Prostate cancer screenings help doctors catch prostate cancer early. Nearly 70% of the time, the cancer is only in the prostate gland at the time of initial diagnosis. This is known as early-stage cancer or Grade Group 1.

Metastatic prostate cancer occurs when cancer cells spread from the prostate gland to other parts of the body. Prostate cancer can metastasize (spread) months or years after you get the diagnosis or after you’ve stopped cancer treatments.

What does metastatic mean?

Metastatic is another way of saying that cancer cells have made their way outside of the original tumor. Prostate cancer most commonly spreads to the bones and lymph nodes. It sometimes spreads to the lungs, liver, or brain.

How does prostate cancer metastasize or spread?

Metastatic prostate cancer is the result of cancer cells breaking free from the original tumor. These cells often go into the lymph nodes that filter bacteria and viruses. Cancer cells may settle in the lymph nodes. They can also make their way through the bloodstream to bones and organs. When cancer cells settle in these distant parts of the body, they start to multiply and form new tumors.

What is stage 4 prostate cancer?

Metastatic prostate cancer and stage 4 prostate cancer are the same thing. You may also know it as advanced prostate cancer. Cancer stage refers to how advanced or widespread the cancer is throughout your body. Doctors use a cancer staging system that includes Grade Groups and the Gleason score to determine prostate cancer stage.

Cancer staging occurs at the time of the initial prostate cancer diagnosis. However, prostate cancer can spread years later. If this happens, the stage or Grade Group changes.

Does metastatic prostate cancer mean I have a new type of cancer?

Prostate cancer that forms in a secondary site is still prostate cancer. For example, prostate cancer that moves to the bones forms bone metastases (bone mets). In this case, you have metastasized prostate cancer in the bones — not bone cancer. Your doctor will run tests to confirm the cause of the secondary cancer. This distinction matters because treatment for bone mets differs from treatments for bone cancer.

What are the symptoms of metastatic prostate cancer?

Symptoms of metastatic prostate cancer vary depending on where the secondary cancer develops. Up to 90% of the time, prostate cancer spreads to bones. Bone mets often form in the ribs, spine, pelvis, arms, and legs.

Bone mets can cause chronic pain in the affected area, as well as bone fractures and spinal compressions. You may experience:

• arthritis-like pain 

• back or neck pain

• difficulty passing urine or stool

• fatigue

• numbness or weakness

• pain that worsens or doesn’t get better when resting

Bone mets can also raise blood calcium to dangerous levels. Too much calcium in the blood (hypercalcemia) can affect brain and heart function. You may feel confused, lethargic, or experience heart palpitations.

How is metastatic prostate cancer diagnosed?

After an initial diagnosis of prostate cancer, your doctor will closely monitor yourprostate-specific antigen (PSA) levels. Rising numbers may indicate that prostate cancer is back or spreading. You’ll also get more frequent imaging scans after a diagnosis or treatment. These scans can show when cancer becomes active again.

How is metastatic prostate cancer treated?

While there isn’t a cure for metastatic prostate cancer, prostate cancer treatments can slow the progression of the disease and alleviate symptoms. An estimated 1 in 3 men with metastatic prostate cancer are alive five years after the diagnosis.

Treatments vary depending on where the cancer spreads. Options include:

• Androgen deprivation therapy (androgen suppression): This hormone therapy lowers testosterone, which fuels the growth of cancer cells.

• Bisphosphonates: Injections of zoledronic acid (Zometa®) or denosumab (Xgeva®, Prolia®) can slow the growth of bone mets. These drugs also help prevent fractures and high blood calcium levels. 

• Corticosteroids: Prednisone and dexamethasone can relieve bone pain and lower PSA levels. 

• Radiation therapy: External radiation therapy for bone mets can lessen bone pain and ease pressure on the spinal cord.

• Radiopharmaceuticals: Radium 223 (Xofigo®) is an injectable form of radiation. It settles in bone mets, slowly giving off radiation and killing cancer cells. 

• Surgery: In addition to removing the prostate (prostatectomy), a surgeon may also remove the testicles. Called orchiectomy or castration, this surgery stops the production of hormones that stimulate cancer growth.

