What is Advanced Prostate Cancer?

Reviewed by: HU Medical Review Board | Last reviewed: November 2017 | Last updated: May 2023

Prostate cancer is often diagnosed at an early stage and can take years to travel beyond the prostate gland. However, some men may be initially diagnosed with a more advanced or aggressive form of prostate cancer. In such cases, the cancer has spread beyond the prostate into nearby structures, the lymph nodes, or other parts of the body more distant from the prostate gland.

Prostate cancer, like all cancers, has the ability to metastasize, or spread, throughout the body. How far the cancer has spread from the prostate, and stage of the cancer or by its level of aggressiveness.1 Metastatic prostate cancer is the term used for the most advanced stage of cancer and occurs when the cancer has spread from the prostate gland to more distant sites, such as bones and lymph nodes.

When prostate cancer metastasizes to the bone

When prostate cancer does metastasize from the prostate, it spreads to the bone about 90% of the time.3 Often one of prostate cancer’s most serious consequences and the one affecting long-term prognosis is the toll it takes on bone tissue. In addition to the impact of the cancer on the bone, a side-effect of hormone therapy used for the treatment of prostate cancer can be the loss of bone tissue. Complications of prostate cancer bone metastases include pain, bone thinning and fractures, weakness in limbs and fatigue, and spinal compression.2

What causes advanced prostate cancer?

It is not entirely known why some men have more aggressive forms of prostate cancer than others and what factors are responsible for advanced metastatic prostate cancer. Men with advanced prostate cancer sometimes have gene mutations that boost their sensitivity to testosterone, a hormone that makes prostate cancer cells grow more aggressively.

One gene mutation that has been of recent interest to researchers is the androgen receptor variant 7 (AR-V7). The AR-V7 mutation is found in about a third of all men with advanced prostate cancer that do not normally respond to hormone treatment.3 The AR-V7 gene variant affects cell receptors for testosterone and thus has an effect on prostate cancer growth. It is still early in the course of this research to determine the ultimate impact that recognition of this genetic mutation has for diagnosing advanced prostate cancer or for developing new treatment options.

Treatment options for advanced prostate cancer

Once prostate cancer has reached an advanced stage or metastasized to the bones, it may be non-responsive to hormone therapy as well as to many other treatment options.

If treatment is unsuccessful, and the cancer is unable to be controlled, it can spread to the tissues and lymph nodes surrounding the prostate, as well as to the rectum, muscles that control urinary functions, or pelvic wall.2 If the cancer does progress to this point, your doctor will help you determine what treatment options, if any, are best for your situation.

Typically, bone metastases are treated with pain medication and either radiation or surgery to stabilize the bone structure. While prior hormone therapy may have failed to halt the progression of prostate cancer, use of a different hormone drug combined with chemotherapy agents may be used by your healthcare provider in order to increase the efficacy of treatment.1 Many bone metastases are inoperable and can cause debilitating pain. In some cases, treatment is primarily palliative in nature, meaning they will not be successful in removing the cancer, but are attempting to provide symptom relief and increase the quality of life.

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