnose prostate cancer at an earlier stage. It’s generally a slow-growing cancer, but it can spread or it can come back, or recur, after treatment.
When cancer is confined to the prostate, many men have no symptoms. Others have trouble urinating or notice blood in their urine.
Metastatic cancer can cause generalized symptoms such as:
- weight loss
Other symptoms of advanced prostate cancer depend on where it has spread and how big the tumors are:
- 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.
- In the brain, cancer can cause headaches, dizziness, and seizures.
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-American men and men who carry certain inherited genetic mutations such as BRCA1, BRCA2, and HOXB13.
Most men with prostate cancer don’t always have a family history of the disease. But having a father or brother 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 have any new symptoms, even if you’ve completed treatment.
To determine if prostate cancer has returned or has spread, your doctor will likely order some imaging tests, which may include:
- CT scans
- MRI scans
- PET scans
- bone scans
You probably won’t need all of these tests. Your doctor will choose the tests based on your symptoms and physical exam.
If any of the images reveal abnormalities, it doesn’t necessarily mean that you have cancer. Additional testing may be necessary. If they find a mass, your doctor will probably order a biopsy.
For a biopsy, your doctor will use a needle to remove samples from the suspicious area. A pathologist will then analyze the removed 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 men need a combination of treatments and they may have to be adjusted from time to time.
Hormone therapy suppresses male hormones that help prostate cancer cells to grow. Your 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 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.
- CYP17 inhibitors and anti-androgens are available as pills you can take daily.
Side effects of hormone therapy drugs include injection site reactions, sexual dysfunction, and anemia.
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 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 include sexual dysfunction, urinary difficulties, and 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 include nausea, loss of appetite, and 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 two weeks apart. Side effects may include:
- a headache
- back pain
- joint pain
While some surgery to remove tumors may be an option, your doctor is less likely to recommend it for prostate cancer that has spread to multiple areas.
Be sure to tell your doctor if some of these treatments are impacting your quality of life. You can also ask about clinical trials for prostate cancer. These trials involve newer treatments that aren’t yet in use.
In addition to treating the cancer, your doctor 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 will depend on how fast the cancer is spreading and how well you respond to therapies.
With treatment, you can live for many 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. 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
A variety of services can help you with everything from lodging while you’re getting treatment to getting some help around the house. Communicating with online or in-person groups are a good way to share information and lend mutual support.