The prostate is a small gland that is part of the reproductive system in people assigned male at birth. It sits at the bottom of the bladder and plays an important role in helping sperm survive and controlling the flow of urine. Prostate cancer is cancer that develops in the prostate. When cancer spreads from one part of your body to another this process is called metastasis and the cancer is called metastatic, or advanced.
How is prostate cancer staged?
Cancers are given stages and grades to help categorise them and decide the best possible treatment. For prostate cancer the TNM system is often used for staging. The T describes the size of the tumour; the N is the number of lymph nodes the cancer has spread to; and the M is whether the cancer has spread to another part of the body.
There are 4 stages of prostate cancer:
• T1 is the earliest stage and means the prostate cancer is too small to be seen on a scan and may not be able to be felt during an examination
• T2 means the cancer is slightly larger but is still completely inside the prostate gland
• T3 means the cancer has broken through the covering of the prostate gland, it may have spread to the surrounding tissues but not to the lymph nodes or other parts of the body
• T4 means the cancer has spread into the lymph nodes and could have spread to other parts of the body
Is there a stage 5 prostate cancer?
Prostate cancer can sometimes spread from the prostate to other areas including the bones, lymph nodes, liver or lungs. If this happens it is called metastatic prostate cancer, or advanced prostate cancer. You may also hear doctors refer to it as stage 4 prostate cancer or secondary prostate cancer.
People sometimes ask us if there is a fifth stage of prostate cancer but no, there is no medically recognised stage 5 and calling it this can be confusing for patients. Stage 4 is the most advanced stage of prostate cancer.
How does prostate cancer progress through the stages?
Different types of prostate cancer start in different cells in your prostate. The most common type are adenocarcinomas which develop in the gland cells which line the prostate gland.
Prostate cancer generally grows relatively slowly, but the way it progresses varies a lot from patient to patient. It always starts by being confined to the prostate, but if is not caught and treated early then it can spread to other places. The bones and lymph nodes are the most common places for prostate cancer to spread to.
How does prostate cancer become metastatic?
Metastasis is the process of cancer spreading from its original site to another part of the body. For prostate cancer this means the cancer cells are able to break away from the prostate and travel through the blood stream or lymphatic system to another area. It is still called prostate cancer wherever it travels to.
Some prostate cancers are more aggressive and likely to spread than others. We don't yet fully understand why some prostate cancers spread, but international cancer research is helping us to find out.
Professor Cynthia Miranti and her team in the United States are using a novel bioengineering method to work out exactly why prostate cancer often spreads to the bone. This could lead to better treatments for patients with advanced prostate cancer.
Where does metastatic prostate cancer commonly spread to?
Prostate cancer can sometimes spread to other parts of the body including:
• Lymph nodes
• Bones including the spine, pelvis, femur or ribs
• Liver
• Lungs
How much it spreads and where it spreads varies from patient to patient. If you have any questions about the grade or stage of your prostate cancer please speak to your oncology team.
Is metastatic prostate cancer curable?
Like other cancers, the earlier prostate cancer is detected and treated the easier it is to cure. Advanced prostate cancer cannot currently be cured, but treatments can help control the disease and manage symptoms.
While more men are surviving a prostate cancer diagnosis than ever before, we still urgently need more research into new ways to prevent and diagnose prostate cancer so that no one has to say goodbye too soon.
Who is more likely to develop advanced prostate cancer?
Prostate cancer is one of the most common cancers in the UK and worldwide. It is more common in people aged over 65, and Black men, and men with a family history of prostate cancer, are also more at risk. Certain inherited mutations and genetic conditions including Lynch syndrome can also be linked to prostate cancer development.
The earlier prostate cancer is diagnosed, the easier it is to treat. The risk of prostate cancer spreading appears to be linked to lifestyle factors, for example research indicates that men who are overweight or have obesity are at more risk of developing advanced prostate cancer.
Symptoms, diagnosis and treatment of metastatic prostate cancer:
What are the symptoms of metastatic prostate cancer?
Sometimes the symptoms of prostate cancer can be hard to spot and in the early stages and you may not even notice any symptoms at all. The most common symptoms of prostate cancer are frequent urination, difficulty urinating or blood in your urine.
