Metastatic prostate cancer is when prostate cancer spreads to other organs, such as the bones, lymph nodes, adrenal gland, liver, and lungs. This is known as metastasis.

This article explains how prostate cancer spreads outside of the prostate and how it affects the body.

We also look at the treatment options for metastatic prostate cancer tumors.

Finally, the article addresses the likely outlook for people with the condition and answers some common questions about it.

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There are many types of cancer. However, prostate cancer is a type that spreads outside of the prostate and is known as metastatic prostate cancer. It can spread to local or distant body areas in several steps:

  1. The cancer cells travel outside the prostate by entering blood or lymphatic vessels.
  2. The blood or lymphatic vessels deposit cancer cells into close tissues or organs outside the prostate.
  3. The cancer cells, as they circulate, become trapped in the lymph nodes and smaller vessels of the bones, liver, lungs, and adrenal glands.
  4. Once these cells establish a blood supply where they locate, they grow into a new tumor.

Prostate cancer with local metastasis means that cancer has spread to other organs within the pelvis or the nearby lymph nodes. However, this type includes any organ or structure in the pelvis.

Sometimes, cancer spreads to other organs away from the prostate. Distant metastasis means that prostate cancer has spread beyond the pelvis. The bones, liver, lungs, and adrenal glands are common sites of distal prostate cancer metastasis.

In many cases, prostate cancer grows slowly. Some males do not even know that they have the disease. However, when prostate cancer metastasizes, it can become more challenging for a doctor to treat.

A note about sex and gender

Sex and gender exist on spectrums. This article will use the terms “male,” “female,” or both to refer to sex assigned at birth. Click here to learn more.

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Most types of prostate cancers are adenocarcinoma (including ductal carcinoma and acinar adenocarcinoma), which are cells that originate from a gland. Other rare types of prostate cancers are:

  • squamous cell carcinoma
  • transitional cell carcinoma
  • neuroendocrine tumors (including small cell carcinoma and large cell carcinoma)
  • sarcoma (including leiomyosarcoma and rhabdomyosarcoma)

Experts believe some males can also have a mixed type, which combines a common and a rare type of prostate cancer. Rare forms of prostate cancer are more likely to metastasize.

Prostate cancer overall is the second most common cancer in males after skin cancer. Doctors discover most prostate cancers in the prostate or nearby tissues. However, about 16% of new cases spread into distant locations.

Between 2012 and 2018, about 14% more cases of prostate cancer occurred in the United States.

Research has shown the incidence of prostate cancer for African American males is twice that of people who are white. Among African Americans, the cancer types tend to be more aggressive, and deaths are double compared with white Americans.

The differences in outcomes for African American males may originate from:

  • Physical: Higher prostate-specific antigen (PSA) levels in the blood.
  • Genetic: Some African American males carry certain gene mutations or chromosomal abnormalities that can increase prostate cancer risk.
  • Environmental: Social disparities may cause people from historically marginalized groups to live on a lower income and have limited access to healthy food.
  • Social: Disparities in healthcare can limit genetic screening or disease treatment access, leading to underdiagnosis.

Doctors recommend that African American males and those with a family history of prostate cancer begin screening at the age of 45. Those with more than one first-degree relative who had prostate cancer before age 65 should get a screening at 40.

Other people should begin screening at the age of 50.

However, in cases of limited access to quality healthcare, a person may find it hard to obtain proper screening.

Often, prostate cancer is symptomless. However, when signs and symptoms do occur, they may include:

  • frequent urination, especially at night
  • difficulty in controlling urination
  • weak or interrupted urine flow
  • pain or burning when urinating
  • erectile dysfunction
  • painful ejaculation
  • producing less semen when ejaculating
  • blood in the urine or semen
  • pain in the hips, lower back, pelvis, or rectum

Many other conditions, including prostatitis and benign prostatic hypertrophy, can cause similar symptoms. However, anyone experiencing these symptoms should consult their doctor as soon as possible to rule out prostate cancer.

