Stage 4 Prostate Cancer Treatments and Prognosis

Stage 4 prostate cancer is the most advanced stage of the disease. It means that cancer has spread beyond the prostate to distant areas of the body. Learn more about this stae, what treatments are available, and the prognosis.

Understanding Staging

The most common staging system used with prostate cancer is the TNM staging system.

With the TNM system, letters stand for:

• T is for tumor size.
• N is for lymph node involvement. N0 means cancer has not spread to any lymph nodes. N1 means the tumor has spread to nearby lymph nodes. N2 means the tumor has spread to distant lymph nodes.
• M is for metastases. M0 means that a prostate cancer has not spread to distant organs. M1 means that a prostate cancer has spread to distant organs—the bones are the most common area of prostate cancer metastases.

Prostate cancer is considered stage 4 in three different ways:

• A T4 tumor (it has spread to tissues next to the prostate meaning it is growing in the rectum, bladder, urethral sphincter, and/or pelvic wall) with no lymph node involvement and no metastases.
• Any size tumor along with nearby lymph nodes positive (N1) and no metastases.
• Any size tumor alone with any lymph node status (none, nearby nodes positive, or distant nodes positive) plus metastases to another region of the body (M1).

Symptoms

Symptoms of stage 4 prostate cancer can be related to cancer in your prostate, or due to metastases. Some of these include:

• Blood in the urine
• Difficulty passing urine
• Erectile dysfunction
• Bone pain from bone metastases
• Pain or swelling in the legs or bladder problems

Diagnosis

Tests to diagnose prostate cancer may include a computerized tomography (CT) scan, ultrasound, magnetic resonance imaging (MRI), or prostate-specific membrane antigen positron emission tomography scan (PSMA PET) to evaluate the growth and look for metastases.

A biopsy of the prostate is usually done to help diagnose and stage the cancer. If there are spots in the bones a biopsy of the prostate can be bypassed and the bones can be directly biopsied for the spread of prostate cancer.

Treatment

While stage 4 prostate cancer isn’t usually curable, it is treatable. A combination of several treatments is usually used over time for this stage of the disease.

Hormone Therapy

Hormone therapy (or androgen deprivation therapy) is often the mainstay for stage 4 disease. Different options are available to reduce the amount of testosterone in your body. Some medications stop the production of testosterone, and others work to prevent testosterone from stimulating prostate cancer cells.

Just as estrogen works as a fuel to stimulate the growth of many breast cancer cells, testosterone works as a fuel to facilitate the growth of prostate cancer cells.

Chemotherapy

Chemotherapy may work to extend life for men with prostate cancer and also relieve pain due to metastases.

Palliative Surgery

If the cancer has spread, there is no surgery that can cure the cancer. Surgeries are often done to help with symptoms and quality of life for urinary symptoms.

One surgery to help symptoms may include a transurethral resection of the prostate (TURP). Sometimes, an orchiectomy (removal of both testicles) can be done as an alternative to hormonal therapy.

Palliative Radiation

Radiation may be used along with hormonal therapy initially to control pain, and after hormonal therapy has stopped working. Radiation may also be used for bone metastases to decrease pain.

Treatment of Bone Metastases

Spread of the cancer into the bones can be painful and can increase the risk of bone fractures or compression of the spinal cord. Treatments can include hormone therapy, chemotherapy, targeted drugs, immunotherapy, and bisphosphonates.

Prognosis

The prognosis of stage 4 disease varies considerably depending on how far cancer has spread. This can be done by breaking stage 4 down into two parts.

Stage 4 with regional metastases: Prostate cancer that is called stage 4 due to a large tumor size (T4) or due to spread to nearby lymph nodes has a five-year survival rate of nearly 100%.

Stage 4 with distant metastases: According to the National Cancer Institute’s SEER data, people who have stage 4 prostate cancer with spread to distant lymph nodes (N2) or to other regions of the body such as bones, had a five-year survival rate of 30.2%.

Coping

Learn about your cancer. Be aware of some common prostate cancer emergenciesso you can be prepared. Accept help. Stage 4 prostate cancer can sometimes cause significant pain. Talk to your healthcare provider and don't try to be "a hero" and avoid treating your symptoms.

Consider joining a support group or check into online stage 4 prostate cancer communities. If it is your loved one coping with prostate cancer, learn important tips on supporting a loved one with prostate cancer.