What to Know About Advanced Prostate Cancer

Symptoms, Diagnosis, Treatment, & Coping

A man receiving chemotherapy.
A man receiving chemotherapy. BSIP/UIG/Getty Images

If you've been told that you or a loved one have advanced prostate cancer, you're probably feeling very anxious. What does this mean? How is it treated? While prostate cancer is more commonly found in the earlier stages of the disease, it's not uncommon for a diagnosis to occur when the disease is advanced, meaning stage 4. It can be helpful in understanding this stage of the disease to first review what staging means for people with prostate cancer.

Prostate Cancer Staging

Prostate cancer, like all cancers, occurs in various stages throughout the duration of the disease. Diagnosis of prostate cancer can occur in any stage. Though this cancer is slow-growing and can remain isolated in the prostate for many years, eventually (or sometimes quickly), it may advance into other areas of the body.

After a prostate cancer diagnosis is given, blood tests, imaging scans, and other examinations are often conducted to evaluate the advancement of a patient’s cancer and determine if and to where the cancer has spread outside of the prostate. This process establishes the “stage” of prostate cancer and describes the exact extent of its spread in the body, and is an important process in determining the best treatment option for the patient.

Many doctors use the TNM System to evaluate the stage and spread of prostate cancer in a patient. “T” stands for “tumor”, and refers to the size of the primary cancer; “N” stands for “nodes”, and refers to whether or not the cancer has spread to lymph nodes nearby; and “M” stands for “metastasis”, and refers to whether or not the cancer has spread beyond the immediate prostate area into surrounding organs and the rest of the body.

These three characteristics establish a “stage” for the patient’s prostate cancer. There are four stages that are widely used to describe the advancement of prostate cancer:

Stage 1: The cancer is localized to the prostate and cannot be identified in routine examinations.

Stage 2: The cancer is still localized to the prostate but has enlarged in size.

Stage 3: The cancer has spread beyond the prostate but is confined to nearby tissues only.

Stage 4: The cancer has advanced, or metastasized, beyond the prostate and nearby tissues into lymph nodes and other organs in the body.

Stage 4 Prostate Cancer Meaning and Symptoms

Stage 4 cancer is considered advanced, as it has spread beyond the prostate and immediate area to other areas of the body. This stage is currently incurable; however, treatment options exist that can alleviate the often painful symptoms of advanced prostate cancer. These symptoms include weakness and anemia due to a lack of red blood cell production in the bone marrow, bone pain or other widespread pain, or fractures due to weakened bones. Some men also experience pain or difficulty urinating due to the enlargement of the prostate; however, this can also be a symptom of any stage of prostate cancer.

Treatment for Advanced Prostate Cancer

It's important to note again that while advanced prostate cancer is not curable, it is treatable.

Treatments may not only reduce the growth of the cancer, but can improve symptoms related to the cancer. Significant progress has been made in the treatment of advanced prostate cancer in recent years, and life expectancy is increasing. New treatments have been approved, and many treatments are currently being evaluated in clinical trials. Since by definition advanced prostate cancer has spread to other regions of the body, surgery is not usually an option for this stage of the disease. Yet there are several options for treatment.

Hormonal Therapy

Hormone therapy is usually prescribed to decrease the size and prevent the spread of the tumor or tumors. These treatments may result in undesirable side effects, such as decreased libido, hot flashes, and development of breast tissue, but can greatly improve the quality and extend the life of men in Stage 4 prostate cancer. Hormone therapy has less and less effect on advanced prostate cancer over time, and eventually this treatment usually stops working.

Chemotherapy

When a patient stops responding to hormone therapy, chemotherapy is often the next step. This is a more aggressive treatment option that involves chemicals that are usually given through an IV in various cycles. Chemotherapy has many negative side effects but can slow or stop the growth of prostate cancer.

Bone Targeted Therapy

Advanced prostate cancer commonly spreads to the skeletal system. Bone ailments due to this advancement can result in continued pain and discomfort for men with Stage 4 prostate cancer. Radiation therapy is often used to treat and eliminate bone pain in these patients. This therapy can further weaken the bones, so it is often combined with drug treatments that promote bone strength and help reduce the risk of fracture.

Immunotherapy

Immunotherapy is an exciting new option for men with prostate cancer, with one medication currently approved, and others being evaluated in clinical trials. This treatment essentially works to boost the body's own immune system in fighting off cancer cells. Immunotherapy can increase life expectancy, and may result in long-term control of the disease for some men who respond well to treatment.

Coping

A diagnosis of advanced cancer is frightening, but you are not alone. Consider joining a support group in your community or online where you can connect with other men facing a similar situation. If it is your loved one who is living with prostate cancer, check out these tips on how to support a loved one with cancer.

Sources:

Mulders, P., De Santis, M., Powles, T., and K. Fizazi. Targeted treatment of metastatic castration-resistant prostate cancer with sipuleucel-T immunotherapy. Cancer Immunology, Immunotherapy. 2015. 64(6):655-63.

National Cancer Institute. Prostate Cancer Treatment – for health professionals (PDQ). Updated 10/23/15.

Park, J., and M. Eisenberger. Advances in the Treatment of Metastatic Prostate Cancer. Mayo Clinic Proceedings. 2015. 90(12):1719-33.

Urology Care Foundation. Advanced Prostate Cancer. Accessed 01/11/16.

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