Prostate cancer is the second leading cancer diagnosis in men in the US, but that doesn't make it any easier to process. Although the five-year survival rate is notably high, the type, stage, and aggressiveness can make a significant difference. To help you better understand your diagnosis, we'll go over everything you need to know about metastatic prostate cancer.
What is Metastatic Prostate Cancer?
Metastatic prostate cancer is cancer that has spread from the prostate to other parts of the body. In this stage, prostate cancer cells commonly spread to the lymph nodes throughout various parts of the body or the bones. Metastasis of cancer cells can also occur in organs further away from the prostate gland, such as the lungs and liver. However, if prostate cancer metastasizes to the lungs, it does not mean you have both lung cancer and prostate cancer. Instead, it means that cells from prostate cancer live in both the prostate gland and the lungs.
Metastatic prostate cancer is sometimes called advanced prostate cancer but is not the same as locally advanced prostate cancer. Locally advanced cancer means that the cancer has spread to nearby lymph nodes and tissue surrounding the prostate. Your diagnosis may be locally advanced if prostate cancer has spread to nearby tissues, such as:
- Lymph nodes near the prostate gland
- Nearby organs like the bladder
- Seminal vesicles
- Tissues surrounding the prostate gland
Many locally advanced cancers can sometimes be cured with medication or a combination of treatment options. Metastatic prostate cancer cannot be cured.
How Does Prostate Cancer Spread?
Prostate cancer can spread when cells break away from the tumor and enter the bloodstream. Here, the cells can be carried to other parts of your body, typically stopping in the capillaries of a newly localized area. Wherever the cancer cells end up, they can break through the walls of the blood vessel and find new tissue to attach to. Cancer cells multiply and grow once they join new tissue, often forming a new tumor in that location. Prostate cancer cells seem to prefer to grow in specific areas of the body, such as the ribs, spine, pelvic bones, and lymph nodes. However, some breakaway cancer cells don't survive in the bloodstream or lie inactive for years without ever reactivating.
How Common is Advanced Prostate Cancer?
According to the National Cancer Institute in the Surveillance, Epidemiology, and End Results Program (SEER), 12 out of 100,000 new prostate cancer diagnoses in 2021 were already advanced. Although the prevalence used to be smaller, the previous misinformation that argued against PSA tests may have contributed to a higher incidence of undiagnosed cancers metastasizing before symptoms even appeared. The increased diagnosis rates stress the importance of early detection and treatment, so talk to your urologist if you're in your 40s or think you may be at risk.
Symptoms of Metastatic Prostate Cancer
Symptoms can occur in various parts of the body, depending on where the prostate cancer cells grow after breaking away. If you notice any symptoms that cause concern or simply aren't feeling yourself, it's always best to see your doctor. Some potential symptoms of metastatic prostate cancer include:
- Dull or stabbing bone pain
- Weakened bones (increased risk of breaks or fractures)
- High levels of fatigue
- Unexplained weight loss
- Feeling unwell for no reason
- Spinal cord compression
- Swollen stomach
- Yellowing of the skin
- Itchy skin
- Coughing up blood
- Breathlessness
- Changes in urination patterns
- Hematuria
Diagnosing Metastatic Prostate Cancer
Diagnosing metastatic prostate cancer will typically involve several tests. Your doctor may recommend these due to high PSA levels on a routine screen or changes in any blood work following a prostate cancer diagnosis. The most common tests will include:
- PET scan
- MRI scan
- CT scan
- X-rays
These scans will focus on the pelvic area and other potential areas of spread to see whether the cancer has spread. If you have symptoms that may indicate the cancer has metastasized to the bones, a bone scan may also be performed. If you have any questions or concerns during diagnostics, don't hesitate to ask your doctor.
Treatments for Metastatic Prostate Cancer
Treatment for metastatic or advanced prostate cancer will depend on your age, general health, and personal preferences. Your doctor may also recommend certain treatments based on your pain, stage or grade of the tumors, and disease progression. However, it's important to remember that metastatic prostate cancer cannot be cured, so managing the condition primarily focuses on extending your life and improving the quality of your life. Treatments can slow the progression of the disease and help reduce pain or discomfort caused by symptoms. Some of the treatment options may include:
External Beam Radiation Treatment (EBRT)
External beam radiation therapy (EBRT) is a type of radiation treatment for metastatic prostate cancer. It uses high-energy X-rays or particles to target and destroy cancer cells in a precise location, minimizing damage to the surrounding healthy tissue. It requires more precision than typical radiation treatments and a longer time commitment. However, it can be effective at targeting advanced stages.
During EBRT, radiation is delivered from a machine outside the body (hence the term "external beam"). The process is carefully planned using imaging tests like CT or MRI scans to pinpoint the exact location of the tumors. This allows doctors to tailor the radiation dose to effectively target cancer cells while sparing as much healthy tissue as possible.
Your doctor may also pair this with androgen deprivation therapy (ADT) for more optimal results. If your doctor recommends this treatment, make sure you ask the necessary questions to learn about the side effects and risks involved.
Androgen Deprivation Therapy (ADT)
Androgen Deprivation Therapy (ADT) is a type of hormone therapy and often the first line of treatment for metastatic prostate cancer. Prostate cancer cells rely on androgens, such as testosterone, to grow. ADT works by reducing the levels of these hormones or blocking their effects on cancer cells, thereby slowing tumor growth. This can be achieved through medications that either lower testosterone production or block its action. In some cases, surgical removal of the testes (orchiectomy) may be recommended to reduce hormone levels.
Chemotherapy
Chemotherapy involves using powerful drugs to target and kill rapidly dividing cancer cells. It’s typically used when prostate cancer has spread extensively or when the cancer is no longer responding to hormone therapy. Common chemotherapy drugs used for prostate cancer include docetaxel and cabazitaxel, which are often paired with hormone therapy.
Surgery
While not typically used to treat metastatic prostate cancer, surgery may be recommended in certain cases to help with specific symptoms and quality of life. For example, transurethral resection of the prostate (TURP) can be performed to relieve urinary symptoms caused by an enlarged prostate. In rare cases, surgery to remove localized tumors in areas of metastasis may also be considered to alleviate symptoms.
Watchful Waiting and Observation
Individuals who are older and don't experience severe symptoms may choose to bypass treatment and take a watchful waiting approach. This way, you don't need to deal with side effects that may decrease your quality of life. If you start to experience any symptoms, then you can explore treatment options with your doctor.
Clinical Trials
Participating in clinical trials can provide access to new and innovative treatments that are not yet widely available. Clinical trials are research studies that explore the safety and effectiveness of new treatments or new combinations of existing treatments. Your doctor can help determine if you are eligible for a clinical trial.
Long-Term Prognosis of Metastatic Prostate Cancer
Unfortunately, advanced prostate cancer cannot be cured, but treatments can help you manage symptoms and control the cancer. The primary goal of treatment during this stage is improved quality of life, so it's important to tell your doctor about practical and physical issues you're experiencing. Everyone is different, so speak with your cancer specialist to understand your long-term prognosis. However, many men who are diagnosed with metastatic prostate cancer go on to live a normal life for several years.
Being diagnosed with prostate cancer does not necessarily mean that it will spread to other parts of your body. However, once it has metastasized, things get a bit more complicated. That's why it's important to see your urologist regularly, keep your appointments, and take a proactive approach to prostate care. This allows you to catch problems early and undergo treatment before metastasis. Whether you receive a urologic cancer diagnosis or are treating another urologic condition, Byram Healthcare carries high-quality urologic products to help you manage your symptoms. Contact us today to learn more.
