While doctors detect most forms of prostate cancer in their earliest stages, prostate cancer can progress. When it spreads to other parts of the body, it's said to be in the more advanced stages.
Prostate cancer occurs when cells in the prostate 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 via tissue, the blood, or the lymph system.
Advanced prostate cancer is cancer that has spread away from the prostate gland.
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's where the cancer started.
There are two types of stage IV prostate cancer:
- Stage IV D1: Patients with prostate cancer that's spread to the pelvis, such as the lymph nodes or surrounding organs. However, the cancer hasn't spread further.
- Stage IV D2: Cancers that 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 treatable.
How does prostate cancer 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 where prostate cancer is known to spread include:
- Lymph nodes, usually those around the pelvis
A doctor will typically recommend imaging scans and potentially tissue samples to test for the presence of cancerous cells.
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 age 65.
Additional risk factors for prostate cancer include:
- Family history: Men who have a father or brother with prostate cancer are twice as likely as men who do not to experience prostate cancer
- Race: African-American men are at 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 with increased risk of aggressive prostate cancer.
Many symptoms of prostate cancer involve the process of urination.
Because the prostate is so close to where urine drains from the body, 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 urine stream
- Experiencing sudden urge to urinate
- 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.
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 has usually undergone treatments such as prostate removal, radiation, or chemotherapy to kill cancer cells. 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, there are other treatments a doctor may use as well.
By stopping hormones that can contribute to cancer growth, hormone therapies can often limit how prostate cancer spreads. They may be prescribed after a man has surgery to remove the testicles, to reduce the hormone production to the prostate, as well as chemotherapy treatments.
Examples of hormone therapies a doctor may prescribe 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 boost 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
In addition to hormone therapies for prostate cancer, there are other treatments a doctor may prescribe to reduce prostate cancer's spread. These include:
- Chemotherapy: Chemotherapy is a treatment that involves taking medications that kill rapidly multiplying cells. Examples of chemotherapy medications used to treat advanced prostate cancer include mitoxantrone, docetaxel, paclitaxel, and estramustine.
- Immunotherapy: Immunotherapy involves building up immune system cells to fight against 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.
Researchers are currently testing many new approaches and treatments for prostate cancer, including new medications.
Researchers refer to the outlook for many cancers in regards to their 5-year survival rates. These survival rates indicate how many people are alive 5 years after they're diagnosed with cancer.
Survival rates for prostate cancer that has spread are lower than those for local prostate cancer.
Another important measurement for cancer survival outlook is relative survival rates. These rates compare the 5-year survival rate of a man with prostate cancer compared with a man who doesn't. This method is helpful because men with prostate cancer may not be alive 5 years later, but this doesn't mean they necessarily died from prostate cancer.
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 prostate cancer stage a man has. Later stages of cancer typically have reduced survival rates compared with cancers diagnosed in earlier stages.
The following are 5-year relative survival rates from the American Cancer Society for the following cancer stages:
- Local stage (cancer hasn't spread past the prostate): nearly 100 percent
- Regional stage (cancer has spread from prostate to nearby areas): nearly 100 percent
- Distant stage (cancer has spread to distant lymph nodes, bones, or other organs): 28 percent
Outlooks are no guarantees. There are many men who live much longer than an estimated outlook, and there are some who do not. Men should always talk to their doctor and cancer care team regarding potential survival rates and outlook.