Metastatic Prostate Cancer

Medically Reviewed by Jabeen Begum, MD on August 30, 2024
12 min read

If your prostate cancer spreads to other parts of your body, your doctor may tell you that it's "metastatic" or that your cancer has "metastasized."

Most often, prostate cancer spreads to the bones or lymph nodes. It also commonly spreads to the liver or lungs but rarely to other organs, such as the brain, though that can happen.

It's still prostate cancer, even when it spreads. For example, metastatic prostate cancer in a bone in your hip is not bone cancer. It has the same prostate cancer cells the original tumor had.

Metastatic prostate cancer is an advanced form of cancer. There's no cure, but you take steps to treat and control it. Most people with advanced prostate cancer live a normal life for many years.

The goals of treatment are to:

  • Manage symptoms
  • Slow the rate at which your cancer grows
  • Shrink the tumor

Localized prostate cancer vs. metastatic prostate cancer

Localized prostate cancer means that the cancer is present only where it started and hasn’t spread anywhere else in your body. However, some cancers are called "locally advanced." That means the cancer has spread from the prostate to nearby tissue but hasn’t reached other body parts. It's not the same as metastatic cancer since it hasn't spread to other parts of your body. Many locally advanced prostate cancers can be cured.

Metastatic prostate cancer is stage IV, and doctors divide it into two types: IVA and IVB.

Stage IVA prostate cancer

If you have stage IVA (pronounced "Stage 4A") prostate cancer, that means the disease is in one or both sides of the prostate and has spread to the seminal glands, the organs that make the fluid that makes up semen, and nearby tissue or organs but not to distant parts of your body. 

Stage IVB prostate cancer

If you have stage IVB (pronounced "Stage 4B") prostate cancer, the disease has spread to organs, such as your bones or brain, far away from the prostate where the cancer started.

When prostate cancer has spread to other parts of your body, your symptoms may depend on the locations it has reached. But metastatic prostate cancer symptoms generally include:

  • Bone pain
  • Back, hip, or pelvic pain
  • Tiredness
  • Feeling sick
  • Unexplained weight loss
  • Difficulty peeing
  • Peeing more often
  • Blood in your pee or semen

About 50% of people diagnosed with local prostate cancer will get metastatic cancer during their lifetime. Finding cancer early and treating it can lower that rate.

A small percentage of people aren't diagnosed with prostate cancer until it has become metastatic. Doctors can find out if it's metastatic cancer when they take a small sample of the tissue and study the cells.

When you are diagnosed with prostate cancer, your doctor will order tests such as:

  • X-rays
  • CT scans
  • MRI scans
  • PET scans

These tests may focus on your skeleton as well as your belly and pelvic areas. That way doctors can check for signs that the cancer has spread.

If you have symptoms such as bone pain and broken bones for no reason, your doctor may order a bone scan. It can show if you have signs of cancer spreading to your bones.

Your doctor will also ask for blood tests, including a check of prostate-specific antigen (PSA) levels, to look for other signs that the cancer is spreading.

PSA is a protein made by the prostate gland. A rise in PSA is one of the first signs your cancer may be growing. But PSA levels can also be high without cancer, such as if you have an enlarged prostate, a prostate infection, trauma to the perineum, or sexual activity.

It mainly depends on the stage of your cancer. Metastatic prostate cancer is stage IV, and doctors divide it into two types: IVA and IVB.

If you have stage IVA prostate cancer, your doctor may recommend one of these treatment options:

External beam radiation treatment (EBRT) with androgen deprivation therapy (ADT). During EBRT, a machine outside your body sends beams of radiation to your prostate gland. Radiation destroys cancer cells.

ADT is a type of hormone therapy. It involves taking medications to lower the levels of male sex hormones (androgens) that your testicles make or getting surgery to remove the testicles. Androgens, like testosterone, often fuel the growth of prostate cancer cells.

Along with ADT, your doctor might also have you take a drug called abiraterone (Zytiga). It helps stop cells in other parts of your body, such as your adrenal glands, from making androgens.

ADT with or without abiraterone. If your doctor recommends this option, you won’t need to get external beam radiation treatment along with ADT.

If you have stage IVA prostate cancer with no symptoms, or if you have other serious health conditions, your doctor might recommend ADT alone. Or they might suggest watchful waiting, also called observation. This means your doctor watches to see if your cancer brings on new or changing symptoms. Then, they give you treatment aimed at controlling those symptoms. You won’t need regular testing if you and your doctor opt for watchful waiting.

