What is the prostate?

The prostate is a part of the male reproductive system, which includes the penis, prostate, and testicles. Approximately the size of a walnut, the prostate is located just below the bladder and in front of the rectum. It surrounds the urethra (the tube that empties urine from the bladder) and is responsible for producing seminal fluid and transporting and nourishing sperm.

What is cancer?

Cancer is a disease in which cells in the body grow out of control. When cancer starts in the prostate, it is called prostate cancer. Not including skin cancer, prostate cancer is the most common cancer in American men.

What is advanced prostate cancer?

Advanced prostate cancer is cancer that has spread from beyond the inside of your prostate gland to other parts of your body. This contrasts with localized prostate cancer which is specifically contained within your prostate gland.

Hearing the news that your prostate cancer has spread can be devastating, but you don’t need to assume the worst right out the gate. The five-year survival rate for advanced prostate cancer can be quite high depending on how far along it has developed. For example, if it has only spread to nearby parts of the body, you have around a 95% chance of still surviving five years from now.

In fact, there’s a whole spectrum of diagnoses to describe the severity and maturity of advanced prostate cancer. There are dramatically significant differences in the outlook depending on where you land on this spectrum.

Like other cancers, prostate cancer is graded on a spectrum of stages (usually from 1 to 4), and advanced prostate cancer focuses on Stages 3 and 4. Even inside of these stages, we can be more specific; for example, you could have Stage 3C prostate cancer.

When prostate cancer becomes advanced and spreads to other areas of the body, it becomes more difficult to treat and contain. You might have heard that the cancer has “metastasized” — this is just another way to say that it has spread outside the prostate. This is also why you might hear it being referred to as metastatic prostate cancer.

There are tests like biopsies that help your doctor to determine where it has spread and to what degree. This can also help with figuring out what stage you are at.

A common place that prostate cancer spreads to is the lymph nodes near the prostate. In cases like this, we refer to the disease as being at the “regional stage”, and the chances of survival at this point are still high.

If it spreads to more distant parts of the body, this is when the chances of survival decline significantly. For example, if it has reached the patient’s bones (a condition known as bone metastasis), the five-year survival rate is around 29%.

Remember though: these numbers are only estimates and every case is different. Your doctor will go over all of this in detail with you as well as the best treatment strategy for your situation, whatever it may be.

Prostate cancer can be broken down into different types depending on the nature of your disease:

• Castration-Resistant Prostate Cancer (CRPC)
  • Non-Metastatic Castration-Resistant Prostate Cancer (nmCRPC)
  • Metastatic Castration-Resistant Prostate Cancer (mCRPC)
• Metastatic Prostate Cancer
• Metastatic Hormone-Sensitive Prostate Cancer (mHSPC)

Although the titles are a mouthful, they’re not as complicated as they seem at first glance.

Castration-Resistant Prostate Cancer (CRPC)

Hormone therapy and starving the cancer

Cancer needs fuel to survive. With prostate cancer, testosterone does the job in most cases.

That’s why hormone therapy is a common approach to fighting this cancer: by reducing the level of testosterone in the body, we can potentially starve the cancer and stop it from growing. Another name for this is androgen deprivation therapy.

There are different ways to go about hormone therapy, including medications (hormone-blocking drugs) or surgery to remove the testicles (castration). The testicles produce androgens like testosterone, so removing them will dramatically reduce the testosterone levels of your body (around a 90%–95% drop).

Whichever route is taken, the goal of hormone therapy is to reduce your testosterone level all the way down to that of a castrated person. In approximately 85%–90% of advanced prostate cancer cases, the tumor shrinks with hormone therapy.

Hormone therapy can significantly slow down the cancer and alleviate side effects, potentially adding years to your life — but it’s not an outright cure. The issue is that not all cancer cells are fueled by hormones, so with time, these cancer cells may grow and spread. On top of that, cancer cells reliant on androgens can also adapt to the lower levels and start multiplying again.

