Prostate cancer occurs when the cells in the prostate grow uncontrollably, forming defective tissue. Sometimes, prostate cancer develops quickly and spreads to other organs. This is known as metastasis. Prostate cancer can often spread to the bones, lymph nodes, adrenal gland, liver, and lungs.

This article explains how prostate cancer spreads outside of the prostate and how it affects the body.

We also look at the treatment options for metastatic prostate cancer tumors.

Finally, the article addresses the likely outlook for people with the condition and answers some common questions about it.

A female nurse taking notes while speaking with a male patient.Share on Pinterest
FatCamera/Getty Images

There are many types of cancer. However, prostate cancer is a type that spreads outside of the prostate and is known as metastatic prostate cancer. It can spread to local or distant body areas in several steps:

  1. The cancer cells travel outside the prostate by entering blood or lymphatic vessels.
  2. The blood or lymphatic vessels deposit cancer cells into close tissues or organs outside the prostate.
  3. The cancer cells, as they circulate, become trapped in the lymph nodes and smaller vessels of the bones, liver, lungs, and adrenal glands.
  4. Once these cells establish a blood supply where they locate, they grow into a new tumor.

Prostate cancer with local metastasis means that cancer has spread to other organs within the pelvis or the nearby lymph nodes. However, this type includes any organ or structure in the pelvis.

Sometimes, cancer spreads to other organs away from the prostate. Distant metastasis means that prostate cancer has spread beyond the pelvis. The bones, liver, lungs, and adrenal glands are common sites of distal prostate cancer metastasis.

In many cases, prostate cancer grows slowly. Some males do not even know that they have the disease. However, when prostate cancer metastasizes, it can become more challenging for a doctor to treat.

A note about sex and gender

Sex and gender exist on spectrums. This article will use the terms “male,” “female,” or both to refer to sex assigned at birth. Click here to learn more.

Most types of prostate cancers are adenocarcinoma (including ductal carcinoma and acinar adenocarcinoma), which are cells that originate from a gland. Other rare types of prostate cancers are:

  • squamous cell carcinoma
  • transitional cell carcinoma
  • neuroendocrine tumors (including small cell carcinoma and large cell carcinoma)
  • sarcoma (including leiomyosarcoma and rhabdomyosarcoma)

Experts believe some males can also have a mixed type, which combines a common and a rare type of prostate cancer. Rare forms of prostate cancer are more likely to metastasize.

Prostate cancer overall is the second most common cancer in males after skin cancer. Doctors discover most prostate cancers in the prostate or nearby tissues. However, about 16% of new cases spread into distant locations.

Between 2012 and 2018, about 14% more cases of prostate cancer occurred in the United States.

Research has shown the incidence of prostate cancer for African American males is twice that of people who are white. Among African Americans, the cancer types tend to be more aggressive, and deaths are double compared with white Americans.

The differences in outcomes for African American males may originate from:

  • Physical: Higher prostate-specific antigen (PSA) levels in the blood.
  • Genetic: Some African American males carry certain gene mutations or chromosomal abnormalities that can increase prostate cancer risk.
  • Environmental: Social disparities may cause people from historically marginalized groups to live on a lower income and have limited access to healthy food.
  • Social: Disparities in healthcare can limit genetic screening or disease treatment access, leading to underdiagnosis.

Doctors recommend that African American males and those with a family history of prostate cancer begin screening at the age of 45. Those with more than one first-degree relative who had prostate cancer before age 65 should get a screening at 40.

Other people should begin screening at the age of 50.

However, in cases of limited access to quality healthcare, a person may find it hard to obtain proper screening.

Often, prostate cancer is symptomless. However, when signs and symptoms do occur, they may include:

  • frequent urination, especially at night
  • difficulty in controlling urination
  • weak or interrupted urine flow
  • pain or burning when urinating
  • erectile dysfunction
  • painful ejaculation
  • producing less semen when ejaculating
  • blood in the urine or semen
  • pain in the hips, lower back, pelvis, or rectum

Many other conditions, including prostatitis and benign prostatic hypertrophy, can cause similar symptoms. However, anyone experiencing these symptoms should consult their doctor as soon as possible to rule out prostate cancer.

