What is Advanced Prostate Cancer?

Advanced prostate cancer refers to prostate cancer that has spread beyond the prostate to other parts of the body. When prostate cancer spreads to distant organs or tissues, it is known as metastatic prostate cancer.

Prostate cancer can spread to different parts of the body, but the bones and nearby or distant lymph nodes are common sites of spread. In some cases, it may also affect organs such as the liver or lungs.

Advanced prostate cancer may cause symptoms such as bone pain, urinary problems, fatigue and loss of appetite. However, some men may have few or no symptoms, particularly in the earlier stages of metastatic disease.

Although advanced prostate cancer is generally not considered curable, treatment can often control the cancer, slow its progression and help manage symptoms. The treatment approach depends on several factors, including where the cancer has spread, previous treatments, overall health and how the cancer responds to therapy.

How Is Advanced Prostate Cancer Diagnosed?

Doctors use a combination of medical history, physical examination, blood tests, imaging and sometimes a biopsy to diagnose and stage prostate cancer.

Depending on the situation, diagnostic tests may include:

• Prostate-specific antigen (PSA) test
• Digital rectal examination (DRE)
• Magnetic resonance imaging (MRI)
• Computed tomography (CT) scan
• Bone scan
• Prostate biopsy
• Positron emission tomography (PET) scan

Not every patient will need every test. Your doctor will recommend investigations based on your symptoms, previous test results and the suspected extent of the disease.

What Treatments Are Available for Advanced Prostate Cancer?

Treatment for advanced prostate cancer is usually aimed at controlling the cancer, slowing its progression and managing symptoms.

Depending on the individual’s condition, treatment may include:

• Hormone therapy
• Hormone therapy combined with other medicines
• Chemotherapy
• Radiotherapy
• Targeted or other systemic treatments in selected patients
• Clinical trials
• Treatments to manage cancer-related symptoms

Hormone therapy, also called androgen deprivation therapy (ADT), is an important part of treatment for many men with advanced prostate cancer because prostate cancer cells often depend on male hormones such as testosterone to grow.

Additional medicines may be combined with hormone therapy depending on the stage and characteristics of the cancer.

Radiotherapy may also be used in selected situations, including to relieve symptoms caused by cancer that has spread to the bones.

Before starting treatment, your doctor will discuss the expected benefits, possible side effects and other available options with you.

How Is Advanced Prostate Cancer Monitored?

Regular monitoring helps doctors determine whether treatment is controlling the cancer and whether the treatment needs to be changed.

Monitoring may include:

• Regular PSA blood tests
• Other blood tests
• Imaging scans when appropriate
• Assessment of urinary symptoms
• Assessment of bone pain or other symptoms
• Monitoring of treatment-related side effects

Your doctor may also monitor kidney and liver function and other aspects of your health depending on the treatment you are receiving.

If you develop new symptoms or notice a change in existing symptoms, tell your doctor or healthcare team. Early communication can help with symptom management and treatment decisions.

What Happens if Advanced Prostate Cancer Progresses?

Advanced prostate cancer can sometimes become resistant to the treatment being used. When this happens, the cancer may continue to grow despite treatment.

If this occurs, your healthcare team may consider other treatment options based on your previous treatment, overall health and the characteristics of your cancer.

Potential options may include:

• Changing or adding hormone-based treatment
• Chemotherapy
• Other systemic medicines
• Radiotherapy for selected areas
• Clinical trials
• Treatments focused on symptom control

Your treatment plan may change over time as your cancer responds differently to different therapies.

Which Treatments Are Suitable for You?

There is no single treatment plan that is suitable for every person with advanced prostate cancer.

Your treatment may depend on factors such as:

• Where the cancer has spread
• How extensive the cancer is
• Your PSA level and other test results
• Previous treatments
• How the cancer has responded to previous treatment
• Your general health
• Your symptoms
• Your personal preferences

Your urologist and oncology team can explain the available options and help you understand the potential benefits and risks of each approach.

Treatments to Help Manage Symptoms

Advanced prostate cancer can cause symptoms such as bone pain, urinary difficulties and fatigue. Treatment can be provided to manage these symptoms and improve quality of life.

Depending on the symptoms and underlying cause, supportive or palliative treatments may include:

• Pain-relieving medicines
• Radiotherapy for painful areas affected by cancer
• Medicines to protect bone health when appropriate
• Treatment for urinary symptoms
• Physiotherapy or other supportive care

If you experience new or worsening pain, difficulty urinating or other concerning symptoms, inform your healthcare team.

What Is a Multidisciplinary Team?

Treatment for advanced prostate cancer may involve several healthcare professionals working together.

Your multidisciplinary team (MDT) may include:

• Urologist
• Medical oncologist
• Radiation oncologist
• Clinical nurse specialist
• Radiologist
• Pathologist
• Radiation therapist
• Physiotherapist
• Dietitian
• Other healthcare professionals depending on your needs

The members of your care team may vary depending on your treatment and individual circumstances.

Prognosis and Living With Advanced Prostate Cancer

If you have been diagnosed with advanced prostate cancer, you may want to understand how well treatment is expected to control the disease and what the future may look like.

Prognosis varies considerably between individuals. It can depend on where the cancer has spread, how extensive it is, how quickly it is progressing, your overall health and how well the cancer responds to treatment.

It is not possible to predict an individual’s prognosis based on a diagnosis alone.

Although advanced prostate cancer is generally not considered curable, treatments can often control the disease for significant periods of time. As treatments continue to develop, there may also be different options available if the cancer stops responding to an existing treatment.

Your doctor can explain what your diagnosis and test results mean for your individual situation.

When Should You See a Urologist?

Speak with a urologist if you experience persistent urinary symptoms, blood in the urine, unexplained bone pain or other symptoms that may require evaluation.

If you have already been diagnosed with prostate cancer, regular follow-up is important so that your healthcare team can monitor the disease and adjust treatment when necessary.

If you are looking for evaluation or treatment for prostate cancer, you can learn more about Dr. Dushyant Pawar and his urological services.

You can also contact the clinic to discuss your symptoms and treatment options.