What you need to know about advanced prostate cancer
The prostate is located below the bladder and surrounds a part of the urethra, the tube that drains urine from the bladder.
While doctors can detect most forms of prostate cancer in their earliest stages, prostate cancer might progress undetected. 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 disease in its earlier, more manageable stages.
- Prostate cancer rarely reaches an advanced stage.
- The disease normally has a very good outlook when diagnosed and treated early.
- Hormone therapy is a treatment option for advanced prostate cancer, as well as chemotherapy and immunotherapy.
- Prostate cancer can spread to the bones, brain, and lungs.
Advanced prostate cancer is a type that has spread to other organs or tissues.
Advanced prostate cancer has several stages to get through before it can be considered advanced.
Prostate cancer occurs when cells in the prostate gland mutate and start to develop abnormally. They will multiply at an uncontrolled rate. In some instances, the cells can spread to other body parts. Cancerous cells can spread 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 the cancer has affected.
A doctor will assign a stage of prostate cancer from stage I to stage IV. Stage IV is the most advanced cancer form and the topic of this article.
Stage IV prostate cancer is advanced prostate cancer that has spread to pelvic lymph nodes or is blocking the ureters. The ureters are the tubes that connect the kidneys to the bladder.
Doctors will test any cancerous cells in the body to determine if the additional cells came from the prostate. Even if cancer is detected in the bone, it is still considered prostate cancer if that is where the cancer started.
There are two types of stage IV prostate cancer:
- Stage IV D1: Prostate cancer has spread to the pelvis, lymph nodes, or surrounding organs. However, the cancer has not spread further.
- Stage IV D2: Cancers have spread to more distant organs, such as the spine, pelvis, ribs, or other bones. Unfortunately, stage IV D2 prostate cancer is the hardest to cure but is still treatable.
What does it mean for prostate cancer to spread?
Cancer cells can spread to other parts of the body. If this occurs, doctors say the cancer has "metastasized" or spread.
Areas of the body to which prostate cancer can spread include:
- the bones
- the brain
- the liver
- the lungs
- the lymph nodes, usually those around the pelvis
A doctor will typically recommend imaging scans and tissue samples to test for the presence of cancerous cells.
Smoking increases the risk of prostate cancer.
According to the Prostate Cancer Foundation, age is the biggest contributing factor to the risk for prostate cancer. An estimated 65 percent of all prostate cancers are diagnosed in men older than 65 years of age.
Additional risk factors for prostate cancer include:
- Family history: Men who have a father or brother with prostate cancer are twice as likely to get prostate cancer as men who do not.
- Race: African-American men face the greatest risk of prostate cancer.
- 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 low in vegetables or high in calcium have been linked to an increased risk of aggressive prostate cancer.
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. Examples of these symptoms include:
- back, hip, or pelvic pain
- blood in the urine or semen
- burning or pain upon urination
- difficulty fully emptying the bladder
- difficulty starting a stream of urine
- experiencing sudden urge to urinate
- a weak urine stream
Some of these symptoms are associated with aging and an enlarged prostate. As a result, some men may ignore these symptoms instead of seeking medical attention.
Early diagnosis can be the difference between curing prostate cancer and the disease reaching an advanced stage.
Treatments for advanced prostate cancer often focus on slowing or stopping the spread of cancer cells.
By the time a man has advanced prostate cancer, he will usually have undergone a range of treatments to kill cancer cells, such as prostate removal, radiation, or chemotherapy. If these treatments do not keep prostate cancer from progressing, other approaches may be used.
The University of New Mexico state that hormone therapies are the standard treatment for metastatic prostate cancer.
However, a doctor may also use other treatments.
By stopping the production of hormones that contribute to cancer growth, hormone therapies can often limit the spread of the disease throughout the body.
Hormone therapies may be prescribed after a man has surgery to remove the testicles, also known as an orchiectomy, to reduce the hormone production to the prostate, as well as chemotherapy treatments.
Examples of hormone therapies for advanced prostate cancer include:
- Abiraterone: This drug is often prescribed with prednisone, a steroid medication. This medication has been shown to reduce pain progression and improve quality of life.
- Enzalutamide: This drug can reduce the risks for cancer to progress without the unwanted side effects of chemotherapy, including intense nausea and hair loss.
Other treatment options
There are other treatments a doctor may prescribe to reduce the spread of prostate cancer: including:
- Chemotherapy: This is a treatment involving medications that kill rapidly multiplying cells. Examples of chemotherapy medications used to treat advanced prostate cancer include mitoxantrone, docetaxel, paclitaxel, and estramustine.
- Immunotherapy: This involves building up immune system cells to more effectively counter cancers. 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.
Researchers are currently testing many new approaches and treatments for prostate cancer, including new medications.
An important measurement for assessing the likelihood of surviving cancer is the relative survival rate. These rates compare the 5-year survival rate of a man with prostate cancer compared with a man who does not.
This method is helpful because men with prostate cancer may not be alive 5 years after diagnosis, but this does not mean that prostate cancer was the direct cause of death.
For all prostate cancer types, the relative survival rates from the American Cancer Society are as follows:
- Five-year relative survival rate: almost 100 percent
- Ten-year relative survival rate: 98 percent
- Fifteen-year relative survival rate: 95 percent
Survival rates for prostate cancer can vary based on the cancer stage. Later stages of cancer typically have lower survival rates when compared with earlier-stage cancers.
The following are 5-year relative survival rates from the American Cancer Society for the following cancer stages:
- Local stage, in which cancer has not spread past the prostate: Nearly 100 percent
- Regional stage, in which cancer has spread from the prostate to nearby areas: Nearly 100 percent
- Distant stage, in which the cancer has spread to distant lymph nodes, bones, or other organs: 28 percent
Outlooks are not guarantees. There are many men who live much longer than an estimated outlook, and there are some who do not.
However, early diagnosis dramatically improves the chance of a good outlook and eventually treating the condition.
Men should always talk to their doctor and cancer care team regarding potential survival rates and outlook.