In later stages, when prostate cancer spreads, the metastasis can cause symptoms including:
• Extreme tiredness
• Loss of appetite
• Pain in the bottom
• Weight loss
• Ache in the bones
• Anaemia
If you are worried about any of these symptoms please speak to your doctor.
How is metastatic prostate cancer diagnosed?
Metastatic prostate cancer is diagnosed through using a combination of the following tests:
• Prostate specific antigen (PSA) test. This blood test looks for levels of a protein called PSA, a raised level can be an indicator of cancer but can also be a result of other prostate problems.
• Digital rectal examination (DRE). This involves a doctor feeling your prostate to see if you may have a problem.
• Magnetic resonance imaging (MRI) or computerised tomography (CT) scan. These scans provide a picture of your prostate, if there are signs of cancer, and if it appears to have spread.
• Bone scan. Since prostate cancer can spread to the bones, a bone scan can be used to look out for this.
• Positron emission tomography (PET) scan. This scan can see even small areas of cancer and is sometimes used to see if prostate cancer has come back after treatment or to work out the stage of your cancer.
• Biopsy. This involves taking a small sample of tissue from your prostate to examine under a microscope.
Together, the results of these tests will help to understand the best treatment options for you.
How is metastatic prostate cancer treated?
Early-stage prostate cancer does not always need treatment. However, metastatic prostate cancer does. The type of treatment you will receive depends on a range of factors including the type of cancer, the stage of the cancer and your health more generally.
Treatment options for metastatic prostate cancer include:
• Hormone therapy: works by stopping testosterone from being produced, since prostate cancer cells need testosterone to grow.
• Chemotherapy: drugs that can shrink the cancer and slow its growth.
• Radiotherapy: some patients are given radiotherapy in combination with other treatments.
• Targeted therapy: some patients with specific mutations can benefit from a therapy called olaparib.
• Surgery: a radical proctectomy involves removing your prostate gland.
How can we make a difference for metastatic prostate cancer patients?
Prostate cancer is the most common cancer in men and in the UK more than 12,000 people die from prostate cancer every year. If it caught early it is often curable, but the later it is diagnosed the harder it is to treat.
And there is still a lot we don’t know about metastatic prostate cancer. What makes it more likely to spread, who is most at risk and how can we stop prostate cancer spreading? Discovery research is critical to finding these answers and paving the way to new cures, and Curestarters like you are helping to fund it.
Is progress being made in curing prostate cancer?
Back in 1999, Professor Ros Eeles came to us with an idea for a project to find out more about inherited prostate cancers - which we funded with the support of our Curestarters.
Since then, she has spent decades co-leading international efforts to identify over 160 genes associated with prostate cancer risk - dramatically expanding our understanding of inherited prostate cancer risk.
Professor Eeles is now part of the team running the £42m research programme TRANSFORM, the biggest ever trial in prostate cancer screening, comparing the saliva test to other potential screening options to find the best way to screen for prostate cancer.
One day we hope this means anyone at risk will be invited for regular tests to detect aggressive prostate cancers early, and support like yours helped make this possible.
Your metastatic prostate cancer FAQs:
What is advanced prostate cancer?
Advanced prostate cancer, also called metastatic prostate cancer or stage 4 prostate cancer, is when prostate cancer has spread beyond the prostate, into another part of the body.
What causes prostate cancer to become advanced?
Prostate cancer generally grows relatively slowly but sometimes it is more aggressive and quicker to spread. We don’t fully know why it sometimes spreads, but researchers are trying to better understand how prostate cancer spreads and how to stop it.
How is metastatic prostate cancer treated?
Advanced prostate cancer may be treated with chemotherapy, radiotherapy, hormone therapy, targeted therapy, surgery or a combination of these. Doctors will work out the best treatment plan for you depending on the type of cancer and what stage it is at.
Is metastatic prostate cancer curable?
The sooner prostate cancer is detected the easier it is to treat. Unfortunately, once it has spread, prostate cancer is not curable, but treatment can help manage the disease and control symptoms.
How does research help improve outcomes for advanced prostate cancer?
All new ways to prevent, diagnose and treat prostate cancer start with discovery research. Thanks to you, cancer research is answering some of the big questions about advanced prostate cancer including how it spreads to the bone and how healthy cells might be involved in prostate cancer spreading.
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