Once hormone therapy has hit a ceiling with its ability to contain cancer, we redefine the cancer as castration-resistant prostate cancer. In other words, this is a cancer that can survive and grow, even with dramatically reduced testosterone levels, so your doctor will have to revise your treatment strategy.

What is castration-resistant prostate cancer (CRPC)?

CRPC is how we describe the point where cancer keeps growing, even when testosterone levels are on par with or below castration levels (less than 50 ng/dL). CRPC is also known as hormone-refractory or hormone-resistant prostate cancer.

We can diagnose CRPC through testing to see if your prostate-specific antigen (PSA, a protein produced by prostate cancer cells) level continues to rise while your testosterone level remains low. This can be backed up by imaging tests that offer visual clues of a growing cancer. PSA doubling time refers to the time it takes for your PSA levels to double.

Central to your treatment strategy will be to stop the cancer frommetastasizing, which means spreading. When cancer spreads, it can be much harder to treat and contain.

If your CPRC has spread beyond the prostate, we can more specifically call it metastatic castration-resistant prostate cancer (MCRPC); if it hasn’t, we call it non-metastatic castration-resistant prostate cancer (nMCRPC).

Your doctor has numerous testing options available to them to figure out if yours has spread.

Non-Metastatic Castration-Resistant Prostate Cancer (nMCRPC)

For patients with nMCRPC, the cancer remains contained within the prostate, and there are often no symptoms as well. To check if the cancer is growing, these patients usually must undergo regular testing with methods including blood tests and physical examinations.

Even though non-metastatic CRPC is not quite as serious as metastatic CRPC (meaning the cancer has spread), it is worthwhile for patients to learn the symptoms of the latter type in case your cancer begins to spread.

Symptoms can be a sign that the cancer has spread outside of the prostate, and the type of symptoms you experience depend on the tumor size and affected organs. Make sure to watch out for:

• Issues with urinating
• Blood in the urine
• Tiredness
• Weakness
• Breathlessness
• Weight loss
• Bone pain

Sometimes, it’s not obvious that symptoms are related to the cancer, and some men are also reluctant to talk about these issues with their doctor. However, it is vital that you keep him/her informed of any developments, even if it seems trivial or irrelevant.

Metastatic Castration-Resistant Prostate Cancer (MCRPC)

This is the type of CRPC that has spread beyond the prostate and for which hormone therapy no longer works. It is normal for hormone therapy to stop working after a few years, and many men with prostate cancer go on to develop MCRPC.

MCRPC can spread to many different parts of the body, for example the nearby lymph nodes, bones, bladder, rectum, liver, lungs, and even the brain. There may be no symptoms, but if there are, these include:

• Issues with urinating
• Blood in the urine
• Tiredness
• Weakness
• Breathlessness
• Weight loss
• Bone pain

Unfortunately, this subtype can be hard to cure — even if doctors catch it early on. This is because it tends to be quite aggressive.

There are numerous treatment options available for MCRPC patients. The main idea here is to slow progress and control symptoms. Your doctor may ask you to stay on hormone therapy because, even though it’s no longer able to contain the cancer, stopping it could actually make things worse.

Typical treatment strategies for MCRPC include:

• Chemotherapy
• Immunotherapy
• Radiation medications
• Treatments to ease symptoms

Metastatic Prostate Cancer

When prostate cancer spreads, we call it metastatic prostate cancer. You may also hear your doctor saying that the cancer has metastasized.

There are common ways in which this plays out. Prostate cancer mostly spreads to the lymph nodes or bones, but the liver and lungs are also relatively common. Rarely, it can reach more distant parts of the body like the brain, kidneys, pancreas, and spleen.

Even when this cancer has spread to other parts of the body, we still refer to it as prostate cancer. Metastatic prostate cancer does not have a cure, but it is possible to treat and manage the disease. In fact, a majority of patients live a relatively normal life, and their lifespan can be comparable to that of a healthy person.

There is an important distinction with metastatic prostate cancer that sets it apart. It specifically refers to cancer that has left the prostate and traveled to more distant parts of the body. Locally advanced prostate cancer is how we describe cancer that has only spread to tissues nearby to the prostate, and this type can be cured.

