If your prostate cancer spreads to other parts of your body, your doctor may tell you that it's "metastatic" or that your cancer has "metastasized."
Most often, prostate cancer spreads to the bones or lymph nodes. It's also common for it to spread to the liver or lungs. It's rare for it to move to other organs, such as the brain, but that can happen.
It's still prostate cancer, even when it spreads. For example, metastatic prostate cancer in a bone in your hip is not bone cancer. It has the same prostate cancer cells the original tumor had.
Metastatic prostate cancer is an advanced form of cancer. There's no cure, but you take steps to treat and control it. Most men with advanced prostate cancer live a normal life for many years.
The goals of treatment are to:
- Manage symptoms
- Slow the rate your cancer grows
- Shrink the tumor
Some cancers are called "locally advanced." That means the cancer has spread from the prostate to nearby tissue. It's not the same as metastatic cancer since it hasn't spread to other parts of your body. Many locally advanced prostate cancers can be cured.
How Does Prostate Cancer Spread?
Cancer cells sometimes break away from the original tumor and go to a blood or lymph vessel. Once there, they move through your body. The cells stop in capillaries -- tiny blood vessels -- at some distant location.
The cells then break through the wall of the blood vessel and attach to whatever tissue they find. They multiply and grow new blood vessels to bring nutrients to the new tumor. Prostate cancer prefers to grow in specific areas, such as lymph nodes or in the ribs, pelvic bones, and spine.
Most breakaway cancer cells form new tumors. Many others don't survive in the bloodstream. Some die at the site of the new tissue. Others may lie inactive for years or never become active.
What Are the Chances of Getting Metastatic Prostate Cancer?
About 50% of men diagnosed with local prostate cancer will get metastatic cancer during their lifetime. Finding cancer early and treating it can lower that rate.
A small percentage of men aren't diagnosed with prostate cancer until it has become metastatic. Doctors can find out if it's metastatic cancer when they take a small sample of the tissue and study the cells.
How Do Doctors Find Metastatic Prostate Cancer?
When you are diagnosed with prostate cancer, your doctor will order tests such as:
- CT scans
- MRI scans
- PET scans
These tests may focus on your skeleton and in your belly and pelvic areas. That way doctors can check for signs that the cancer has spread.
If you have symptoms such as bone pain and broken bones for no reason, your doctor may order a bone scan. It can show if you have signs of cancer spreading to your bones.
Your doctor will also ask for blood tests, including a check of PSA levels, to look for other signs that the cancer is spreading.
PSA is a protein made by the prostate gland. A rise in PSA is one of the first signs your cancer may be growing. But PSA levels can also be high without there being cancer, such as if you have an enlarged prostate, a prostate infection, trauma to the perineum, or sexual activity.
What Are the Treatments for Metastatic Prostate Cancer?
It mainly depends on the stage of your cancer. Metastatic prostate cancer is stage IV, and doctors divide it into two types: IVA and IVB.
If you have stage IVA prostate cancer, that means the disease has spread to nearby lymph nodes but not to distant parts of your body. If you’re healthy enough to get treatment, or if you’re having symptoms from the cancer, your doctor may recommend one of these treatment options:
External beam radiation treatment (EBRT) with androgen deprivation therapy (ADT). During EBRT, a machine outside your body sends beams of radiation to your prostate gland. Radiation destroys cancer cells.
ADT is a type of hormone therapy. It involves taking medications to lower the levels of male sex hormones (androgens) that your testicles make, or getting surgery to remove the testicles. Androgens, like testosterone, often fuel the growth of prostate cancer cells.
Along with ADT, your doctor might also have you take a drug called abiraterone (Zytiga). It helps stop cells in other parts of your body, like your adrenal glands, from making androgens.
ADT with or without abiraterone. If your doctor recommends this option, you won’t need to get external beam radiation treatment along with it.
If you have stage IVA prostate cancer with no symptoms, or if you have other serious health conditions, your doctor might recommend ADT alone. Or they might suggest watchful waiting, also called observation. This means your doctor watches to see if your cancer brings on new or changing symptoms. Then they give you treatment aimed at controlling those symptoms. You won’t need regular testing if you and your doctor opt for watchful waiting.
If you have stage IVB prostate cancer, the disease has spread to distant organs, like your bones. Your doctor can give you treatments that help keep your cancer under control for as long as possible and improve your quality of life.
