Metastatic Prostate Cancer

Overview 

Prostate cancer begins in the tissue of the prostate gland. But when it metastasizes (spreads) beyond the prostate, it is called advanced prostate cancer or metastatic prostate cancer. There are different stages of metastatic prostate cancer: Stage III cancer occurs when the tumor spreads outside the prostate to nearby tissues, and Stage IV cancer occurs when the cancer spreads outside the prostate to other parts of the body, such as the lymph system, bones, liver, lungs or brain.

Metastatic prostate cancer causes

Prostate cancer spreads when cancer cells leave the prostate and quickly grow and metastasize to nearby tissue. These cells often spread first to the nearby lymph nodes and the bloodstream. When this happens, the cancer cells can spread to other organs and start new tumors. Cancer that spreads to the bone is seen in 85% to 90% of metastatic prostate cancer cases.

Metastatic prostate cancer risk factors

Understanding what raises your risk for certain cancers can help you make an informed decision about the risk factors you can change. There are some risk factors, such as a person’s age or family history, that cannot be changed.

Several factors may influence the risk of getting metastatic prostate cancer. These include:

• Age
• Exposure to chemicals, such as Agent Orange
• Family history of prostate cancer
• Genetics and hereditary conditions, such as inherited mutations of the BRCA1 and BRCA2 genes or men with Lynch syndrome
• Obesity
• Prostatitis, inflammation of the prostate gland
• Race - prostate cancer develops more often in African-American men 
• Smoking

Metastatic prostate cancer symptoms

Prostate cancer can be found early through screening. Prostate cancer in its early stages may not cause any symptoms. When prostate cancer progresses, symptoms may occur, including:

• Hematuria (blood in your urine)
• Difficulty getting an erection
• Loss of bladder or bowel control
• Pain in the hips, back and chest
• Problems urinating
• Weakness in the legs or feet

Metastatic prostate cancer diagnosis

With prostate cancer, doctors usually find cancer during prostate cancer screening. Your urologist may use the following methods to either screen for cancer or help determine the cause of your symptoms:

• Prostate-specific antigen (PSA) blood test - PSA is a protein made by cells in the prostate gland. This screening is often used on men without any symptoms. Screening can determine the levels of PSA in your blood. If the PSA levels are high, your urologist will recommend further tests.
• Medical history - this helps doctors understand your current symptoms and how long you’ve had them.
• Digital rectal exam - your doctor may recommend this exam to feel for any bumps or hard areas on the prostate that might be cancer. 
• Advanced imaging - imaging, such as ultrasound, magnetic resonance imaging (MRI), transrectal ultrasound (TRUS), or positron emission tomography (PET) scans to produce images of the inside of your body to look for cancer in the prostate.
• Biopsy - this is a procedure that removes cells or tissues so they can be examined under a microscope. Doctors use a thin needle inserted into the tumor and a sample of tissue is taken.

Metastatic prostate cancer treatments

The treatment for metastatic prostate cancer depends on the stage of the cancer. The goal is to shrink the tumor and relieve or control symptoms. Treatment may include:

• Hormone therapy - this is a type of treatment that works to lower the levels of testosterone within the body. It can help slow the growth of the cancer cells and help shrink a tumor that has not spread.
• Chemotherapy - doctors use this therapy to slow the growth of cancer or reduce symptoms by shrinking the tumors. This therapy is administered through a vein (intravenous IV) or taken orally (by mouth) to attack and kill cancer cells. 
• Immunotherapy - this is medication therapy that stimulates your immune system to recognize and destroy cancer cells. It uses your body’s own immune system to fight the cancer. 
• Radiation therapy - when prostate cancer spreads to the bones, radiation treatment, using high-energy X-rays or other types of radiation, works to destroy cancer cells. Radiation therapy may be used to reduce pain or prevent fractures caused by cancer spreading to the bones.
• Surgery - there are different types of surgery approaches depending on whether the tumor has spread outside of the prostate gland. Different surgeries include minimally invasive procedures as well as open surgery, such as an open prostatectomy. 

When should I seek care?

If you experience any of these symptoms, start by voicing your concerns and symptoms to your primary care provider. From there, your doctor may suggest seeing an oncologist for more specialized treatment.