As one of the first destinations for prostate cancer that spreads, the lymph nodes can act as a launching pad for the cancer to colonize other parts of the body too. The same goes for the bloodstream, as this allows the cancer to deposit its cells in numerous sites around the body. Bone metastasis, i.e., cancer that has spread to the bones, make up approximately 85%–90% of all metastatic prostate cancer cases.

Roughly half of all men diagnosed with localized prostate cancer (cancer that has not spread) will go on to develop metastatic prostate cancer. The key is to catch it early, as this gives us the best chance at preventing it from spreading.

In some cases, patients are completely unaware they have prostate cancer until it spreads. Doctors can determine this through testing, for example, with X-rays, CT scans, or an MRI.

Metastatic Hormone-Sensitive Prostate Cancer (mHSPC)

This advanced prostate cancer subtype is when cancer has spread outside the source, but it can still be treated with hormone therapy. That means that blocking androgens like testosterone will continue to be effective at slowing or stopping the growth of the cancer. Discontinuing hormone therapy has the potential to fuel mHSPC, making it grow more powerful.

There is currently no cure for mHSPC, but it is possible to slow it down and manage it. Besides going on some kind of hormone blocking medication program, some mHSPC patients may be asked to consider having surgery to remove their testicles, which could help to starve the cancer.

A note on treating castrate-resistant prostate cancer

Even if your CRPC has metastasized, a combination of medications and other treatments can significantly hamper the progression of the disease.

You might think that hormone therapy is pointless now because you have been diagnosed with CRPC, but that’s not necessarily the case. Your doctor may recommend keeping you on hormone therapy because allowing a natural rise in testosterone could add more fuel to the fire, making the cancer even worse.

Treating CRPC heavily depends on whether yours has metastasized.

Some of the main treatment options available include:

• Chemotherapy. Thesemedications directly kill cancer cells, but the side effects can be difficult to tolerate.
• Immune therapy. A complicated procedure that involves making a personalized vaccine using your own white blood cells. The vaccine assists your immune system with attacking the cancer cells and can help to extend your lifespan.
• New hormone therapies. There are specialized hormone therapies available that can be effective with CRPC cases, and trials have shown that they can help you live longer.
• Radiation therapy. Using high-energy rays or particles, we can attack cancer cells as a main treatment or to relieve symptoms; for example, if you have urinary issues (peeing) caused by a tumor.
• Treatments for bone-metastases. If your cancer has spread to your bones, there are specific treatments to tackle this problem including drugs, corticosteroids, and radiation therapy. The bones are the most common place for advanced prostate cancer to spread, and tumors here can cause bone fractures and intense pain.

In the early stages of prostate cancer, you might not notice any symptoms. This is a key reason why screening is so important. Sometimes symptoms only become apparent when the cancer advances.

However, even with advanced prostate cancer (meaning cancer that has spread to other parts of the body), it is still possible to not have signs or symptoms. This is because cancer behaves in different ways from person to person, and factors like genetics play a large role. It’s a complicated disease, and not everyone’s experience of it is uniform.

When symptoms do appear for advanced prostate cancer patients, the nature of the symptoms depends on factors like the size of the tumor growth and where the cancer has spread to. General signs include tiredness, weakness, bone pain, and feeling unwell, but there are numerous treatments available to help manage pain and other difficulties.

The following are some of the most common symptoms of advanced prostate cancer.

Urinary and bowel issues

If a prostate tumor grows to a certain size, it can start pressing on the bladder and urethra, causing urinary issues. The closeness of the two organs is the cause.

Key signs of bladder and urinary issues include:

• More frequent urination
• Having to get up in the middle of the night to pee
• Feeling the need to pee even if nothing comes out
• Blood in the urine or semen
• Being unable to hold in urine (also known as incontinence)

Although less common than urinary issues, bowel problems related to advanced prostate cancer can come about if the cancer spreads to the rectum, which is nearby to the prostate.

Blood in your stools is a solid clue, along with pain in your stomach and issues with passing stools (constipation).

