Metastatic (stage 4) prostate cancer

Metastatic prostate cancer is cancer that starts in the prostate and spreads to other parts of the body. Other terms for this condition include advanced prostate cancer and stage 4 prostate cancer.

Prostate cancer is a growth of cells that starts in the prostate. The prostate is a small gland that helps make the fluid part of semen. It's found just below the bladder. The prostate is part of the male reproductive system.

Most prostate cancers are found when the cancer is only in the prostate. It's less common for someone to have metastatic prostate cancer when first diagnosed with prostate cancer. Metastatic prostate cancer happens most often in people who had treatment for prostate cancer in the past.

There are many treatments for metastatic prostate cancer. Treatments aren't likely to cure the cancer, but they can slow its growth.

Metastatic prostate cancer doesn't always cause symptoms. As the cancer grows and becomes more advanced, symptoms might happen. Signs and symptoms of metastatic prostate cancer can include:

• Feeling very tired.
• Having to urinate more often or feeling pain when urinating.
• Losing weight without trying.
• Nausea and vomiting.
• Pain, which might be felt in the back, hips, pelvic area or in a bone. The pain tends to get worse over time.

It's not clear what causes metastatic prostate cancer. This advanced form of prostate cancer happens when cancer cells break away from where they started in the prostate. The cancer cells can travel through the lymphatic system or the blood to other areas of the body. A metastatic prostate cancer also is a stage 4 prostate cancer.

Metastatic prostate cancer most often spreads to the:

• Bones.
• Lymph nodes.
• Liver.
• Lungs.

Rare places that metastatic prostate cancer spreads include:

• Adrenal glands.
• Brain.
• Pancreas.

The risk factors that raise the risk of metastatic prostate cancer are the same for prostate cancer in general. Factors that can increase the risk of prostate cancer include:

• Older age. The risk of prostate cancer goes up with age. It's most common after age 50.
• Race and ethnicity. In the United States, Black people have a greater risk of prostate cancer than do people of other races and ethnicities. Healthcare professionals aren't exactly sure why. In Black people, prostate cancer also is more likely to grow quickly or be advanced when detected.
• Family history of prostate cancer. If a blood relative, such as a parent or sibling, has been diagnosed with prostate cancer, your risk may be increased. The risk also may be increased if other close relatives have had prostate cancer. This includes your grandparents and your parents' siblings.
• Family history of DNA changes. Some DNA changes that increase the risk of cancer are passed from parents to children. The DNA changes called BRCA1 and BRCA2 can cause a higher risk of prostate cancer. These DNA changes are best known for increasing the risk of breast cancer and ovarian cancer.
• Obesity. People with obesity may have a higher risk of prostate cancer compared with people considered to have a healthy weight. Studies of this issue have had mixed results. In people with obesity, prostate cancer is more likely to grow quickly and more likely to come back after treatment.
• Smoking tobacco. Some research shows a link between smoking and prostate cancer. But not all studies agree. People with prostate cancer who smoke may have a higher risk of the cancer coming back. People who smoke also have a higher risk of the cancer spreading beyond the prostate.

Some treatments for metastatic prostate cancer can cause thinning bones. This complication can cause bones to break more easily.

To help reduce the risk of thinning bones, your healthcare team might recommend that you:

• Limit how much alcohol you drink.
• Stop smoking if you smoke.
• Get 30 minutes of weight-bearing exercise most days of the week. Weight-bearing exercises include activities where your legs carry your weight. Examples include strength training, lifting weights, walking, running, basketball and pickleball.
• Eat foods that are rich in calcium. Examples include dairy products, such as cheese, milk and yogurt, and some vegetables, such as bok choy, broccoli and kale.
• Take vitamin supplements, but don't do this without talking with your healthcare team. Your care team can tell you which vitamins to take and how much to take.

You might have bone density testing when you start treatment. The test might repeat every year or two to watch for signs of thinning bones. Sometimes medicines can help build up the bones that start to thin.