Radical prostatectomy. Radical prostatectomy is surgery to remove the prostate and some nearby tissues, such as the seminal glands. Doctors do this surgery through a cut on the lower belly or the area between the scrotum (the pouch of skin below the penis) and the anus. 

Your doctor may also perform this surgery through a procedure called laparoscopic radical prostatectomy. This procedure involves using a tube-like instrument with a camera called a laparoscope and other instruments, which are put through a small cut your doctor makes for the surgery. Your doctor will likely use a robotic system for the procedure. 

If successful, this surgery can extend your lifespan by at least 10 years. 

If you have stage IVB prostate cancer, some treatment options are:

Androgen deprivation therapy (ADT). Your doctor may suggest you get ADT alone or with one of these:

  • A hormone therapy drug (such as abiraterone, apalutamide, or enzalutamide)
  • A chemotherapy drug called docetaxel
  • External beam radiation

Surgery. An operation called transurethral resection of the prostate (TURP) can ease symptoms such as bleeding or a urinary blockage.

Treatments for bone pain and other problems. If prostate cancer spreads to your bones, it could cause pain, broken bones, and other problems. Treatments that can bring you pain relief or prevent other problems include:

  • External radiation
  • An injectable drug called denosumab (Xgeva)
  • A bisphosphonate drug called zoledronic acid (Zometa), which you get through an IV
  • Medicines containing radiation that get injected into your body (such as radium-223, strontium-89, or samarium-153)

Observation (watchful waiting). Your doctor may recommend this for you if you’re older or you have other serious health problems and don’t have bad cancer symptoms.

Clinical trials. You could ask your doctor if you’re eligible to take part in one of these studies, which tests new drugs, procedures, and other treatments on people.

Metastatic hormone-sensitive prostate cancer (mHSPC) is a type of metastatic prostate cancer where the cancer cells use the hormone androgen to grow.

If your doctor tells you that you have this type of metastatic prostate cancer, it means your cancer responds to hormone therapy (or that you haven’t gotten hormone therapy yet.)

Most prostate cancer cells need male sex hormones, including androgens like testosterone, to grow. A type of hormone therapy such as androgen deprivation therapy could slow the growth of mHSPC by lowering the level of these hormones.

There's no cure for mHSPC. Though many people respond well to androgen deprivation therapy — the first treatment you’ll likely get in this case — it gets to a point where the treatment stops working.

You could also ask your doctor if you’re eligible for any clinical trials.

Still, some people with mHSPC prefer to avoid or delay getting treatment with an option called active surveillance. That’s when your doctor keeps close tabs on your health but doesn’t give you treatment unless test results show your cancer is getting worse.

You can ask your doctor if watchful waiting is an option for you.

This means you have a type of metastatic prostate cancer that’s able to grow and spread after you've had hormone therapy to lower your testosterone levels.

Still, most people with metastatic castration-resistant prostate cancer (mCRPC) stay on androgen deprivation therapy because it might still be effective against some prostate cancer cells.

Your doctor may recommend adding other treatments such as:

  • Chemotherapy
  • Immunotherapy
  • Other hormone treatments
  • Medicines containing radiation
  • Treatments to ease symptoms such as pain

You could also find out if a clinical trial might be right for you.

Some people with mCRPC simply choose to try active surveillance or watchful waiting.

The 5-year survival rate for metastatic prostate cancer is 32%. The earlier you’re diagnosed, the more likely you’ll be disease-free with treatment, as 99% of localized and regional metastatic prostate cancer (earlier stages) cases have a 5-year survival rate.

The American Cancer Society recommends that you ask questions such as:

  • What treatment might be best for me?
  • What are the possible benefits of getting it?
  • How soon would I need to start treatment?
  • Will I need to get surgery as part of my treatment? If so, what will it be like and who will do it?
  • Will I need other treatments, too? If so, how might they benefit me?
  • What side effects could my treatments cause? And what should I do if I get them?
  • Is there a clinical trial that might be a good option for me?
  • Can you review any vitamins or the diet I’m on to make sure it won’t interfere with my cancer treatment?

If you've been treated, especially if a surgeon removed your prostate, your PSA levels should start to go down. Doctors usually wait several weeks after surgery before checking PSA levels.

A rise in PSA after treatment may suggest the cancer is back or spreading. In that case, your doctor may order the same tests used to diagnose the original cancer, including a CT, MRI, or bone scan. The radiotracer Axumin could be used along with a PET scan to help detect and localize any recurrent cancer.

Though very rare, it's possible to have metastatic prostate cancer without a higher-than-normal PSA level.