Some treatment options are:
Androgen deprivation therapy (ADT). Your doctor may suggest you get ADT alone or with one of these:
- A hormone therapy drug (like abiraterone, apalutamide, or enzalutamide)
- A chemotherapy drug called docetaxel
- External beam radiation
Surgery. An operation called TURP (transurethral resection of the prostate) can ease symptoms like bleeding or a urinary blockage.
Treatments for bone pain and other problems. If prostate cancer spreads to your bones, it could cause pain, broken bones, and other problems. Treatments that can bring you pain relief or prevent other problems include:
- External radiation
- An injectable drug called denosumab (Xgeva)
- A bisphosphonate drug called zoledronic acid (Zometa), which you get through an IV
- Medicines containing radiation that get injected into your body (like radium-223, strontium-89, or samarium-153)
Observation (watchful waiting). Your doctor may recommend this for you if you’re older or you have other serious health problems and don’t have bad cancer symptoms.
Clinical trials. You could ask your doctor if you’re eligible to take part in one of these studies, which tests new drugs, procedures, and other treatments on people.
What if You Have Metastatic Hormone-Sensitive Prostate Cancer (mHSPC)?
If your doctor tells you that you have this type of metastatic prostate cancer, it means your cancer responds to hormone therapy (or that you haven’t gotten hormone therapy yet.)
Most prostate cancer cells need male sex hormones, including androgens like testosterone, to grow. A type of hormone therapy like androgen deprivation therapy could slow the growth of mHSPC by lowering the level of these hormones.
You could also ask your doctor if you’re eligible for any clinical trials.
Still, some people with mHSPC prefer to avoid or delay getting treatment with an option called active surveillance. That’s when your doctor keeps close tabs on your health but doesn’t give you treatment unless test results show your cancer is getting worse.
You could ask your doctor if watchful waiting is an option for you.
What if You Have Metastatic Castration-Resistant Prostate Cancer (mCRPC)?
This means you have a type of metastatic prostate cancer that’s able to grow and spread after you had hormone therapy to lower your testosterone levels.
Still, most people with mCRPC stay on androgen deprivation therapy because it might still be effective against some prostate cancer cells.
Your doctor may recommend adding other treatments like:
- Other hormone treatments
- Medicines containing radiation
- Treatments to ease symptoms like pain
You could also find out if a clinical trial might be right for you.
Some people with mCRPC simply choose to try active surveillance or watchful waiting.
What Should You Ask Your Doctor About Treatments?
The American Cancer Society recommends that you ask questions like these:
- What treatment might be best for me?
- What are the possible benefits of getting it?
- How soon would I need to start treatment?
- Will I need to get surgery as part of my treatment? If so, what will it be like and who will do it?
- Will I need other treatments, too? If so, how might they benefit me?
- What side effects could my treatments cause? And what should I do if I get them?
- Is there a clinical trial that might be a good option for me?
- Can you review any vitamins or diet I’m on to make sure it won’t interfere with my cancer treatment?
What Happens After Treatment?
If you've been treated, especially if a surgeon removed your prostate, your PSA levels should start to go down. Doctors usually wait several weeks after surgery before checking PSA levels.
A rise in PSA after treatment may suggest the cancer is back or spreading. In that case, your doctor may order the same tests used to diagnose the original cancer, including a CT scan, MRI, or bone scan. The radiotracer Axumin could be used along with a PET scan to help detect and localize any recurrent cancer.
Though very rare, it's possible to have metastatic prostate cancer without a higher-than-normal PSA level.
Go to all of your follow-up doctor appointments. At these checkups, let your doctor know about any symptoms you’re having, especially ones like bone pain or blood in your pee. You could keep track of your symptoms by writing them down in a journal or diary.
At home, follow some healthy habits to feel your best:
Eat a balanced diet. It can boost your energy and your immune system. Fill your plate with fruits and vegetables and high-fiber foods. Cut back on fattening foods, sugar, and processed foods and meats.
Let your doctor know if you’re having trouble staying at a healthy weight or if you’re losing your appetite.
Get exercise if your doctor OKs it. It can be good for your body and mind. It can also help you stay at a healthy weight, keep up your strength, and help manage medication side effects.
Before you get started, ask your doctor what types of exercise are right for you and how much you should aim for. The doctor may talk to you about doing aerobic exercise that gets your heart pumping and strength training.