What It Means To Have Advanced Prostate Cancer

Hearing that you or a loved one has advanced prostate cancer can be frightening, especially if you don’t know exactly what that means or what it signals for the future.

The term “advanced prostate cancer” covers a wide range of situations. And it may not be what you think.

“Advanced prostate cancer is a loose definition to describe more aggressive forms of prostate cancer,” says urologic oncologist Zeyad Schwen, MD. “The good news is that it’s still very treatable.”

Dr. Schwen explains what you need to know.

What is advanced prostate cancer?

Advanced prostate cancer refers to any prostate cancer that has grown beyond its original location.

“There’s a range of what can be considered ‘advanced,’” Dr. Schwen notes.

It may mean your cancer has grown just beyond your prostate. Or it could mean that it’s spread to nearby lymph nodes or more distant parts of the body.

Types of advanced prostate cancer

Advanced prostate cancer generally falls into one of these categories:

• Locally advanced prostate cancer: The cancer is still centered in your prostate, but it has moved beyond the prostate’s capsule and affected nearby tissue in your pelvis. That can include structures like your bladder, seminal vesicles or lymph nodes in your pelvis just outside the prostate.
• Oligometastatic prostate cancer: The cancer has spread farther, but only to a small number of locations. That may mean it’s affecting your bones or a few lymph nodes outside of your pelvis.
• Widely metastatic prostate cancer: The cancer has spread beyond your pelvis to many other locations throughout your body. That may include distant organs like your liver, lungs or brain.
• Recurrent prostate cancer: Prostate cancer has come back after surgery, radiation or other treatments. Even if it’s localized to your prostate, recurrent cancer is still considered “advanced” because your team may need to use different treatments to manage it.

In general, the later the prostate cancer is found, the more likely it is to have spread beyond the prostate.

“Advanced prostate cancer can be curable in earlier stages,” Dr. Schwen says. “Detecting it earlier can make a difference.”

Symptoms

You may have been surprised to learn that you have advanced prostate cancer. That’s because prostate cancer can be sneaky — many people don’t have any symptoms of the disease until the cancer has already spread widely. 

“We often don’t see symptoms at all until prostate cancer has spread beyond a few metastatic spots,” Dr. Schwen notes. “And even then, you may not notice any symptoms.”

When symptoms do develop, you may notice:

• Bone pain
• Unexplained weight loss
• Fatigue
• Pelvic or rectal pain
• Changes in urination, like pain when you pee, blood in your urine, or a weak or slow stream

Treating advanced prostate cancer

Treatment depends on how far the cancer has advanced. The sooner prostate cancer is found, the more treatment options are available and the greater the chance of curing it. When it’s discovered after it has spread farther from its original site, treatment often focuses on slowing tumor growth and helping you live longer with a good quality of life.

Dr. Schwen explains what treatment may entail, depending on the specifics of the cancer itself.

If the cancer is confined to your prostate or pelvis

Advanced prostate cancer that hasn’t spread far may be treated — and even cured — with surgery to remove your prostate (called a prostatectomy).

Your provider may also suggest radiation therapy in addition to or instead of surgery. Depending on your situation, your healthcare team may also recommend a form of hormone therapy called androgen deprivation therapy (ADT). 

“Hormone therapy stops your testosterone production, which can slow the cancer’s growth and may improve the effectiveness of radiation.” Dr. Schwen explains.

If the cancer has spread beyond your pelvis

Treatment for advanced prostate cancer that’s spread farther usually includes hormone therapy and radiation therapy, chemotherapy or newer targeted medications. Your treatment plan will depend on things like:

• Where the cancer has spread
• How aggressive it is
• How it’s responding to treatment

“While metastatic prostate cancer usually isn’t curable, today’s therapies can often keep it managed for years,” Dr. Schwen reassures.

Follow-up and monitoring after treatment

No matter what stage of advanced prostate cancer you have, regular follow-up visits are an important part of your care.

Your healthcare team will monitor how well treatment is working by looking at several factors, including:

• PSA blood tests to track changes in your cancer over time
• Imaging tests, like PET scans or other scans, when needed
• Your symptoms, including any changes in pain, urination or energy levels
• Your overall health and quality of life

Remember, even the most advanced prostate cancers often respond well to treatment. And these days, people are living longer and better.

“Many of the biggest treatments in prostate cancer care over the past decade have come in treatments for advanced disease,” Dr. Schwen encourages. “Even with advanced metastatic prostate cancer, you can go into remission for many years and maintain a good quality of life while receiving treatment.”