Advanced prostate cancer

Consultant urologist, Jonathan Aning, talks you through what prostate cancer is, the main types, risk factors, stages and common treatments available to you.

Advanced prostate cancer can also be called metastatic prostate cancer.

Advanced prostate cancer is when cancer cells have spread from the prostate gland and very nearby areas to other parts of the body.

The cancer cells spread through the blood or through the lymphatic system. When the cancer cells reach a new area of the body, they start growing in these areas.

The most common places for prostate cancer to spread to are the lymph nodes and the bones. It can also spread to other organs, such as the liver or lungs. Even if it spreads to other parts of the body, it is still prostate cancer.

Sometimes, prostate cancer is advanced when it is first diagnosed. Some people are diagnosed with advanced prostate cancer after having treatment to cure early or locally advanced prostate cancer. This can happen because at the time of their treatment, it was not possible to detect the cancer cells that were present outside the prostate gland.

It is not possible to cure advanced prostate cancer, but there are treatments that can help to control it and slow it down. These treatments can also help with symptoms and your quality of life.

Prostate cancer is one of the most common cancers in the UK. It is more common over the age of 65. Prostate cancer can happen in younger people, but it is uncommon in people aged under 50.

Doctors do not know the exact causes of prostate cancer. But there are risk factors that can increase the chance of developing it. Having one or more risk factors does not mean you will get prostate cancer.

If you are a trans woman or are non-binary or assigned male at birth, you also need to be aware of prostate cancer. Advanced prostate cancer may affect trans women, but there is not enough evidence to know how common this is.

Prostate Cancer UK has detailed information about trans women and prostate cancer. The LGBT Foundation can also give you confidential advice and support. OUTpatients is another charity that supports LGBTQ+ people who have been diagnosed with cancer. You can also talk to our cancer support specialists.

The stage of a cancer describes its size and how far it has spread. The results of your tests help your doctors decide on the stage. You and your doctors can then talk about the best treatment choices for you.

Your doctors also look at the grade of the cancer to help them plan your treatment. The grade gives an idea of how quickly the cancer might grow or spread.

Doctors often use the TNM staging system or a number staging system for prostate cancer.

Find out more about staging and grading for prostate cancer.

Advanced (metastatic) prostate cancer can cause physical symptoms that are difficult to cope with. But there are ways to manage or control them. For example, if you are having hormonal therapy or chemotherapy to control the cancer, this may help improve any symptoms you have.

Your cancer team can support you. You may see healthcare professionals who specialise in pain and symptom control. They are called the palliative care team.

Other healthcare professionals can also help. A physiotherapist can advise you if you have problems with mobility. They can plan an exercise programme and help you build your muscle strength. Occupational therapists can help suggest equipment that makes it easier and safer to manage at home.

You may feel extremely tired (fatigued). This can be because of the cancer and treatment side effects. There are things you can do to help manage tiredness.

Tell your doctor or nurse if you are very tired. They can test your blood for anaemia (a low level of red blood cells). This can make you feel tired, dizzy and short of breath. Sometimes a blood transfusion is needed to treat anaemia.

Always tell your cancer team if you have pain. Different painkillers work in different ways.

If pain is an ongoing problem, you may be advised to take painkillers regularly rather than as you need them.

Many hospitals have specialist pain teams. The team includes doctors, nurses and usually an anaesthetist. Some teams also have a psychologist. Your cancer team can refer you to a pain clinic if that might be helpful.

A common place for prostate cancer to spread to is the bones. This is called secondary cancer in the bone. There are different ways bone pain can be controlled. You may have:

• drugs called non-steroidal anti-inflammatory drugs (NSAIDs)
• a bone-strengthening drug called zoledronic acid
• 1 or 2 sessions of radiotherapy.

Zoledronic acid is a type of drug called a bisphosphonate. Bisphosphonates can also help prevent or reduce bone thinning (osteoporosis). This can be a side effect of long term hormonal therapy.

Radiotherapy can help with bone pain but it can take a few weeks to feel the effect. Follow any advice about taking your painkillers regularly until the radiotherapy works.

Sometimes cancer in the bones of the spine grows and presses on the spinal cord. This may stop the spinal cord nerves from working properly. This is called metastatic spinal cord compression or MSCC.

MSCC is not common, but it needs to be treated quickly. This is to stop permanent damage to the nerves.

MSCC can be treated with radiotherapy to the spine. You usually have a single treatment. Some people have surgery or cancer drugs to treat MSCC. You may also be given steroids to relieve the compression.

MSCC can cause:

• new pain that can feel like a band around your chest or tummy
• new pain that spreads down an arm or leg or into your lower back or buttocks
• pain that can be severe, get worse with movement and disturb your sleep
• weakness in your arms of legs
• unsteadiness
• numbness or pins and needles in your legs
• bladder or bowel problems such as constipation, not passing much pee (urine) or poo (stool), or problems controlling your bladder and bowel (incontinence).

If you develop any symptoms of MSCC, you should get medical advice immediately. Even if it is the weekend or a holiday, contact the hospital team where you usually go for cancer treatment and follow-up appointments.

Make sure you have their contact details and you know who to phone at evenings and weekends. If you are unable to get in touch with anyone, go to the nearest Emergency Department (A&E) straight away.

For some people, secondary cancer in the bone may cause other problems that need treatment. There are ways of managing these problems. 

If you develop symptoms, it is very important to let your doctor or specialist nurse know straight away.

Advanced prostate cancer can cause bladder or bowel problems, such as needing to go to the toilet frequently or urgently, or leakage (incontinence).

Some people may need a urinary catheter to help with bladder problems. A catheter is a small, flexible plastic tube put into the bladder. It drains urine into a bag. Some people need a catheter while they recover from treatment. Other people need a catheter for a longer period, to manage ongoing symptoms.

If you have radiotherapy to the prostate gland or nearby areas (pelvic radiotherapy), you may develop bladder and bowel problems later. There are different ways to manage the late effects of pelvic radiotherapy.

The tubes that connect the kidneys to the bladder (ureters) may get blocked by prostate cancer. This will make it difficult to pass urine. If this happens, you may be offered surgery.

Your doctor or specialist nurse can give you more information about this type of surgery.

If you have eating problems or are worried about losing weight or gaining weight, there is lots of information to help you. You can ask your nurse or a dietitian for advice.

Weight gain can be a side effect of hormonal therapy. Healthy eating and cutting down on foods that are high in fat or sugar can help manage your weight. Try to only eat as much as you need. Try to combine this with physical activity, such as regular short walks.

It is important to know where to get support or information if you need it.

To find support:

• ask your GP or someone from your cancer team for advice about support in your area
• find cancer support services near you
• call the Macmillan Support Line free on 0808 808 00 00
• chat to our cancer information specialists online
• visit our Online Community to talk to people who have been affected by prostate cancer, share your experience, and ask questions.