Metastatic prostate cancer is also referred to as stage 4 or advanced prostate cancer. It’s cancer that began in the prostate, a gland located under the bladder of people assigned male at birth, and has spread to distant areas of the body, such as the lymph nodes or bones.
Prostate cancer may include bladder symptoms such as:
- Increased urinary urgency
- Frequent nighttime awakenings to urinate
- A slow or weak urinary flow
- Blood in the urine or semen
As prostate cancer progresses and spreads to other areas of the body, it may cause several symptoms, including:
- Erectile dysfunction: As the tumor grows, it may cause an inability to get or maintain an erection.
- Bone pain: When prostate cancer spreads to the bones, you may feel pain in your hips, back, and chest. You may also experience bone fractures.
- Numbness or weakness: When prostate cancer spreads to the spine, it may compress nerves that affect feeling in your legs and feet.
- Fatigue: Advanced cancer often causes significant daytime fatigue.
- Unintentional weight loss: Metastatic cancer may cause decreased appetite and unintended weight loss.
- Shortness of breath: Prostate cancer may spread to the lungs and cause breathing symptoms like shortness of breath.
- Liver symptoms: When prostate cancer spreads to the liver, it may cause swelling in the abdomen (ascites) and yellowing of the eyes and skin (jaundice).
Metastatic prostate cancer occurs when cancer cells in the prostate spread to other areas of the body. Cancer cells may grow into and invade nearby tissues and organs. They can also travel through your lymph fluid (a part of your immune system) or bloodstream to areas of the body farther from the prostate.
Because prostate cancer does not usually cause symptoms in the early stages, it can often spread undetected.
Risk Factors
About 1 in 8 men will develop prostate cancer. Some people are more likely to develop metastatic prostate cancer than others. Risk factors for developing prostate cancer include:
- Age: Older age is a risk factor. About 60% of prostate cancers in the United States occur in people over age 65.
- Race and ethnicity: Prostate cancer affects more people who are Black than White, Latino, Hispanic, or Asian American.
- Family history: Having a close family member with prostate cancer increases your risk.
Healthcare providers often detect prostate cancer using routine screening tools, including a digital rectal exam and a prostate-specific antigen (PSA) blood test. To confirm the diagnosis, your provider will likely refer you to a urologist, a medical doctor who specializes in diagnosing and treating prostate cancer, for a prostate biopsy.
To determine whether your prostate cancer has metastasized (spread), your healthcare provider may recommend these tests:
- X-ray: To detect bone fractures in case of metastasis to the bone
- Computed tomography (CT) scan: To detect cancer cells in other parts of the body
- Magnetic resonance imaging (MRI): To detect cancer cells in other organs and tissues
- Positron emission tomography (PET) scan: To detect cancer spread, especially if results from other tests are unclear
- Bone scan: To determine if cancer has weakened your bones
Stages of Metastatic Prostate Cancer
Metastatic prostate cancer refers to the highest stage: Stage 4. In this stage, cancer cells have spread to distant areas of the body. The sub-stages of metastatic prostate cancer include:
- Stage 4A: The cancer has spread to nearby lymph nodes, and the tumor is growing.
- Stage 4B: The cancer has spread to distant areas of the body that may include your distant lymph nodes, bones, lungs, liver, or other organs.
There is no known cure for metastatic prostate cancer, but treatment options can help ease the symptoms and stop further spread. Your healthcare team will work with you to develop a treatment plan to improve your quality of life.
Hormone Therapy
Your healthcare provider may recommend starting treatment with hormone therapy to slow the cancer’s growth and address any uncomfortable symptoms.
The male sex hormone testosterone fuels prostate cancer cell growth. Hormone therapy can block the production of testosterone to slow a cancer’s growth. Hormone therapy is usually available as an oral pill or injection. Your healthcare team may recommend taking hormone therapy with chemotherapy or radiation therapy.
Surgery
Your healthcare team may recommend surgery if you have urinary symptoms. Transurethral resection of the prostate (TURP) is a procedure that removes small portions of the prostate through the penis. The goal of this surgery in metastatic prostate cancer is to shrink the size of your prostate gland to relieve symptoms.
While TURP can make urination easier, it does not cure the cancer.
Bone Treatments
Metastatic prostate cancer commonly spreads to the bones. Treatment options for metastatic prostate cancer that has spread to the bones may include:
- Bisphosphonates: This group of drugs targets cells called osteoclasts to slow bone breakdown. Your provider may recommend this type of drug to relieve bone pain and prevent further bone damage.
- Prolia (denosumab): Like bisphosphonates, this drug blocks osteoclast activity to help strengthen your bones.
- Corticosteroids: Your provider may prescribe a corticosteroid such as Deltasone (prednisone) to ease bone pain.
- Radiation therapy: Your healthcare team may suggest radiation therapy to shrink a tumor in your spine and relieve uncomfortable symptoms.
- Ablative treatments: These treatments use extreme hot or cold temperatures to shrink a cancerous tumor and relieve pain and other symptoms.
- Pain medication: Bone pain can be difficult, so talk with your healthcare team about options for pain management.
Clinical Trials
Your healthcare team may recommend taking part in a clinical trial to receive new treatments before the U.S. Food and Drug Administration (FDA) has approved them.
There is no guaranteed way to prevent metastatic prostate cancer. Seeing your primary healthcare provider regularly and receiving routine screening tests may lower your risk of advanced prostate cancer. Screening tests may catch prostate cancers before they grow and spread to distant areas.
Metastatic prostate cancer can increase your risk of certain health conditions, which may vary based on where the cancer has spread. Possible related conditions include:
- Bone fractures: When prostate cancer metastasizes to the bones, it leads to bone weakening and fractures.
- Hypercalcemia (high calcium levels in the blood): If prostate cancer spreads to the bone, it may cause calcium to leak out of your bones and into your bloodstream. This may lead to dangerously high blood calcium levels.
- Spinal cord compression: When cancer spreads to the spine, it can cause a spinal tumor that presses on the nerves in your spine. This may lead to weakness, numbness, and balance problems.
Metastatic prostate cancer may affect your quality of life, relationships, ability to work, and finances. While there is no known cure, it is treatable. Your healthcare team can develop a treatment plan that treats symptoms and improves quality of life. Consider meeting with a therapist or support group for emotional support as you navigate your treatment journey.
To support your overall health, aim to get regular physical activity each day. Avoid tobacco products and foods that are high in added sugars and fats.
