Stage 4 prostate cancer is when cancer has spread from the prostate gland to distant parts of the body. Symptoms include urination problems and other issues, depending on the organs affected. Various treatment options are available.

The prostate is located below the bladder. It surrounds a part of the urethra, which is the tube that drains urine from the bladder.

Prostate cancer risk increases with age. According to the National Cancer Institute, an estimated 20% of people with a prostate will experience prostate cancer in their lifetimes.

While doctors can detect most forms of prostate cancer in their earliest stages, the condition can progress without symptoms. This can make it hard for a doctor to detect. The advanced stages of prostate cancer occur once it has spread to other parts of the body.

Prostate cancer does not often progress to an advanced stage as routine testing can help diagnose and treat the condition in its earlier, more manageable stages.

Fast facts on prostate cancer

  • Prostate cancer rarely reaches an advanced stage.
  • People with the condition normally have a very good outlook when they receive an early diagnosis and treatment.
  • Hormone therapy is a treatment option for advanced prostate cancer, as are chemotherapy and immunotherapy.
  • Prostate cancer can spread to the bones, brain, and lungs.
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Prostate cancer occurs when cells in the prostate gland mutate and start to develop abnormally, multiplying at an uncontrolled rate. In some instances, the cancerous cells can spread to other body parts through tissue, the blood, or the lymphatic system.

After a doctor diagnoses prostate cancer, they will test to see if the cancer has spread to other areas of the body, or how much of the body is affected.

The doctor will assign a stage of prostate cancer from 1 to 4. Stage 4 is the most advanced form.

Stage 4 prostate cancer has spread to pelvic lymph nodes or is blocking the ureters. The ureters are the tubes that connect the kidneys to the bladder. Stage 4 prostate cancer may also have spread to the bladder, the rectum, the bones, or distant lymph nodes.

Doctors will test any cancerous cells in the body to determine if the additional cells came from the prostate. Even if they detect cancer in the bones, doctors still consider this prostate cancer if that is where the cancer originated.

There are two types of stage 4 prostate cancer:

  • Stage 4A: This is prostate cancer that is present in one or both sides of the prostate. This cancer may have spread to the seminal vesicles or to nearby tissues or organs, including the rectum, bladder, or pelvic wall. Stage 4A prostate cancer may also have spread to nearby lymph nodes.
  • Stage 4B: This is prostate cancer that has spread to other parts of the body. This includes the bones or distant lymph nodes. Prostate cancer often spreads to the bones.

What is the difference between prostate cancer and advanced prostate cancer?

Prostate cancer occurs when cells in the prostate gland begin to grow out of control. In the early stages of prostate cancer, the cancer cells are only present in the prostate and have not spread to nearby tissues.

Advanced prostate cancer, also known as stage 4 prostate cancer, occurs when cancer cells have spread to other areas of the body.

What does it mean for prostate cancer to spread?

Cancer cells can spread to other parts of the body. Doctors say the cancer has “metastasized” or spread if this occurs.

Prostate cancer can spread to:

A doctor will typically recommend imaging scans and tissue samples to test for the presence of cancerous cells.

The prostate is very close to the point at which urine drains from the body. As a result, many prostate cancer symptoms affect the urination process.

Common symptoms of prostate cancer include:

These symptoms can also occur with aging and an enlarged prostate. As a result, some people may ignore them instead of seeking medical attention.

According to the Prostate Cancer Foundation, age is the biggest contributing factor to prostate cancer risk. Doctors diagnose an estimated 60% of all prostate cancers in males older than 65 years of age.

It states that additional risk factors for prostate cancer include:

  • Family history: People with a close relative who has had prostate cancer may be twice as likely to get prostate cancer as those who do not.
  • Race: Males of African descent are about 75% more likely to develop prostate cancer than white males and more than twice as likely to die from the condition.
  • Smoking: A history of smoking is associated with a higher risk of aggressive prostate cancer.

Researchers are also studying a link between diet and increased prostate cancer risk. Diets high in calcium or low in vegetables may cause an increased risk of aggressive prostate cancer.

Treatments for advanced prostate cancer often focus on slowing or stopping the spread of cancer cells.

By the time a person has advanced prostate cancer, they have usually undergone a range of treatments to kill cancer cells. These include prostate removal, radiation, or chemotherapy.

If these do not keep prostate cancer from progressing, a doctor may suggest another approach. Below are some of these other treatments.

Hormone therapies

By stopping the production of hormones that contribute to cancer growth, hormone therapies can often limit its spread throughout the body.

A person may undergo hormone therapy after they have had surgery to remove the testicles, also known as an orchiectomy. This procedure reduces hormone production in the prostate.

Examples of hormone therapies for advanced prostate cancer include:


Doctors often prescribe this drug with prednisone, a steroid medication. Studies suggest that this drug significantly improves survival rates in people with advanced prostate cancer.


This drug can reduce the risk of cancer progressing without the need for chemotherapy. It can also reduce the risk of a person’s advanced prostate cancer being fatal.