Lungs and breathing

Advanced prostate cancer can spread to many distant parts of the body, and your lungs are one of the potential targets. Naturally, breathing issues can arise, like coughing that won’t go away, breathlessness, and hacking up blood in your coughs.

Fluid buildup between the chest wall and lung is also a risk in this scenario, and this can cause infections.

The liver and weight loss

You might notice that even though you’re eating the same amount as before, you’re losing weight regardless. This is potentially a sign of advanced prostate cancer, along with a loss of appetite.

It’s often an indication that it has spread to your liver. As such, you may feel pain in your right abdomen and experience itchy skin or jaundice (yellowing of the skin).

Bones

When prostate cancer spreads, one of the most common destinations is the bones, where it starts muscling in on healthy bone material. This can cause weaknesses in the bones that cause them to break much easier than normal.

Since your hip and spine are closest to your prostate, these are the most common sites for when cancer spreads to the bones (also known as bone metastasis).

The experience of bone metastasis is notoriously painful, so treatments to manage this pain can be necessary. This pain tends to interrupt daytime activities and sleep, be it a dull and vague pain or something sharp and stabbing.

Spinal cord compression is also a possibility. The cancer can push against the spine so much that the nerves aren’t able to function properly, and back pain is usually the first sign of this. You may also notice pain, tingling, or swelling in the feet or legs.

Medical intervention is necessary when there is spinal cord compression. Your doctor can go over the details with you.

Lymph nodes and groin pain

The lymph nodes are a network of glands throughout the body that help you to fend off infections and filter fluids. Prostate cancer typically uses this network to travel throughout the body and reach distant organs, but it’s very common for cancer to infect the lymph nodes themselves.

Your groin area hosts many lymph nodes, and since these are the ones closest to your prostate, they’re likely first in the firing line for where the cancer will spread. Cancer stops your lymph nodes from doing their job, so they may fail to drain fluids and swell up instead. This can result in pain in the area around the lymph node.

When it comes to diagnosing advanced prostate cancer, there are two ways that this tends to happen.

For most men, advanced prostate cancer doesn’t just come out of the blue; they already have a history of the disease as well as some treatment to contain it. Perhaps they underwent surgery, radiation therapy, or a combination of different techniques to stop the cancer from advancing.

During post-treatment monitoring, when your doctor routinely examines you for signs of what way things are going, evidence emerges that the cancer is back and getting stronger. In other words, it’s moving into a more advanced presentation. This can happen even when there are no signs or symptoms that things have gotten worse.

In a minority of cases (between 5% and 10%), some men present with no history of the disease at all. These people may or may not have any symptoms, and it’s usually the case that routine testing sounds the alarm by showing they have very high PSA levels.

For the others, they go to their doctor complaining of symptoms like urinary issues or pain, and the doctor requests testing to check for prostate cancer, which turns out to be positive.

Whatever the scenario, there are numerous tests that doctors use to determine whether or not you have advanced prostate cancer. The following are used to diagnose as well as monitor the disease:

• PSA Blood tests
• Digital rectal exam
• Imaging and scans
• Biopsy

Let’s explore each one in further detail.

PSA Blood tests

Prostate-specific antigens are proteins made by the cells of the prostate gland, and that includes both cancerous and non-cancerous cells. As such, it’s a good indicator that something could be wrong, though it’s not foolproof.

The results of the test usually come back measured in nanograms of PSA per milliliter of blood (ng/ml). Your doctor will be observing the results for changes in the way your prostate is producing PSA, and it helps them to stage your cancer, devise a treatment strategy, and assess how well treatment is working.

Many prostate cancer patients are found to have PSA levels that are higher than normal or have gotten higher over time.

However, a higher PSA does not automatically translate to a cancer diagnosis, confusing as that may sound. As men age, their prostate gland can become larger over time. This growth, along with other health conditions, can result in high PSA levels in men who do not have prostate cancer.

Digital rectal exam (DRE)

Another way that your doctor can find clues is to physically examine your prostate for suspicious changes. This test also adds to the staging of your cancer, as well as how well treatment is going.