• Systemic treatments: These therapies include chemotherapy and immunotherapy, as well as hormone therapy.

• Targeted therapy: Poly(ADP)-ribose polymerase (PARP) inhibitors target certain proteins in cancer cells. PARPs for advanced prostate cancer include rucaparib and olaparib.

Should I try a clinical trial?

Researchers are actively conducting clinical trials to find better ways to treat metastatic prostate cancer and stop cancer spread. Many prostate cancer clinical trials focus on new therapies that target gene changes, as well as immunotherapies and chemotherapies. Your doctor can help you determine if you might benefit from a clinical trial.

Can I prevent prostate cancer recurrence?

There isn’t much you can do to keep prostate cancer from returning or spreading. One of the most important steps is to get frequent prostate cancer screenings, so you can catch cancer spread quickly.

These lifestyle changes can have a positive effect on your overall physical and mental health:

• cutting back on alcohol 

• quitting smoking

• maintaining a healthy weight

• making smart food choices

• staying physically active 

Living with prostate cancer

Living with a chronic disease like prostate cancer is stressful. These steps can help you cope:

• Connect with members of the Inspire ZERO Prostate Cancer Support Community.

• Join an online or in-person support group and seek mental health counseling (psychotherapy).

• See a dietitian to improve your diet and address treatment side effects like loss of appetite and nausea.

• See a palliative care specialist if you have pain or lingering treatment side effects.

“I was diagnosed with stage four … with a spot on the spine and was put on Lupron. A little later I had radiation to the prostate and spine. Some time later I had chemotherapy. More recently I had radiation to a new pelvic lymph node. My PSA is now undetectable and I have a good quality of life.”

“My story. After being diagnosed with prostate cancer I elected radiation... Numbers went down and held ... Had a pet scan , bone scan, body scan ... The pet scan showed hot only in my prostate. The Lungs came back with spots and enlarged lymph nodes. Had a 6 month chest scan and it showed changes from 6 months ago. Had a Lung biopsy and unfortunately it came back positive for prostate. So it’s in my blood. Stage 4. My oncologist is scheming me for my first Lupron on the 19th. With a secondary drug called Apalutamide. Would appreciate any responses from folks with similar journeys. Comments on alternatives, side effects,, longevity , etc.”

Sources

• Key Statistics for Prostate Cancer. American Cancer Society. January 2023.

• Observation or Active Surveillance for Prostate Cancer. American Cancer Society. August 2019.

• Prostate Cancer Risk Factors. American Cancer Society. June 2020.

• Prostate Cancer Stages. American Cancer Society. October 2021.

• Radiation Therapy for Prostate Cancer. American Cancer Society. February 2023.

• Screening Tests for Prostate Cancer. American Cancer Society. January 2021.

• Survival Rates for Prostate Cancer. American Cancer Society. March 2023.

• Tests to Diagnose and Stage Prostate Cancer. American Cancer Society. May 2023.

• Treatments for Prostate Cancer Spread to Bones. American Cancer Society. August 2019.

• What’s New in Prostate Cancer Research. American Cancer Society. October 2021.

• What Is Prostate Cancer? American Cancer Society. August 2019.

• Advanced Prostate Cancer. American Urological Association. September 2021.

• Adenocarcinoma. City of Hope. July 2022.

• Metastatic Stage 4 Prostate Cancer. City of Hope. May 2022.

• Hypercalcemia. Mayo Clinic. April 2023.

• Gleason Score and Grade Group. Prostate Cancer Foundation.

• Prostate Cancer Metastases. Prostate Cancer Foundation.

• Prostate Cancer Staging. Prostate Cancer Foundation.

Disclaimer

Member comments are lightly edited for length and to remove identifying information but are otherwise reproduced as they appear in the community as part of public posts.

This content is for general informational purposes only and does not necessarily reflect the views and opinions of any organization or individual. The content should not be used as a substitute for professional medical advice, diagnosis, or treatment. Please consult your healthcare provider about any questions you may have regarding a medical condition.