Other treatment options

Other treatments a doctor may prescribe to reduce the spread of prostate cancer include:

  • Chemotherapy: This is a treatment involving medications that kill rapidly multiplying cells. Examples of chemotherapy medications to treat advanced prostate cancer include mitoxantrone, docetaxel, paclitaxel, and estramustine.
  • Immunotherapy: This involves building up immune system cells to counter cancers more effectively. Examples of biological therapies include administering colony-stimulating factors, interferon, interleukin, or monoclonal antibodies.
  • Medications to treat bone metastasis: If cancer spreads to the bones, doctors can prescribe several medications to reduce the breakdown of bones and lessen pain. Examples of medications used to treat bone pain include denosumab, xofigo, and zoledronic acid.

Experimental treatments for advanced prostate cancer

Researchers are currently testing many new approaches and treatments for prostate cancer, including new medications. These include the following:

Immune checkpoint inhibitors

The immune system uses “checkpoints” to stop it from attacking the body’s healthy cells. These checkpoints are proteins on immune cells.

Cancer cells often use these checkpoints to keep the immune system from attacking them.

Immune checkpoint inhibitors are drugs that can target these checkpoints on cancer cells. Inhibiting these checkpoints can allow a person’s immune system to attack the cancer cells.

Chimeric antigen receptor T cell therapy

This treatment involves taking immune cells (T cells) from the person’s blood. A scientist then alters these cells in a lab to have receptors called chimeric antigen receptors on their surface.

These receptors help the cells attach to proteins on the surface of prostate cells. A scientist then multiplies these altered T cells in a lab before putting them back into the person’s blood.

Scientists hope these T cells can then find prostate cancer cells and launch a targeted immune attack.

However, this treatment is complicated and may have some serious side effects. This means it is currently only available as part of clinical trials.

Targeted drug therapies

Targeted drug therapies can act on specific parts of cancer cells and the environments surrounding them.

These drugs can:

  • alter the way a cancer cell grows and divides
  • affect the way a cancer cell repairs itself
  • affect the way a cancer cell interacts with other cells in the body

Two possible targeted therapy treatments are:

  • Poly adenosine diphosphate-ribose polymerase inhibitors: This treatment works by blocking DNA repair pathways in cancer cells. This can stop cancer cells from being able to repair themselves. If a cancer cell cannot repair itself, it dies.
  • Monoclonal antibodies: These are human-made versions of the immune proteins that attach to specific targets on cancer cells. These drugs may work alongside other drugs such as chemotherapy drugs or radioactive molecules. They may be able to enter the body and seek out prostate cancer cells, bringing the drug or radioactive molecule directly to the cancer cell to make them more effective.

Treating prostate cancer that has spread to the bones

Radiofrequency ablation (RFA) is a treatment that may help control pain in people who have prostate cancer that has spread to their bones.

During this treatment, a doctor will use a CT scan or ultrasound to guide a metal probe into the tumor area. The probe then emits a high frequency current that can heat and destroy the tumor.

RFA is a treatment that medical professionals have used for years to treat tumors in organs, such as the liver. It is a fairly new treatment for bone pain.

An important measurement for assessing a person’s likelihood of surviving cancer is the relative survival rate. These rates compare the 5-year survival rate of a person with prostate cancer compared with a person without the condition.

This method is helpful because while some people with prostate cancer may not be alive 5 years after diagnosis, this does not always mean that prostate cancer was the direct cause of death.

According to the American Cancer Society, relative survival rates for all prostate cancer types are as follows:

  • 5 years: almost 100%
  • 10 years: 98%
  • 15 years: 95%

Survival rates for prostate cancer can vary based on the cancer stage. Later stages of cancer typically have lower survival rates than those at earlier stages.

The American Cancer Society reports the following 5-year relative survival rates for different cancer stages:

  • local, in which cancer has not spread beyond the prostate: nearly 100%
  • regional, in which cancer has spread from the prostate to nearby areas: nearly 100%
  • distant, in which cancer has spread to distant lymph nodes, bones, or other organs: 31%

Outlooks are not guarantees. Many people live much longer than an estimated outlook, while others do not. Early diagnosis dramatically improves the chance of doctors successfully treating the condition.

A person can talk with their doctor and cancer care team regarding their outlook.

Prostate cancer occurs when cells in the prostate gland grow out of control. Advanced prostate cancer occurs when these cancer cells have spread to other areas of the body. Doctors also refer to this as stage 4 prostate cancer.

Prostate cancer symptoms include problems urinating, blood in the urine or semen, and constant back, hip, or pelvis pain. People may also experience shortness of breath, feeling very tired, a fast heartbeat, dizziness, and pale skin due to anemia.

A doctor can treat prostate cancer with chemotherapy, hormone therapies, immunotherapy, and some medications.

A person’s chances of having a positive outlook are greater the earlier they begin treatment. If a person has symptoms of prostate cancer, they should contact their doctor.