During a DRE, the doctor is required to insert a finger into your rectum using a lubricated glove to assess your prostate gland. They are looking for hard spots and irregularities in the shape or thickness of the gland that could indicate cancerous growth.

Some men experience discomfort or embarrassment with the invasive and intimate nature of the exam. There may also be pain if the gland is swollen or irritated.

DREs are often paired with a PSA blood test. Abnormal results warrant further investigation, so other testing methods may be brought in to get to the bottom of the matter. This includes biopsies and imaging techniques.

Imaging and scans

Modern imaging technologies allow doctors to take a more detailed look at what’s going on inside you. Some of the main techniques used today are:

• Computed tomography (CT) scan. CT scans are a combination of X-rays and calculations that allow for detailed imaging from multiple angles. This scan can distinguish between solid and liquid structures. While not as powerful as an MRI, CT scans are useful for evaluating the tissues and structures in the locality of your prostate.
• Magnetic resonance imaging (MRI) scan. MRI scans provide excellent pictures of the prostate and can illustrate whether cancer has spread into nearby tissues. Sometimes, doctors will inject a contrast dye into a vein before the procedure to amplify the contrast in the details, making things clearer. Whereas CT scans use X-rays, MRI scans use radio waves and magnets.
• Positron emission tomography (PET) scans. This test is useful for determining where and to what degree cancer is developing. It involves the use of a tracer, which is a special drug that helps your doctor to observe the cancer. The tracer may be inserted through a vein or you may be asked to swallow it.
• Bone scan. One of the main places that prostate cancer spreads to is the bones, so we use bone scans to confirm or rule this out. As part of the test, you’ll be injected with a low-level radioactive substance which helps the images to appear more clearly. A special camera picks up the radioactivity and develops an image of your skeleton. Further testing may be necessary after a bone scan if there is a suspicious finding.

Biopsy

Biopsies involve tissue samples being taken from the prostate or for closer examination in the lab. A pathologist — someone who specializes in analyzing tissue for disease progression — will examine your tissue sample and report on their findings.

There are different ways you can go about a prostate biopsy. One involves a probe being placed in the rectum, and another requires penetrating the skin of the perineum (the area between the scrotum and rectum). Doctors sometimes use imaging devices like an MRI or ultrasound to help guide them as they do the job of extracting the sample. The procedure is usually around 10–20 minutes.

The pathologist can grade your cancer, which gives us insight into how aggressive it is and what the chances are that it will spread. Your doctor can use the results to determine your cancer’s stage, risk level, and prognosis (outlook).

In most cases of advanced prostate cancer, patients have experienced a prostate biopsy before. If a new tumor has been found in someone who has been previously treated, it’s usually because of cancer that spread.

If prostate cancer has been detected, it’s now a question of determining how far along the cancer has progressed and how likely it is to grow and spread further. Prostate cancer is not always predictable: it can grow slowly over years or develop rapidly in a short space of time.

The purpose of staging is to classify your cancer based on the level of cancer in the body and where it was located upon discovery. You may hear your doctor refer to this as the “extent” of the cancer.

Testing allows us to learn how big the tumor is, what sections of the prostate are cancerous, whether the cancer has spread, and if so, to what parts of the body. This information is crucial for your healthcare team, as they need it to develop a treatment strategy and form a prognosis (the outlook for your case).

How does prostate cancer spread?

It can take years for prostate cancer to develop within the prostate gland, but eventually, it will spread outside the prostate through one of three methods:

• Invading nearby tissues
• Spreading along the network of lymph nodes and vessels
• Using your blood to travel to distant parts of the body

We use staging to determine how far the cancer has spread away from the source.

How will my doctor assess my cancer?

A pathologist is a type of doctor who specializes in analyzing cell samples and assessing how much a disease has progressed. Cancer cells appear differently to normal, healthy cells. The more abnormal they appear, the more aggressive the cancer will likely be.