Go to all of your follow-up doctor appointments. At these checkups, let your doctor know about any symptoms you’re having, especially ones like bone pain or blood in your pee. You could keep track of your symptoms by writing them down in a journal or diary.

At home, follow some healthy habits to feel your best:

Eat a balanced diet. It can boost your energy and your immune system. Fill your plate with fruits and vegetables and high-fiber foods. Cut back on fattening foods, sugar, and processed foods and meats.

Let your doctor know if you’re having trouble staying at a healthy weight or if you’re losing your appetite.

Get exercise if your doctor OKs it. It can be good for your body and mind. It can also help you stay at a healthy weight, keep up your strength, and help manage medication side effects.

Before you get started, ask your doctor what types of exercise are right for you and how much you should aim for. The doctor may talk to you about doing strength training or aerobic exercise that gets your heart pumping.

Having metastatic prostate cancer can be a distressing experience that can seriously impact your physical and mental well-being. With the support of family, friends, and your care team, you can learn to live meaningfully with this condition.

  • Educate yourself about your cancer, asking your care team everything you need to know about your prostate cancer stage, tests, symptoms, treatment options and side effects, and clinical trials right for you. You can also learn about your cancer from sources such as the American Cancer Society and the National Cancer Institute.
  • Try to be as physically and mentally active as possible. You can do exercises that redirect your attention to activities that could help you relax and improve your mood, such as meditation, yoga, dancing, and stretching. You can also spend more time on hobbies such as knitting, reading, and taking pictures.
  • Try to have open conversations about your cancer, sharing concerns that matter to you with your loved ones and asking for support with your needs, such as everyday errands or company when you might be feeling lonely. You can ask someone from your care team to start this conversation with your loved ones if you’re uncomfortable doing so.
  • Consider joining support groups for people with metastatic prostate cancer to meet with and learn from new people who also have your condition. These support groups can be in-person or online and can help you feel hopeful and less alone. You can find them on websites such as Prostate Cancer Foundation and ZERO Prostate Cancer.
  • If you feel comfortable doing so, engage in activities that help you reflect on and find contentment in your life so far. Spiritual activities such as prayer or meditation may help. You could also start a daily journal, draw a family tree, make a scrapbook, write poems, or do volunteer activities.

Having a loved one with metastatic prostate cancer is a reality many people aren’t prepared for. It can also take a toll on your well-being and daily functioning. As you try your best to be there for your loved ones, try as much as possible to take care of yourself too.

  • Ask for help from your friends and family to ease your daily workload. They could help with home chores or running errands like picking up medicines.
  • Create "me-time" for yourself, setting aside some minutes to do things that help you relax or interest you, such as watching TV, taking deep breaths, yoga, or journaling. 
  • Create and follow a daily routine to ease stress and make your obligations more manageable.
  • Consider joining a support group. It can provide an avenue to meet people you can share your experiences with and learn from, making your experience as a caregiver less isolating. You can find these support groups by searching the National Cancer InstituteCancerCare, and American Cancer Society.
  • Listen to your body, and don’t try to push yourself when it tells you to rest. Go for regular checkups and screenings, get consistent quality sleep, eat healthy meals, exercise, and take any medicines as prescribed.
  • Maintain a strong support system that could include your loved one's care team, friends, and neighbors. Your loved one’s care team can help you feel empowered with health information, and your friends can physically, emotionally, and financially be there for you.
  • Learn more about your loved one’s condition from resources such as the National Cancer Institute and get permission to be updated with their medical information.

Having metastatic prostate cancer means that the disease has spread from the prostate to faraway areas, such as the bones or, rarely, the brain. There are many treatment options for reducing the spread of metastatic prostate, improving your symptoms, and shrinking your tumor. The one your doctor recommends will depend on whether you have stage IVA or IVB. Speak with them about your treatment options and potential to join clinical trials. Ask your care team about concerns, join support groups, and create time to do things you genuinely enjoy.

What is the longest you can live with metastatic prostate cancer?

About 32% of people with metastatic prostate cancer live for 5 years or longer.

What is the difference between prostate cancer and metastatic prostate cancer?

Prostate cancer is a type of cancer that starts in the tissues of the prostate. Metastatic prostate cancer is a stage of prostate cancer where the cancer cells have spread from the prostate to distant parts of the body. It is also called stage IV cancer.

Does chemo work for metastatic prostate cancer?

Chemotherapy works for metastatic prostate cancer to improve your symptoms and help you live longer, whether or not your cancer is still responding to hormone therapy.