Advanced prostate cancer includes tumours that have grown beyond the prostate into nearby tissue, and metastatic cancer that has spread to lymph nodes, bones or other organs. It is a hard stage for patients and families, but treatment has advanced a great deal, many men live for years after treatment, and the aim is to control the disease and protect quality of life.
Medically reviewed by Prof. Dr. Samir Ahmed Al-Samarrai, consultant urologist. Last reviewed:
Types of advanced disease
- Locally advanced: beyond the prostate capsule or into the seminal vesicles or nearby tissue, without distant spread.
- Metastatic (stage 4): spread to distant lymph nodes, bones or other organs.
- Hormone-sensitive: responds to lowering testosterone.
- Castration-resistant: keeps growing despite low testosterone.
Symptoms
- Bone pain, especially in the back, pelvis and ribs.
- Tiredness and unexplained weight loss.
- Urinary symptoms or blood in the urine.
- Leg swelling when lymph nodes are enlarged.
Go to the emergency department immediately with back pain plus weakness or numbness in the legs, or loss of bladder or bowel control.
Tests
PSA, CT, bone scan, or PSMA PET-CT, which detects small deposits more accurately. These define the extent of spread and the right treatment.
Treatment
A multidisciplinary team of urologist, medical oncologist and radiation oncologist plans treatment according to European guidelines:
- Hormone therapy (androgen deprivation): the foundation, given as injections or tablets, or by removing the testicles in some cases.
- Adding newer medicines such as abiraterone, enzalutamide, apalutamide or darolutamide, or chemotherapy (docetaxel), because the combination prolongs life compared with hormone therapy alone in metastatic hormone-sensitive disease.
- Radiotherapy to the prostate in low-volume spread, and to bones to relieve pain.
- For castration-resistant disease: options include further hormonal agents, chemotherapy, PSMA-targeted radioligand therapy, and targeted drugs for men with mutations such as BRCA.
- Bone protection with specific medicines plus calcium and vitamin D, and palliative care to relieve pain and symptoms at any stage.
Side effects of hormone therapy
Hot flushes, low desire and erections, tiredness, muscle loss and bone thinning, weight gain and effects on blood sugar and cholesterol. Regular exercise and monitoring of bones and the heart reduce these effects.
Related topics
Frequently asked questions
What does stage 4 prostate cancer mean?
It means the cancer has spread beyond the prostate to lymph nodes or distant organs such as bones. It is treated to control it, and many men live for years with modern treatment.
Is metastatic prostate cancer treatable?
Yes. Effective treatments control it, relieve symptoms and prolong life, including hormone therapy, newer medicines, chemotherapy and radiotherapy. It is rarely cured, but for many men it is managed like a long-term condition.
What are the symptoms of spread to the bones?
Persistent pain in the back, pelvis or ribs, especially at night, and sometimes fractures from minor strain.
What are the emergency signs?
Back pain with weakness or numbness in the legs, or difficulty controlling the bladder or bowel. These suggest spinal cord compression and need emergency care immediately.
What is castration-resistant prostate cancer?
Cancer that keeps growing even though hormone therapy has lowered testosterone. Further treatment options exist and are chosen by the oncology team.
Sources
Book a consultation
Prof. Al-Samarrai and Dr. Amer Mousa assess prostate cancer in coordination with the oncology team at Prof. Al-Samarrai Medical Center, Dubai Healthcare City, and discuss the options that suit your case. Medical consultations are confidential.
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