If a doctor suspects a patient has prostate cancer that has metastasized outside the prostate, they may need several tests to determine how far and where the cancer has spread. This will help the medical team determine the best course of treatment.

Types of tests include:

  • Computerized tomography (CT) scan: To see the spread to local lymph nodes.
  • Magnetic resonance imaging (MRI) scan: To see the spread outside the prostate into nearby soft tissue.
  • Bone scan: To see the spread into the bone.
  • PSMA-PET (prostate-specific membrane antigen-positron emission tomography) scan: To see the spread in the body if the prostate-specific antigen levels are rising. Doctors also use it before a prostatectomy or radiation in high risk patients.
  • A combination of PET-MRI or PET-CT: This can give more detailed pictures and speed up access to therapy but may be unavailable in certain places for reasons including cost.

A person rarely needs a biopsy outside of the prostate. If a person has a diagnosis of metastatic cancer, they may need a biopsy of other areas where cancer may have spread, such as the bones or the lymph nodes.

Once a doctor diagnoses prostate cancer that has spread, complications will depend on where the cancer lodges and how quickly it grows.

For example, a person with prostate cancer that has spread to nearby lymph nodes may not experience any change in symptoms.

When prostate cancer metastasizes to the following areas, it can cause a range of complications.

  • Bone: This can cause fractures and pain.
  • Brain: This can lead to dizziness, headaches, and seizures.
  • Liver: This can result in jaundice and swelling in the abdomen.
  • Lungs: This can lead to shortness of breath.

There are various types of treatments available for advanced prostate cancer. A doctor or oncologist will develop a plan that considers the individual’s symptoms, outlook, goals for therapy, age, and general health.

Chemotherapy

Chemotherapy uses medications to destroy cancer cells and prevent them from multiplying. People usually receive chemotherapy once the prostate cancer has stopped responding to hormone therapy.

Chemotherapy is usually a combination of two or more drugs that people receive intravenously, by injection, or by taking a pill.

People may use this with hormone therapy if their prostate cancer has not yet become hormone-resistant.

Radiation therapy

A doctor may request the use of high-powered radiation to shrink a tumor on the prostate or kill newly metastasized cancer cells in other areas.

External radiation is therapy from outside the body using a machine to kill cancer cells. This type of radiation may also destroy healthy tissue around the cancer site.

Doctors may request alpha emitter radiation therapy if prostate cancer spreads to the bone. This type of radiation therapy involves injecting a radioactive substance into the blood.

The radioactive substance collects in specific tissues, including areas of bone to which prostate cancer has spread. Alpha emitter radiation therapy may damage less healthy tissue.

Bisphosphonate therapy

If prostate cancer has spread to the bones, it may cause considerable pain and high calcium levels in the blood.

Bisphosphonates are a class of medication that doctors administer for some people with metastatic prostate cancer. They block bone cell action that causes the breakdown of bone and relieves pain. This helps strengthen the bones and prevent fractures.

Surgery

In metastatic prostate cancer cases, doctors will usually not intervene surgically because the cancer has already spread beyond the prostate.

In cases when surgery is still necessary, a doctor may recommend transurethral resection of the prostate (TURP), which removes prostate cancer tissue blocking the urethra. This helps decrease urinary symptoms and improve quality of life.

However, TURP does not cure or delay the progression of prostate cancer. A person may need other treatments, such as radiation or chemotherapy.

Another option is an orchiectomy, which is surgery to remove the testicles to decrease the amount of testosterone in the system. This helps reduce the cancer cell growth rate but does not cure cancer.

Immunotherapy

Doctors use immunotherapy to trigger the immune system to attack cancer cells or “boost” the immune cells to respond to cancer cells.

The U.S. Food and Drug Administration (FDA) has approved sipuleucel-T (Provenge), a cell-based cancer vaccine, to treat males with hormone-resistant metastatic prostate cancer.

This treatment involves filtering immune cells out of the body and stimulating them in a lab to target prostate cancer. Doctors then reinfuse the cells into the person’s body intravenously.

Cancer specialists often recommend this treatment before chemotherapy for males who experience minimal to no pain. However, it may also be effective in some males after they have undergone chemotherapy.