There are different methods used to make an overall assessment of your cancer’s stage and outlook:

• PSA level. Describes the level of prostate-specific antigens in the blood
• Gleason score. Assesses the probability of the cancer growing and spreading
• TNM system. Informs us of how much your cancer has progressed, which can in turn be ranked as a stage. Three different aspects are covered under the TNM system:
  • Tumor: concerns the size of the cancer in its main location
  • Nodes: confirms whether the cancer has spread to any lymph nodes
  • Metastasis: describes how far the cancer has spread

PSA levels

Prostate-specific antigens (PSA) are a substance made by the prostate, and they can be produced by both cancerous and non-cancerous cells. Men normally have low PSA levels in their blood.

A high PSA level may be a sign of prostate cancer, but it can also mean non-cancerous prostate conditions too. Although it isn't a foolproof method of determining cancer, it can offer useful clues as to whether it is present or not.

Gleason score

The purpose of the Gleason score is to determine how fast your prostate cancer is likely to grow. Gleason scores can range from 2 to 10, but most often range from 6 to 10. The higher the Gleason score, the more likely your cancer is to grow and spread.

To obtain a Gleason score, doctors combine your primary and secondary numbers, and the result indicates how aggressive your cancer is. The most common cell pattern is considered the primary number, and the second most common is considered the secondary number. Each number is scored between 1–5, and then the two are combined to obtain the Gleason score.

The lowest score for cancer is 6; medium is 7; and 8–10 is considered high.

The more aggressive your cancer is, the more likely it is to spread to other parts of the body.

The TNM system

Tumor (T) is a score between 1 to 4. Higher numbers mean that the tumor takes up a lot of space in the prostate or it may have grown outside the prostate to nearby tissues. The T score can be further subdivided with letters (a, b, and c).

Doctors can provide an estimate of the extent of your cancer using a variety of tests. Physical examinations, biopsies, imaging, and digital rectal exams can help them to determine what Is known as the clinical T (cT).

Below is a table describing the spectrum of T scores:

T1: The cancer is too small to be felt during a digital rectal exam or seen in an imaging test (such as an ultrasound). The cancer is found from a biopsy performed after the patient has a high PSA level or has surgery because of problems with urinating. The cancer is only in the prostate gland.

T2: The cancer can be felt during a digital rectal exam and may be seen in an imaging test. The cancer is still only in the prostate gland.

T2a: The cancer is in one-fourth of the prostate gland (half of one side).

T2b: The cancer is in more than one-fourth of the prostate gland (more than half of one side), but has not grown into the other side of the prostate gland.

T2c: The cancer has grown into both sides of the prostate gland.

T3: The cancer has grown outside the prostate gland (T3a). The cancer may have spread to the seminal vesicles (T3b), the pair of glands attached to the prostate gland that help to make semen.

T4: The cancer has grown outside the prostate gland into nearby tissues, such as the rectum or bladder. Prostate cancer also commonly spreads to the lymph nodes (also called lymph glands) and bone.

Nodes. There are two scores: N0 is negative, i.e., the cancer has not spread to nearby lymph nodes. Conversely, N1 means that it has.

Metastasis is similar to Nodes: M0 means that the cancer hasn’t spread to other areas of the body, while M1 confirms that it has spread.

Stages of prostate cancer

By combining the results of the three key assessments above, your doctor can determine your overall disease stage (a process called stage grouping).

Prostate cancer has four stages (I – IV). The higher the number, the more the cancer has spread. Each numeral can be further broken down into a more specific stage using letters (A, B, and C). Advanced prostate cancer concerns Stages III and IV, along with their lettered subdivisions.

Let’s take a closer look at what constitutes both stages and their subdivisions.

Stage III

Stage IIIA

• The cancer has not spread outside the prostate, though it may be detectable by physical examination
• Gleason score is 8 or less; PSA level is minimum 20
• Lymph nodes have not yet been affected
• TNM score is T1 or T2, N0, M0

Stage IIIB

• The cancer has spread outside the prostate (T3 or T4) but not to the lymph nodes (N0, M0)
• Gleason score is 8 or less; PSA level can be any value

Stage IIIC

• The cancer may or may not be growing into nearby tissues (any T number), but the lymph nodes remain unaffected (N0, M0).
• Gleason score is 9 or 10; PSA level can be any value

Stage IV

Stage IVA

• The cancer may or may not be affecting nearby tissues (any T number), and the lymph nodes are now affected (N1).
• Cancer has not yet spread to other parts of the body (M0)
• PSA level can be any value.

