Metastatic Prostate Cancer

Metastatic prostate cancer means that the cancer has spread beyond the prostate to distant lymph nodes or organs, often to bones. If you have been diagnosed with metastatic prostate cancer, we are here for you with a community of support, direct assistance, and education.

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What is metastatic prostate cancer?

Metastasis—also referred to as “metastatic cancer”—is the medical term for cancer that has spread to a part of the body outside of where it originated. Metastatic prostate cancer or stage IV (4) prostate cancer generally refer to cancer that has spread beyond the lymph nodes and tissues immediately surrounding the prostate. It is often referred to as advanced prostate cancer. Prostate cancer most frequently spreads to the bones, liver, or lungs.

How and where prostate cancer spreads?

Metastasis most commonly occurs when cancer cells break away from the main tumor and circulate through the body via the bloodstream or lymphatic system. These cancer cells can collect and grow in different parts of the body, forming metastases. Several factors influence the likelihood of metastasis in prostate cancer, including the cancer’s aggressiveness, indicated by its Gleason score or Grade Group, and the point at which treatment begins.

Theoretically, any cancer can spread to any part of the body. In reality, certain types of cancer tend to spread to specific places. Prostate cancer most commonly spreads to the bones, followed by the lymph nodes, lungs, liver, and brain. Regardless of where metastases form, the type of cancer remains the same. Prostate cancer that has metastasized to the bones is still prostate cancer, not bone cancer.

Bone metastasis

Many men experience bone related problems as a result of prostate cancer or its treatment. Among other things, the spread of the prostate cancer to the bones (bone metastases) can cause severe pain and fractures (bone breaks). Hormonal therapy for prostate cancer can also cause bone loss, fracture, and joint pain. All men are at risk for fractures as they age, and this risk is compounded when living with a prostate cancer diagnosis.

When prostate cancer spreads beyond the prostate to another organ, most frequently it spreads to the bone. Prostate cancer that spread to the bone is still considered prostate cancer. It is still treated with therapy for prostate cancer.

More than 60% of men with advanced prostate cancer will eventually develop bone metastases. The bones most commonly affected are the spine, hips, and ribs. Once prostate cancer has spread to the bone it can become painful, but treatments like pain medications or radiation therapy to those areas can dramatically reduce pain and improve quality of life.

Metastatic prostate cancer treatment options

While there is no cure for metastatic prostate cancer, there is hope to manage the disease effectively through new treatments. These new treatment options for metastatic prostate cancer can help slow the disease progression and give you more time to live your best life.

When making a treatment plan, it is important to include strategies to maintain good bone health. There are several treatments available to strengthen bones and manage spread and pain. Below is more information on these treatment options.

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Bisphosphonates prevent the thinning of the bone, help make them stronger, and help relieve bone pain. Zometa (zolendronic acid) is the most commonly used bisphosphonate. It is usually given once every 3 or 4 weeks, or once every 12 weeks, by an intravenous (IV) infusion through a vein. Patients given this drug are often advised to take a calcium and vitamin D supplement to prevent problems with low calcium levels.
Some side effects related to bisphosphonate use include flu-like symptoms, bone or joint pain, and kidney problems. A rare but serious side effect is osteonecrosis of the jaw (ONJ). This is a condition where part of the jaw bone loses its blood supply and dies, which can lead to tooth loss and jaw bone infections. Patients are advised to have a dental checkup and any dental problems treated before they start taking a bisphosphonate.
Xgeva (denosumab) works to prevent or delay problems like fractures and is given as an injection under the skin every 4 weeks. Men given this drug are often advised to take a calcium and vitamin D supplement to prevent problems with low calcium levels.
Some common side effects include diarrhea, nausea, weakness, and fatigue. Similar to bisphosphonates, ONJ is a rare but serious side effect. Therefore, the same precautions are recommended.
There are several types of radiation therapies that can be used to treat and manage the cancer and the pain it can cause when it grows in the bones. While these types of therapies will not eliminate all cancer cells or cure the cancer, they do relieve bone pain and can slow the growth of cancer. External radiation can be given to the affected bone or single area of treatment. After the end of the series of radiation treatments, pain continues to lessen over several weeks.
If several areas of the skeletal system are affected by cancer then radiation, in the form of radiopharmaceuticals, can be administered via IV injection into the blood stream through a vein. They are then quickly absorbed by the bones, especially in areas with cancer in the bone, and work by bringing small doses of radiation to the cancer cells.
There are several medications in this family of treatments that can help relieve pain caused by bone metastases.
- One form of infused radiation approved by the FDA, Xofigo (Radium-223), gives off an alpha wave radiation and has also been shown to help those with prostate cancer spread only to their bones live longer.
- Other radiopharmaceuticals are Metastron (Strontium-89) and Quadramet (Samarium-153). These treatments give off a beta wave, and are approved by the FDA to reduce the pain caused by the cancer in the bones.
The main side effect associated with these drugs is a blood cell count decrease, which can increase the risk for bleeding or infection.

