Metastatic Prostate Cancer

Metastatic prostate cancer means that the cancer has spread beyond the prostate gland to other parts of the body. The likelihood of developing metastatic prostate cancer depends on various factors, including the stage and grade of the cancer at initial diagnosis, age, genetic predispositions, and overall health. Generally, prostate cancers identified early and at a lower grade have a lower risk of becoming metastatic. However, aggressive, or high-grade tumors are more likely to spread beyond the prostate.

Bone metastasis of prostate cancer.
Bone metastasis of prostate cancer in F-18-Choline PET-CT Scan. Source

How does metastatic prostate cancer spread?

Prostate cancer can metastasize to other internal organs in several ways. One method of metastasis is through the blood vessels, where the cancer cells enter the bloodstream and travel to distant organs. Another pathway is through the lymphatic system, wherein the cancer cells can infiltrate the lymph nodes near the prostate and subsequently spread to other lymph nodes or organs. 

Additionally, prostate cancer can metastasize through direct invasion, where the cancer cells grow into nearby tissues or organs, such as the bladder or rectum. The most common sites of metastasis for prostate cancer are the bones and the lymph nodes. Other possible sites include the liver, lungs, and adrenal glands.

What are the symptoms of metastatic prostate cancer?

Metastatic prostate cancer may initially present no symptoms. However, as it progresses, it can lead to a variety of signs and symptoms, which vary depending on its location. These symptoms include pain or discomfort in the pelvic area, lower back, hips, or ribs, difficulty urinating or changes in urine flow, and the presence of blood in the urine or semen. 

Men may experience erectile dysfunction or painful ejaculation. There can also be swelling in the legs or feet, unexplained weight loss or loss of appetite, and general fatigue or weakness. Additional symptoms of metastatic prostate cancer can include shortness of breath or coughing, jaundice (yellowing of the skin or eyes), nausea, or vomiting may occur as the cancer progresses.

How is metastatic prostate cancer diagnosed and treated?

While localized prostate cancer can be diagnosed with tests like the prostate-specific antigen (PSA) and Digital Rectal Exam (DRE), these are not specific for detecting metastatic prostate cancer. In other words, while these tests can indicate the presence of prostate cancer or any abnormalities in the prostate, they cannot determine if the cancer has spread. Imaging tests are the most reliable methods for identifying metastatic prostate cancer. A biopsy from suspected areas of distant organs could confirm if the cancer originated from the prostate gland. 

The treatment of metastatic prostate cancer depends on several factors and is often determined by a multidisciplinary team of experts, including urologists, radiologists, and oncologists. This patient-specific approach may involve various strategies such as orchiectomy (removal of the testicles), hormone therapy, chemotherapy, immunotherapy, radiation therapy, surgery (prostatectomy or targeting other organs affected by metastasis), and palliative care.

What is metastatic hormone-sensitive prostate cancer?

Metastatic Hormone-Sensitive Prostate Cancer (mHSPC) is a stage of prostate cancer where the cancer cells have spread beyond the prostate gland to other parts of the body (metastasized) but still respond to hormonal therapy. Hormone therapy, often involving lowering testosterone levels, is typically effective at this stage as the growth of prostate cancer cells is still driven by hormones. 

This type of cancer is sensitive to treatments that reduce or block the action of testosterone, a key growth factor for most prostate cancers. Treatment aims to control the spread and manage symptoms, prolonging survival and maintaining quality of life.

What is metastatic castration-resistant prostate cancer?

Metastatic Castration-Resistant Prostate Cancer (mCRPC) refers to prostate cancer that has spread to other parts of the body and no longer responds to standard hormone therapy, including treatments that lower testosterone levels. This means the cancer continues to grow despite the hormonal level being reduced to very low or "castrate" levels. mCRPC is more challenging to treat as it becomes resistant to conventional hormone-based therapies. Treatment options often involve chemotherapy, newer types of hormone therapy, immunotherapy, or clinical trials, focusing on controlling the disease's spread and managing symptoms.

What is the prognosis of metastatic prostate cancer?

The prognosis of metastatic prostate cancer is influenced by a variety of factors. These include the location and number of metastases, indicating how far the cancer has spread. The type and grade of the prostate cancer also play a crucial role, as they determine the cancer's aggressiveness and how it behaves. Another significant factor that influences the prognosis of metastatic prostate cancer is the patient's response to treatment, which can vary widely depending on the cancer's characteristics and the treatment methods used. 

Additionally, the age and overall health of the patient are important considerations, as they can affect both the progression of the cancer and the patient's ability to tolerate specific treatments. Metastatic prostate cancer is not curable, but it can be controlled with treatment for some time. The average survival time for men with metastatic prostate cancer is about 3 years. However, some men may live longer or shorter depending on their individual situation.

Further Reading

  1. Bratt O, Drevin L, Akre O, Garmo H, Stattin P. Family History and Probability of Prostate Cancer, Differentiated by Risk Category: A Nationwide Population-Based Study. J Natl Cancer Inst. 2016. PMID: 27400876.
  2. Achard V, Putora PM, Omlin A, Zilli T, Fischer S. Metastatic Prostate Cancer: Treatment Options. Oncology. 2022;100(1):48-59. PMID: 34781285.

Disclaimer: The blog post titled ' Metastatic Prostate Cancer’ is intended solely for informational purposes, based on the references cited. It is not meant to serve as medical advice. For professional medical guidance, please consult your doctor.

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