A diagnosis of metastatic prostate cancer can feel overwhelming. At this stage, cancer has spread to other parts of the body, most often the bones or lymph nodes. Even though this means you have an advanced form of the disease, it doesn't mean you're out of options.
Thanks to advances in treatment, many men are living longer. They're also maintaining a good quality of life. Understanding this disease and the treatments available can help you take an active role in your care.
Here's what you should know about metastatic prostate cancer.
What is Metastatic Prostate Cancer?
Metastatic prostate cancer occurs when cancer cells spread to other parts of the body from the prostate. It's also known as advanced prostate cancer or stage IV prostate cancer.
The prostate is a small, walnut-sized gland located just below the bladder and in front of the rectum. It's responsible for producing fluid that nourishes and protects sperm. Many prostate cancers grow slowly and may not cause symptoms for years. Metastatic prostate cancer, however, signifies a progression that requires specialized treatment and management.
In metastatic prostate cancer, cancer cells have traveled beyond the prostate gland to distant areas such as the:
- Bones. This is the most common area where cancer spreads, particularly affecting bones in the pelvis, spine, ribs, and hips.
- Lymph nodes. As part of the body's immune system, the lymph nodes can harbor migrating cancer cells.
- Liver
- Lungs
Regardless of the location, these metastatic tumors consist of prostate cancer cells. This means they require prostate cancer-specific treatment.
Symptoms of Metastatic Prostate Cancer
Early-stage prostate cancer often presents no symptoms. As the disease advances, symptoms may become more apparent and can include:
- Frequent or painful urination
- Difficulty initiating or stopping the urine stream
- Weak or interrupted urine flow
- Blood in the urine or semen
- Pain in the back, hips, or other bones
- Swelling in the legs or feet
- Unexplained weight loss or fatigue
Other conditions can also cause these symptoms. So, if you have them, it doesn't necessarily mean you have prostate cancer. Only a medical evaluation can confirm the diagnosis.
Diagnosis and Staging for Prostate Cancer
To determine the extent of metastatic prostate cancer, doctors may use several diagnostic tests:
- Prostate-specific antigen (PSA) test, which measures the level of PSA in the blood and is often elevated in men with prostate cancer.
- Biopsy to collect a small sample of prostate tissue to confirm cancer and assess its aggressiveness.
- Imaging tests to detect the spread of cancer, including CT, MRI, PET, or bone scans
Staging helps determine the extent of cancer spread and guides treatment decisions. Stage IV indicates that the cancer has spread beyond the prostate to distant parts of the body.
Metastatic Prostate Cancer Treatment Options
Metastatic prostate cancer is challenging. However, today's treatments can slow cancer growth and ease symptoms. Your doctor will create a personalized treatment plan, considering factors like your:
- Cancer's spread
- Overall health
- Treatment preferences
Several treatment options are available.
1. Hormone therapy: androgen deprivation therapy (ADT)
Prostate cancer relies heavily on male hormones, especially testosterone, to grow and spread. Hormone therapy lowers testosterone levels, limiting the fuel cancer cells need. This treatment can shrink and slow the disease while easing symptoms.
2. Chemotherapy
Chemotherapy drugs, such as docetaxel or cabazitaxel, target rapidly dividing cancer cells. Chemotherapy can significantly reduce symptoms and slow the spread of cancer. It can be beneficial when hormone therapy alone is no longer effective.
3. Radiation therapy
Radiation therapy uses high-energy beams to shrink or slow tumor growth, primarily when cancer has spread to bones. Targeted radiation can significantly relieve pain and improve mobility. It can be delivered externally via beam radiation therapy or internally through radioactive implants or injections.
4. Radiopharmaceutical therapy (Pluvicto)
Pluvicto (lutetium Lu 177 vipivotide tetraxetan) is a newer targeted radiation treatment. It targets prostate cancer cells that express a protein called prostate-specific membrane antigen (PSMA). Pluvicto attaches directly to PSMA-positive cancer cells. This allows radiation to be delivered precisely to these cells while minimizing damage to healthy tissues. Pluvicto is approved for metastatic prostate cancer that has continued growing despite prior hormone therapy and chemotherapy.
5. Immunotherapy
Immunotherapy harnesses your body's own immune system to recognize and destroy cancer cells. Sipuleucel-T (Provenge) is a type of immunotherapy specifically designed for advanced prostate cancer. It involves modifying your immune cells to better fight cancer, which may help extend survival in some men.
6. Bone-strengthening medications
If prostate cancer has spread to your bones, treatments like denosumab (Xgeva) or zoledronic acid (Zometa) can help prevent fractures and reduce bone pain. These medications strengthen bones weakened by metastatic tumors.
7. Surgery for symptom relief
While surgery is rarely the primary treatment for metastatic prostate cancer, it can be useful to relieve symptoms. Procedures such as transurethral resection of the prostate (TURP) can improve urine flow if the prostate gland is obstructing the urethra. Surgery might also help stabilize bones affected by metastatic lesions or relieve spinal cord pressure.
Living with Metastatic Prostate Cancer
Managing metastatic prostate cancer involves a well-rounded approach that prioritizes your health.
Nutritious meals with fruits, vegetables, and lean proteins help keep your body strong. They also support your energy levels. Staying physically active with light exercise can also boost your mood and reduce fatigue. Talking openly about your symptoms and side effects with your doctor helps tailor your care to fit your needs.
The prognosis for metastatic prostate cancer varies depending on factors. While it is generally considered incurable, advancements in treatment have improved survival rates and quality of life for many men.
Don't continue to worry about advanced prostate cancer - schedule an appointment with an experienced urologist today!