If prostate cancer spreads from its original location in the prostate to other parts of the body, it’s called metastatic disease. It may also be known as stage 4 prostate cancer or advanced prostate cancer. The cancer may have grown to the point that it no longer responds to hormone treatment. In this situation, doctors have fewer options for treatment. But new treatments are improving survival for men with this type of prostate cancer.
Doctors diagnose metastatic prostate cancer based on a patient’s symptoms and medical history, as well as results from blood tests and imaging exams. The patient will likely be referred to a specialist, such as an oncologist (a doctor who treats cancer).
The health care team will evaluate the patient and determine the best treatment option. This might involve surgery, radiation therapy or chemotherapy. Hormone therapy is an important part of treatment for people with metastatic disease. It works by blocking the production of testosterone, which is a male hormone.
Other cancer treatments include targeted therapy, immunotherapy and theranostics. These treatments can increase survival in some patients and help reduce the number of side effects. It’s important to understand the risks and benefits of each option. Your health care provider can explain these to you in detail.
A biopsy is a sample of tissue from the prostate or other organs that is examined under a microscope for cancer cells. A prostate biopsy can be done through a gloved finger inserted into the rectum or through the skin of the perineum (the area between the scrotum and rectum). It is usually easy to perform.
Other imaging tests that can be used to look for cancer in the prostate or other areas of the body are computed tomography scans, magnetic resonance imaging (MRI) and positron emission tomography (PET). During a PET scan, a radioactive substance is injected into a vein. Then, a scanner measures the amount of activity in the organs and tissues that absorb the dye. A CT scan combines x-rays with computer calculations to see cross-sectional views of tissue and organs. A contrast dye is sometimes injected before a CT scan to make tissue and organs show up more clearly.
If your doctor thinks that the cancer hasn’t spread and you have a good prognosis, watchful waiting may be an option. During this time, routine PSA tests and the digital rectal exam (DRE) aren’t usually done. Your health care provider might recommend treatments to relieve any symptoms, such as hormone therapy.
Radiation therapy is sometimes used to treat stage 4 prostate cancer. It can be given in addition to hormone therapy or after surgery. It is also used to prevent the cancer from spreading. Several types of radiation are available, including external beam radiation and proton therapy.
After treatment, some men experience urinary, bowel, sexual and hormone-related side effects. These usually go away as treatment progresses. Having support from family and friends can be helpful. Having a faith or a belief in something greater than yourself can also be comforting.