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Prostate cancer is the second most common
cancer affecting American men after skin cancer. In the United States, it
affects 1 in 7 men at some point during their lifetime.
Most prostate cancers grow very slowly. Men
with this type of prostate cancer usually end up dying from another cause.
However, some prostate cancers can grow faster and spread (metastasize) to
other areas of the body. Metastasis is one of the criteria for staging prostate
cancer. The stages of prostate cancer use the Roman numerals I, II, III and IV.
When it has spread outside the prostate gland, it is advanced prostate cancer,
usually stage III or IV.
Local Sites
One of the ways cancer can spread
is by growing into nearby—or local—tissues. When prostate cancer starts to
spread just beyond the prostate, doctors classify it as stage III. In this
stage, doctors can find cancer in the seminal vesicles—glands that help make
semen. However, the cancer has not reached any lymph nodes. As the cancer
continues to spread, it can affect the lymph nodes and nearby organs, such as
the rectum, bladder, or pelvic wall. Doctors classify this spread as stage IV
prostate cancer.
Distant Sites
In stage IV prostate cancer, cancer
cells can also spread to distant body sites through the blood or lymph system.
The most common place for prostate cancer to spread is the bones. This can
cause bone pain and other problems, such as fractures and dangerously high
calcium levels. Prostate cancer can also spread to the liver, lungs, and
adrenal glands.
Treatment Options
In most cases, prostate cancer that
has spread is not curable. Instead, doctors try to control the cancer’s growth,
prolong life, and improve quality of life. They typically use a combination of
treatments for these late-stage cancers. This includes hormone therapy,
chemotherapy, radiation therapy, and surgery.
A second part of treatment at this
stage is preventing or slowing the spread of cancer to the bones. Your doctor
may also recommend treatment to manage symptoms, such as bone pain. Treatments
may include:
-
Bisphosphonates such as zoledronic acid (Zometa)
-
Corticosteroids such as prednisone
-
Monoclonal antibodies such as denosumab (Xgeva,
Prolia) -
Pain medicines including both over-the-counter
and prescription drugs -
Radiation therapy and radioactive drugs such as
strontium-89 (Metastron)
In general, the higher a cancer’s
stage, the more severe the disease. Lower stage cancers usually have a better
outlook because they are confined to the prostate. Their smaller size makes
them easier to target with cancer treatment.
Talk with your doctor about your
specific situation. Ask about the treatment options available for the stage and
grade of your prostate cancer. Make sure you understand the goals of your
treatment and whether or not it is curative. You may also want to consider
enrolling in a clinical trial. This can help expand your treatment options and
give you access to experimental treatments. Finally, think about getting a
second opinion about your options for prostate cancer that has spread. It can
help you feel more comfortable with your treatment decisions.