Dealing With Advanced Prostate Cancer

Prostate cancer is the second leading cause of cancer deaths in men (only lung cancer claims more lives). In 2010, the American Cancer Society reported 217,730 new cases of prostate cancer with 32,050 men dying from it. Prostate cancer is a urologic disease that approximately one in six men over the age of 50 will be diagnosed with in his lifetime. The prostate is part of the male reproductive system and is a walnut-sized gland located below the bladder and in front of the rectum that secretes fluid making up part of the semen.

5 to 10 percent of the total number of prostate cancers diagnosed each year are in advanced stages.  Advanced prostate cancer can be confined to the prostate gland or spread via metastasis from the original location most often in the bones, lungs, and liver.

Diagnosing Advanced Prostate Cancer

Some men don't discover their prostate cancer until after a metastatic tumor causes symptoms. For example, a man experiences lower back pain from prostate cancer that has spread to his pelvis. Other symptoms of advanced prostate cancer include: a  slow or weakened urinary stream, more frequent urination, blood in the urine, and impotence (difficulty having an erection). In some cases, kidney blockage can occur but it's worth noting that non-cancerous diseases of the prostate such as BPH-but benign prostatic hyperplasia-may also be responsible for some of these symptoms.

Shortness of breath can be a sign of lung metastasis. Abdominal swelling or yellowing of the skin (jaundice) can indicate the cancer has spread to the liver. Numbness in the legs or feet can be caused by cancer that has spread to the spine. Advanced prostate cancer is a very complex disease.

The first step in diagnosing prostate cancer is a physical exam, which includes a digital rectal exam (DRE). A prostate specific antigen (PSA) blood test may be used in combination with a DRE to check for significant changes in the PSA levels. If certain symptoms and/or results of these early detection tests suggest prostate cancer, a prostate biopsy will likely be performed for further confirmation. If a metastatic tumor is detected, the search for primary cancer may also involve lab tests, x-rays, computed tomography (CT) scans, magnetic resonance imaging (MRI) scans, positron emission tomography (PET) scans, and other procedures.

There are four types of advanced prostate cancer:

Locally Advanced Prostate Cancer fills the prostate gland or has grown through the prostate into the glands that produce semen (seminal vesicles) or the bladder.

Biochemically Recurrent Prostate Cancer is the classification given to patients who do not show evidence of the disease spreading to the bone or other organs but have a rising PSA level after undergoing hormone therapy or local treatment. (Note: the interpretation of rising PSA levels is controversial in the medical community.)

Metastatic Prostate Cancer is cancer that has metastasized to the bone, lymph nodes, or other parts of the body. Pain relief and improved urinary function can often be achieved through testosterone depletion or medications.

Castrate Resistant Prostate Cancer (CRPC) continues to grow despite the suppression of male hormones (testosterone) that are thought to fuel the growth of prostate cancer cells.

Treating Advanced Prostate Cancer

Sadly, there is no cure for advanced prostate cancer, but it is possible to slow the growth of the cancer and diminish cancer-related symptoms such as pain, urinary malfunction, and sexual side effects.

The most common types of therapy for advanced prostate cancer include hormone therapy (such as androgen deprivation therapy) which works to deprive the body of testosterone, targeted therapy, surgery, radiation, chemotherapy, immunotherapy or a combination of these treatments. The choice of treatment generally depends on the type of primary cancer; the size, location, and number of metastatic tumors; the patient's age and general health, and the types of treatment the patient has had in the past. Treatment side effects may include erectile dysfunction, weight gain, depression, osteoporosis, memory loss, and elevated cholesterol.

Intense research efforts are currently underway to develop more specific, targeted therapies designed to improve the prognosis and quality of life for patients with advanced or recurrent prostate cancer along with new ways to boost the strength of immune responses against tumors and kill or stop the growth of both primary and metastatic cancer cells.

In the meantime, the FDA approved a new drug called cabazitaxel for use in combination with prednisone for treatment of patients with metastatic hormone-refractory prostate cancer previously treated with docetaxel-containing regimen.

For general questions about prostate cancer, contact the American Cancer Society 24 hours a day at 1-800-227-2345 to speak with a trained cancer information specialist or visit: and click "contact us."




American UA Foundation

The Centers for Disease Control

National Cancer Institute

American Cancer Society