If a doctor suspects a patient has prostate cancer that has metastasized outside the prostate, they may need several tests to determine how far and where the cancer has spread. This will help the medical team determine the best course of treatment.

Types of tests include:

  • Computerized tomography (CT) scan: To see the spread to local lymph nodes.
  • Magnetic resonance imaging (MRI) scan: To see the spread outside the prostate into nearby soft tissue.
  • Bone scan: To see the spread into the bone.
  • PSMA-PET (prostate-specific membrane antigen-positron emission tomography) scan: To see the spread in the body if the prostate-specific antigen levels are rising. Doctors also use it before a prostatectomy or radiation in high risk patients.
  • A combination of PET-MRI or PET-CT: This can give more detailed pictures and speed up access to therapy but may be unavailable in certain places for reasons including cost.

A person rarely needs a biopsy outside of the prostate. If a person has a diagnosis of metastatic cancer, they may need a biopsy of other areas where cancer may have spread, such as the bones or the lymph nodes.

Once a doctor diagnoses prostate cancer that has spread, complications will depend on where the cancer lodges and how quickly it grows.

For example, a person with prostate cancer that has spread to nearby lymph nodes may not experience any change in symptoms.

When prostate cancer metastasizes to the following areas, it can cause a range of complications.

  • Bone: This can cause fractures and pain.
  • Brain: This can lead to dizziness, headaches, and seizures.
  • Liver: This can result in jaundice and swelling in the abdomen.
  • Lungs: This can lead to shortness of breath.

Prostate cancer treatment can cause some severe side effects, including:

Fortunately, several medications are available to treat cancer therapy’s side effects. However, because these side effects can be severe, doctors often recommend watchful waiting before prescribing potent medications.

It is important for anyone undergoing cancer treatment to communicate with their healthcare team about any side effects they are experiencing.

The following are some answers to common questions about prostate cancer.

How likely is it that my prostate cancer will spread?

This depends on the spread of cancer at diagnosis, an individual’s health status, and response to treatment, among other factors.

Because of the slow-growing nature of prostate cancer, a doctor may decide to wait or start treatment depending on a person’s risk factors.

What is the life expectancy of metastasized prostate cancer?

If the prostate cancer has spread to the local area, such as the pelvis or nearby lymph nodes, a person would have almost a 100% chance of surviving 5 years.

If the prostate cancer has spread to distant sites such as the liver, lungs, or bone, a person would have approximately a 30% chance of surviving 5 years.

What stage of prostate cancer is metastatic?

According to the ACS, prostate cancer is metastatic at stage 4B, which means it has spread to other parts of the body, such as the distant lymph nodes, bones, or other organs.

Can people recover from metastatic prostate cancer?

Recovery depends on the aggressiveness and location of the cancer spread. Local spread and nonaggressive types have a better outlook. Researchers are developing new therapies more quickly than ever before. It is worthwhile for people to check with their doctor about treatment options and participation in clinical trials.

The American Cancer Society (ACS) measures the outlook for numerous types of cancer using a 5-year survival rate. This compares the likelihood that a person will survive for 5 years beyond diagnosis to that of a person without cancer living for the same amount of time.

According to the ACS, the rates are:

  • Local prostate cancer without spread has a 5-year survival rate of nearly 100%.
  • Prostate cancer with local spread also has a 5-year survival rate of nearly 100%.
  • Prostate cancer with distant metastasis has a 5-year survival rate of close to 30%.

The survival rate is excellent if a doctor diagnoses prostate cancer before it spreads or has only spread to nearby structures. However, the survival rate does not take into account many other factors, such as a person’s age and overall health.

A doctor with a working knowledge of a person’s prostate cancer progression can produce a more accurate and individual outlook.

This makes routine screening and early diagnosis essential to treat prostate cancer successfully.

African American males ages 45 years and up, and other males over the age of 50, should speak with a healthcare professional about the different screening options and which one is most appropriate for them.