Bone metastasis in prostate cancer treatment

Testosterone, the male sex hormone, fuels the growth of prostate cancer but it also is crucial to bone health. Treatment of prostate cancer with hormone therapy, also called androgen deprivation therapy (ADT), blocks the production of testosterone which stops or slows the growth of the cancer. Without testosterone, bones can become weak and break more easily.

When a man is on ADT, recovery from a bone fracture takes longer than for other men. It is especially important for patients taking ADT to speak with their doctor about how to plan for and manage the bone loss before a problem arises. Bone strength can also be decreased as a result of radiation and chemotherapy used to treat prostate cancer.

Managing bone loss from prostate cancer treatment

Fortunately, there are ways to strengthen and repair your bones including medicines and lifestyle changes. See below on some opportunities to help with bone loss.

Bisphosphonates can prevent the thinning of the bone and help make them stronger
- Oral bisphosphonates include Fosamax (alendronate) and Actonel (risendronate)
- The intravenous bisphosphonate is Zometa (zolendronic acid)
Strive for a healthy diet and make sure to get enough calcium and vitamin D
When exercising, include weight bearing and muscle strengthening exercises
Avoid tobacco and excessive alcohol

Metastatic prostate cancer prognosis

When facing a metastatic prostate cancer diagnosis, many patients want to get a better understanding of their prognosis and survival rates in hope that this will help them make informed decisions about their treatment and care. While metastatic prostate cancer is not curable, many factors influence a patient's prognosis and life expectancy.

Factors that impact metastatic prostate cancer prognosis include:

Extent of metastasis: The number and location of metastatic sites can affect prognosis. Patients with fewer metastases or metastases confined to the bones may have a better prognosis than those with widespread metastases or visceral involvement (such as liver or lung metastases).
Overall health: A patient's age, performance status, and the presence of other health conditions can influence their ability to tolerate treatments and impact their overall prognosis.
Response to treatment: How well a patient responds to hormone therapy, chemotherapy, and other treatments can significantly affect their prognosis and survival. Patients who have a good initial response to treatment and maintain that response over time may have a better prognosis.

Survival rates for metastatic prostate cancer can vary widely depending on individual factors. According to the American Cancer Society, the 5-year relative survival rate for distant (metastatic) prostate cancer is about 34%. However, this statistic doesn't account for individual variations and advancements in treatment.

It's essential to discuss your individual prognosis with your healthcare team. Your doctors can provide a more personalized assessment based on your specific case, taking into account factors such as your PSA levels, Gleason score, extent of metastases, and overall health. They can also help you understand the potential benefits and risks of various treatment options, so you can make informed decisions about your care.

Remember, while metastatic prostate cancer is a serious diagnosis, many patients can live for several years with appropriate treatment and support. Advances in therapies like hormone therapy, chemotherapy, immunotherapy, and targeted agents continue to improve outcomes and quality of life for men with advanced prostate cancer.

If you have questions about your metastatic prostate cancer prognosis or treatment options, don't hesitate to talk to your healthcare team. They are there to provide guidance, support, and personalized recommendations to help you navigate this challenging journey.

Have you been diagnosed with metastatic prostate cancer?

It's important to explore all your treatment options and make informed decisions about your care. Download our free Advanced Prostate Cancer Patient Guide to learn more about managing advanced disease.

Download the Advanced Prostate Cancer Patient Guide