While most prostate cancers grow slowly, some may classify as aggressive prostate cancers based on stage and grade.
Prostate cancers mostly consist of adenocarcinomas, which develop within the prostate gland cells.
In general, cancers that are “aggressive” are those that can form, grow, or spread rapidly. In some cases, having aggressive cancer can mean that the disease is more severe or has come back after treatment.
Anaplastic prostate cancer is an aggressive cancer that involves the nervous and endocrine (neuroendocrine) systems. It’s not considered common.
Aggressive prostate cancer requires careful diagnosis and prompt treatment.
Aggressive prostate cancer has a different cellular makeup than adenocarcinomas of the prostate gland, which can cause it to grow and replicate quickly. It also sometimes resists certain hormone treatments typically used for prostate cancer.
A doctor may also diagnose prostate cancer as “aggressive” based on data collected from the following:
Based on a biopsy sample, having a Gleason score of 8–10 could indicate a risk of cancer spreading from the prostate to other parts of the body.
Prostate-specific antigen (PSA) blood tests
TNM cancer staging system
This staging system assesses the size of the tumor and whether the cancer has spread to any lymph nodes or more distant areas in the body.
The TNM staging system is also responsible for the common number staging system, which ranges from 0–4, with stage 3 indicating aggressive cancer and stage 4 meaning cancer has spread to distant organs.
Grade 3 indicates that the cancer cells are abnormal and are more likely to grow aggressively.
Aggressive prostate cancers spread rapidly. When diagnosed at an advanced stage, the cancer classifies as stage 3. This stage means that the cancer may have spread outside of the prostate gland.
The diagnosis of aggressive prostate cancer may also occur at stage 4. Stage 4, or metastatic cancer, is the most advanced stage and means that cancer has spread to at least one other organ of the body.
Prostate cancer — including aggressive subtypes — may or may not have symptoms until the tumor has become large.
As the cancer becomes more aggressive or advanced, you might experience:
- weak urine flow
- frequent urination or difficulty urinating
- blood in urine
- hip or pelvic pain
- back pain
- excessive fatigue
- shortness of breath
- changes in heart rate
- unintentional weight loss
While the exact cause of aggressive prostate cancer isn’t known, this subtype may develop as a result of hormone treatment resistance. This may explain why aggressive prostate cancers may be more common in those who have previously undergone treatment for adenocarcinoma.
There’s no single timeline, but aggressive prostate cancer progresses in the body rapidly. This tendency is in stark contrast to traditional adenocarcinomas of the prostate gland, which tend to progress very slowly for years.
Aggressive prostate cancer tends to present with metastasis in the bones and lymph nodes in the pelvic region despite a low PSA level.
A doctor may confirm aggressive prostate cancer with the following tests:
Due to a high rate of spread and possible resistance to hormone-based treatments, aggressive prostate cancer isn’t considered curable.
The goal is to undergo treatments that may help shrink the tumor, prevent further spread, and help reduce prostate cancer symptoms.
Treatment options may help manage the spread of aggressive prostate cancer while preventing the advancement of the cancer and improving symptoms.
Surgery may be the most effective treatment strategy for aggressive prostate cancers that have not yet spread to distant areas of the body. Surgery may involve removing tissues from the prostate or removing the prostate gland.
Additional treatments for aggressive prostate cancer include:
While most cases of prostate cancer are slow-growing, aggressive forms may have even lower life expectancy if they are not detected and treated early.
According to data between 2013 and 2019 from the National Cancer Institute’s Surveillance, Epidemiology, and End Results Program
The exact outlook for aggressive prostate cancer depends on numerous factors. According to a 2020 clinical review of 94 cases of aggressive prostate cancer, the average life expectancy was less than
Aggressive prostate cancer is a subtype that grows quickly and may possibly be resistant to hormone therapies. While it is not considered curable, treatments are available to help prevent the cancer from spreading further and improve the quality of life.