Stage 4 prostate cancer happens when cancer spreads beyond the prostate to other parts of the body.

Most prostate cancers are diagnosed when the cancer is only in the prostate. Sometimes prostate cancer doesn't cause symptoms, and the cancer may not be detected until it has spread. When prostate cancer spreads to other parts of the body, it's called metastatic cancer.

Treatments can slow or shrink a stage 4 prostate cancer. But most stage 4 prostate cancers can't be cured. Still, treatments can lengthen life and reduce symptoms of cancer.


Signs and symptoms of stage 4 prostate cancer may include:

  • Pain while urinating.
  • Trouble starting to urinate.
  • Trouble emptying the bladder all the way.
  • Weaker urine stream.
  • Urinating more often.
  • Blood in the urine or semen.
  • Pain in the back, hips or pelvis.
  • Tiredness.

When to see a doctor

Make an appointment with a doctor or other health care professional if you have ongoing symptoms that worry you.


The cause of stage 4 prostate cancer is not known. Stage 4 prostate cancer happens when prostate cancer cells break away from where they formed in the prostate. The cancer cells spread to other parts of the body.

Prostate cancer starts when cells in the prostate develop changes in their DNA. A cell's DNA holds the instructions that tell a cell what to do. In healthy cells, the DNA gives instructions to grow and multiply at a set rate. The instructions tell the cells to die at a set time. In cancer cells, the DNA changes give different instructions. The changes tell the cancer cells to replicate much more quickly. Cancer cells can keep living when healthy cells would die. This causes too many cells.

The cancer cells form a mass called a tumor in the prostate. These tumors can grow to invade and destroy nearby healthy tissue. In time, cancer cells can break away and spread to other parts of the body.

Prostate cancer cells that spread past the prostate most often go to the:

  • Lymph nodes.
  • Bones.
  • Liver.

Risk factors

Factors that can increase the risk of stage 4 prostate cancer include:

  • Getting older. The risk of prostate cancer increases with age.
  • Having a family history of prostate cancer. Certain DNA changes that are passed from parents to children can increase the risk of prostate cancer. These inherited DNA changes also increase the risk of more-aggressive forms of prostate cancer.
  • Being Black. For reasons not yet known, Black people have a greater risk of prostate cancer than do people of other races. Black people also are more likely to have prostate cancer that is aggressive or advanced.