A person receives three treatments, each given every 2 weeks. This treatment does not resolve symptoms or reduce tumor size. However, the Prostate Cancer Foundation advises that it can extend the lifespan of those with advanced prostate cancer.

The FDA has also approved pembrolizumab (Keytruda) and dostarlimab (Jemperli). These prevent specific chemical signals from activating immune cells that kill tumors. Doctors only use these on people who have progressed despite prior treatment but for whom there are no alternative treatment options.

Hormone therapy

Hormone therapy for advanced prostate cancer shuts down the production or blocks the action of male sex hormones. This can help prevent cancer from continuing to spread.

Prostate cancer cells grow because androgens — a type of sex hormone — attach to proteins that doctors call androgen receptors.

Certain hormone-suppressing drugs can help prevent the androgens from attaching and causing tumor growth. This is known as androgen deprivation therapy (ADT).

Broadly, these drugs are sometimes known as anti-androgens or androgen receptor antagonists. There are different types that work in different ways. Some require oral administrations, while others are injections. They include:

  • luteinizing hormone-releasing hormone (LHRH) agonists such as leuprolide (Lupron, Eligard)
  • LHRH antagonists such as degarelix (Firmagon)
  • newer androgen receptor inhibitors such as enzalutamide (Xtandi), apalutamide (Erleada), and darolutamide (Nubeqa)

Watchful waiting and active surveillance

Because prostate cancer develops slowly, a doctor may not recommend any treatment. However, this likely applies to prostate cancer that has not yet metastasized.

In metastatic prostate cancer cases, aggressive treatment is likely necessary.

Clinical trials

Currently, there are many promising clinical trials ongoing for advanced prostate cancer.

People interested in clinical trials for cancer treatment should talk with a doctor about the benefits and risks and how to participate.

Prostate cancer treatment can cause some severe side effects, including:

Fortunately, several medications are available to treat cancer therapy’s side effects. However, because these side effects can be severe, doctors often recommend watchful waiting before prescribing potent medications.

It is important for anyone undergoing cancer treatment to communicate with their healthcare team about any side effects they are experiencing.

The following are some answers to common questions about prostate cancer.

How likely is it that my prostate cancer will spread?

This depends on the spread of cancer at diagnosis, an individual’s health status, and response to treatment, among other factors.

Because of the slow-growing nature of prostate cancer, a doctor may decide to wait or start treatment depending on a person’s risk factors.

What is the life expectancy of metastasized prostate cancer?

If the prostate cancer has spread to the local area, such as the pelvis or nearby lymph nodes, a person would have almost a 100% chance of surviving 5 years.

If the prostate cancer has spread to distant sites such as the liver, lungs, or bone, a person would have approximately a 30% chance of surviving 5 years.

What stage of prostate cancer is metastatic?

According to the ACS, prostate cancer is metastatic at stage 4B, which means it has spread to other parts of the body, such as the distant lymph nodes, bones, or other organs.

Can people recover from metastatic prostate cancer?

Recovery depends on the aggressiveness and location of the cancer spread. Local spread and nonaggressive types have a better outlook. Researchers are developing new therapies more quickly than ever before. It is worthwhile for people to check with their doctor about treatment options and participation in clinical trials.

The American Cancer Society (ACS) measures the outlook for numerous types of cancer using a 5-year survival rate. This compares the likelihood that a person will survive for 5 years beyond diagnosis to that of a person without cancer living for the same amount of time.

According to the ACS, the rates are:

  • Local prostate cancer without spread has a 5-year survival rate of nearly 100%.
  • Prostate cancer with local spread also has a 5-year survival rate of nearly 100%.
  • Prostate cancer with distant metastasis has a 5-year survival rate of close to 30%.

The survival rate is excellent if a doctor diagnoses prostate cancer before it spreads or has only spread to nearby structures. However, the survival rate does not take into account many other factors, such as a person’s age and overall health.

A doctor with a working knowledge of a person’s prostate cancer progression can produce a more accurate and individual outlook.

This makes routine screening and early diagnosis essential to treat prostate cancer successfully.

African American males ages 45 years and up, and other males over the age of 50, should speak with a healthcare professional about the different screening options and which one is most appropriate for them.