Stage IVB

• The cancer has spread to other parts of the body (M1), e.g., bones, distant lymph nodes, other organs. Any T number may be applicable.
• Nearby lymph nodes may or may not be affected (N0 or N1)
• PSA level can be any value

A note on survival rates across Stages III and IV

It is important to note that the five-year survival rate for Stage I all the way up to Stage IVA is around 95%, so your lifespan may be comparable to that of a healthy person.

Most prostate cancers are discovered early thanks to improved screening. This means that we tend to catch them while the survival rates are still really high.

Stage IVB, when cancer has spread distantly from the prostate, has a significantly lower five-year survival rate of 29%.

These rates are not an estimate of your expected lifespan; rather, they are an estimate of the likelihood that treatments will work.

It can be a difficult truth to swallow, but there is currently no cure for advanced prostate cancer. What we can do, however, is combat the cancer and potentially arrest its development while also tempering symptoms.

Treatments can cause side effects. Tolerance of these side effects varies from person to person, both in the intensity of their impact and what each individual is willing to go through. Some believe the side effects are worth it to stave off cancer; others choose not to treat their cancer at all.

Either way, scientists continue to investigate advanced prostate cancer to unearth new treatments that produce fewer side effects and improve control over the disease.

There are many aspects to consider when developing an appropriate treatment strategy with your doctor. They will take into account important elements such as your risk level, age, and any pre-existing health problems.

On your end, taking the time to gain a solid understanding of each treatment option and weighing up the balance with side effects is wise.

Surgery

The goal of prostate cancer surgery is to remove the prostate gland (also called a prostatectomy) and seminal vesicles (the pair of glands attached to the prostate gland that help make semen). There may also be a reconfiguration of the urethra (which may be affected by the cancer) to ensure the proper flow of urine.

Sometimes it is also necessary to remove lymph nodes or other tissues nearby to the prostate gland if the cancer has spread to these places.

If it is deemed necessary to further reduce testosterone levels in the body, the removal of the testicles may be recommended as well. This operation is known as an orchiectomy. This can be challenging to tolerate from a psychological point of view, and some men opt to get prosthetic replacements after the fact.

Surgery isn’t as common an option for Stage 4 prostate cancer patients, though there are exceptional situations. This is usually related to problematic symptoms that could be resolved or managed by surgery; for example, urinary issues.

Endocrine Drugs for Prostate Cancer

A more popular way to reduce hormone levels in the body is through drugs. There are three major drug types approved for treating hormone levels in advanced prostate cancer patients:

• Luteinizing hormone-releasing hormone (LHRH) analogs
• Luteinizing hormone-releasing hormone (LHRH) antagonists
• Antiandrogens

Notably, drugs can be as effective as surgery at lowering your hormone levels. This is why most men prefer this option.

Radiation therapy

Using high-powered energy beams (for example, X-rays and protons), radiation therapy can kill cancer cells. For advanced cancer patients, a big machine will go around different parts of the body to attack the cancer by specifically directing energy beams at the right locations.

Sometimes, this therapy may be combined with hormone therapy. This is often the case with patients diagnosed with localized prostate cancer — cancer that has only spread to nearby tissues like the lymph nodes. Radiation can also be used after surgery to clean up outlying cancer cells that survived the operation.

Radiation therapy is useful for relieving pain and other symptoms in cases where the cancer has spread to distant parts of the body.

Immune therapy (Provenge vaccine)

Provenge is a special vaccine that can help extend your lifespan.

This vaccine is not quite like what you’re used to. Instead of boosting the immune system to prevent infections, this vaccine works by helping your immune system to attack prostate cancer cells. If your cancer has stopped responding to hormone therapy and you are experiencing little to no symptoms, you could be a good candidate for this vaccine.

