Advanced prostate cancer
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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 is when the cancer cells have spread from the prostate to other parts of the body. It is not possible to cure advanced prostate cancer. But there are treatments that can help to keep control it.
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Symptoms of prostate cancer may not develop for many years. The symptoms of advanced prostate cancer may be caused by an enlarged prostate. Symptoms of an enlarged prostate can include:
- needing to pee (pass urine) more often than usual, especially at night
- difficulty peeing – for example, a weak flow or having to strain to start peeing
- feeling like you have not completely emptied your bladder afterwards
- an urgent need to pee
- blood in your pee or semen
- rarely, pain when peeing or ejaculating.
Symptoms can also be a sign of secondary cancer, where the cancer has spread to another part of the body. The symptoms will depend on which part of the body is affected.
General symptoms may include:
- being more tired than usual
- generally feeling unwell
- having less of an appetite
- losing weight for no obvious reason.
If you have any of the symptoms we mention here, it is important to have them checked by your doctor.
Secondary cancer in the bones
After the lymph nodes, the most common place for prostate cancer to spread to is the bones. Prostate cancer may spread to bones, such as the:
- thigh bone (femur)
It may affect different areas of the bones rather than only one area.
The first sign of a secondary cancer in the bones is usually an ache in the bone. This is often in the hips or in the back. A secondary cancer in the bone may gradually make the bone weaker. Bones that are very weak may break (fracture) more easily. There are treatments you can have to help strengthen the bones and reduce pain.
Spinal cord compression
If the bones in the spine have cancer in them, the cancer may press on the spinal cord. This is called Malignant spinal cord compression (MSCC). It usually affects your legs and may cause:
- numbness or tingling in your legs.
Spinal cord compression is not common. But if you notice these symptoms, you should contact your doctors straight away – even at the weekend or during a holiday period. If you cannot contact your GP or cancer doctor, you should go to the nearest emergency department (A&E).
Prostate cancer can sometimes spread from the bone to the bone marrow. Bone marrow is the spongy material in the middle of our bones where our blood cells are made. This includes red blood cells, which carry oxygen around the body.
If the bone marrow cannot produce enough red blood cells, you may become anaemic. This can make you feel very tired and breathless, and you may look very pale.
Prostate cancer can sometimes spread to other parts of the body, such as the lymph nodes, lungs or liver. If you notice any new symptoms that last for 2 weeks or more, you should talk to your cancer doctor.
It is important to remember that any of the symptoms mentioned here can be caused by problems other than cancer.
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.
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 have detailed information about trans women and prostate cancer.
Doctors do not know the exact causes of prostate cancer. But there are risk factors of prostate cancer that can increase the chance of developing it. Having one or more risk factors does not mean you will get prostate cancer.
How you are diagnosed with advanced prostate cancer will depend on your situation. It may be:
- after previous treatment for early or locally advanced prostate cancer – possibly many years ago
- after being diagnosed with cancer in the prostate, if further tests show the cancer is advanced
- after tests to check symptoms of bone pain, with no previous diagnosis of prostate cancer.
The most common places for prostate cancer to spread to is the lymph nodes outside the pelvis and the bones. It sometimes spreads to areas such as the lungs or liver.
Your doctor or specialist nurse will explain the tests you will have. You may not need all the tests we mention here.
If you have, or have had, prostate cancer and have symptoms, you will have tests to see if the cancer has spread. These usually include a PSA test and bone scan.
If you have just been diagnosed with prostate cancer, you will have further tests to see if the cancer is advanced. These include a bone scan, a CT scan or an MRI scan.
If you were diagnosed with secondary cancer in the bones, you will need tests to find out if it started in the prostate. You will have a PSA test and depending on your situation, you may be offered a biopsy of the prostate. A biopsy is when samples of tissue are taken.
You may also have x-rays of the bones in a painful area, to find out if there are any abnormal areas.
A PSA test is when your doctors take a blood sample to check the PSA level (prostate-specific antigen) in your blood. PSA is a protein made in the prostate. Some of this PSA leaks into the blood and can be measured in the PSA test.
You may have an MRI scan before you have a biopsy. Specialised scans called multi-parametric MRI scans can give more detailed images of the body. If you have just been diagnosed with prostate cancer, you will this scan tests to see if the cancer is advanced. Depending on the results of the scan you may not need a biopsy.
Waiting for test results can be a difficult time, we have more information that can help.
The stage of a cancer describes its size and how far it has spread, based on your test results. Doctors often use the TNM staging system or a number staging system.
A doctor decides the grade by how the cancer cells look under the microscope. This gives an idea of how quickly the cancer might grow or spread. You and your doctors can then talk about the best treatment choices for you.
Find out more about staging and grading for prostate cancer.
Although advanced prostate cancer cannot be cured, it can be controlled with treatment, sometimes for several years. Treatments can also help relieve symptoms and improve your quality of life.
A multidisciplinary team (MDT) will meet to discuss the best possible treatment options for you. This will depend on different factors, like your general health. Your cancer doctor will talk to you about the advantages and disadvantages of these treatments.
The main treatments are:
Hormonal therapies is recommended for most people with advanced prostate cancer. Hormonal therapies reduce the amount of testosterone in the body. This may slow the growth of the cancer, or stop it growing for a while.
Chemotherapy uses anti-cancer (cytotoxic) drugs to destroy cancer cells. It is given with hormonal therapy when you are first diagnosed with advanced prostate cancer. It may also be used to treat advanced prostate cancer that is no longer being controlled by hormonal therapy.
The aim of chemotherapy for advanced prostate cancer is to shrink the cancer and slow its growth. This will help to relieve symptoms and improve quality of life.
The most commonly used chemotherapy drug to treat prostate cancer is docetaxel (Taxotere®). Other drugs that may be used are:
Your doctor or nurse will usually ask you to sign a form giving your permission (consent) for them to give you the treatment. They cannot give treatment without your consent.
Treatments can help to control the cancer and relieve the symptoms. But there may be a time when the treatment has little effect on the cancer. This means you have the side effects without the benefits.
Making decisions about treatment is always difficult. You may want to talk it over carefully with your cancer doctor, specialist nurse, and family.
If you decide not to have further treatment, you will be given supportive (palliative) care, with medicines to control any symptoms. Specialist nurses called palliative care nurses can provide help and support. They are experienced in assessing and treating symptoms of advanced cancer.
Advanced prostate cancer may cause symptoms that are difficult to cope with. But there are different ways to manage or control them. Treatments for the cancer can also improve symptoms.
Treatments for prostate cancer can also affect your sex life and relationships. This can feel very difficult to cope with. You do not need to be in a relationship to feel this.
We have more information on living with advanced prostate cancer.
Macmillan is also here to support you. If you would like to talk, you can:
Below is a sample of the sources used in our prostate cancer information. If you would like more information about the sources we use, please contact us at email@example.com
C. Parker, E. Castro, K. Fizazi, et al. Prostate cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Annals of Oncology, 2020, Volume 31, Issue 9, p1119-1134. Available from www.esmo.org/guidelines/genitourinary-cancers/prostate-cancer
National Institute for Health and Care Excellence (2019) Prostate cancer: diagnosis and management (NICE guideline NG131). Last updated December 2021 to include Risk stratification for localised or locally advanced prostate cancer. Available at www.nice.org.uk/guidance/ng131
This information has been written, revised and edited by Macmillan Cancer Support’s Cancer Information Development team. It has been reviewed by expert medical and health professionals and people living with cancer. It has been approved by Senior Medical Editor, Dr Lisa Pickering, Consultant Medical Oncologist.
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