Every instance of this vaccine is unique to each patient. In order to make it, white blood cells must be removed from your blood over the course of a few hours, and these cells are then mixed with a protein called prostatic acid phosphatase in the lab. Next, the enhanced cells are reinfused into your bloodstream. The whole process requires three rounds.

Although this vaccine does not appear to stop prostate cancer from growing, it does help men to live for several months longer.

Chemotherapy

Chemotherapy drugs can slow down the growth of cancer, reduce symptoms, and extend lifespans. It is a useful option for men whose prostate cancer has spread to distant parts of the body.

The drugs are usually administered through an IV drip, which goes in through a vein. These drugs travel throughout the body and kill fast-growing cancer cells as well as non-cancer cells. Sometimes doctors recommend that patients begin chemotherapy to proactively prevent pain if the cancer is spreading to sensitive areas like the bones.

Chemo drugs aren’t usually a primary means of tackling prostate cancer, but they are a helpful sidearm. The problem with them is that they come with a host of well-known side effects:

• Hair loss
• Nausea
• Tiredness
• Vomiting
• Shifts in how you taste or feel things.
• Infections
• Neuropathy (tingling and numbness in hands and feet)

If you and your healthcare team decide to use chemo as part of your treatment strategy, your doctor will be watching closely for side effects. There are medicines available to help you tolerate them, and most of the side effects go away once you finish with chemo.

Bone-targeted therapy

For advanced prostate cancer patients whose disease has spread into the bones, targeted therapies can help to alleviate the complications that can arise, like brittle bones. Cancer weakens bone tissue, and this can lead to fractures, pain, and other issues.

Specially targeted drugs can help fight the cancer in the bones, reduce pain, and help to reinforce the bones to some degree. Your doctor may also recommend taking calcium and vitamin D supplements to help with protecting your bones.

Alternative treatments

Outside of the primary treatment methods used by doctors to fight prostate cancer, some patients opt for alternative treatments. The following are some examples:

• Green tea. Compounds called polyphenols may have an impact on tumors, although the evidence is inconclusive. Some studies have found a positive connection between drinking green tea and lowering prostate cancer risk.
• Pomegranate juice. Studies involving rodents have shown some evidence of being able to reduce cancer cell growth. More studies are required to confirm the findings.
• Lycopene. This powerful antioxidant can be found in abundance in fruits and vegetables. There is some research showing lower cancer rates among people who have high amounts of lycopene in their diet.

Advanced prostate cancer cannot be cured, but it’s possible to keep it under relative control for potentially many years with treatment.

The outlook varies greatly depending on several factors. Even among cases where the cancer has spread, there is a big difference between a case where the cancer has reached nearby lymph nodes and one where it has spread to the bones.

The five-year survival rate is a common measure used to assess the likelihood of survival. As per the name, the percentage is the relative chance that the patient will still be alive five years from now.

For those whose cancer has spread distantly from the prostate (i.e., Stage IVb patients), their five-year survival rate is around 29%. Remarkably, this steep drop contrasts greatly with advanced prostate cancer patients all the way from Stage IIIa to Stage IVa, as this entire cohort has a rate close to 100%.

Prostate cancer is more manageable nowadays

Overall, prostate cancer is not as terrifying a diagnosis as it used to be. Yes, it can still be quite serious, but the vast majority of cases are identified before they advance all the way to Stage IVb, when it has spread so far that it is hard to contain.

Across the entire spectrum of staging for prostate cancer, 92% of cases are identified while the cancer is still localized or regional. Modern treatment techniques can be very effective at keeping cancer at bay for these men, many of whom go on to live a life that is comparable in length to that of a healthy individual.

We have statistics to back this up: the 15-year survival rate for those with localized or regional prostate cancer is around 95%, according to the American Society of Clinical Oncology. That’s a very reassuring number.

Only around 7% of cases involve advanced prostate cancer at the time of diagnosis. Because of routine screening and improved diagnostics, most prostate cancer cases are caught before they get out of control.