According to the National Cancer Institute, 8 percent of men diagnosed with prostate cancer have metastatic (stage 4) cancer at the time of their diagnosis. It’s also possible to be diagnosed at an earlier stage of cancer and later develop metastatic disease if cancer spreads.

Being told that you have stage 4 prostate cancer can be overwhelming. By definition, metastatic prostate cancer has spread to other parts of the body, often the bones or lymph nodes. Although most stage 4 prostate cancer is not considered curable, many people live for years with the disease. Advancements in treatment can slow cancer growth, ease symptoms, and improve your quality of life.

Keep reading to learn what stage 4 prostate cancer means, how it’s treated, and factors that affect your prognosis, or outlook.

Defining Stage 4 Prostate Cancer

In stage 4 prostate cancer, also called metastatic prostate cancer, the cancer has grown beyond the prostate gland and has spread to other parts of the body. Stage 4 may be further categorized depending on where it’s spread, for instance:

• Cancer has spread to nearby lymph nodes (stage 4A).
• Cancer has spread to bones, distant lymph nodes, or other organs like the liver or lungs (stage 4B).

How Prostate Cancer Spreads

Prostate cancer spreads when cancer cells break away from the original tumor and travel through the bloodstream or lymphatic system. Once prostate cancer cells settle in a new location, they grow into additional tumors. No matter where prostate cancer spreads, it’s still considered prostate cancer. For example, cancer that’s spread to the bones is called prostate cancer with bone metastases, not bone cancer.

Stage 4 Prostate Cancer Symptoms

Some men with stage 4 prostate cancer have no noticeable symptoms at first, while others notice changes that affect their quality of life. Symptoms depend on how big the tumors are and where they’ve spread. Common symptoms of metastatic prostate cancer include:

• Loss of bladder control
• Erectile dysfunction
• Bone pain, especially in the hips, spine, ribs, or pelvis
• Weakness or numbness in the legs or feet
• Fatigue or low energy
• Weight loss

Some of these symptoms may occur if cancer spreads to the spine and presses on the spinal cord. Spinal cord compression can cause numbness or weakness in the legs or problems with bowel or bladder control.

Treatment Options for Stage 4 Prostate Cancer

Metastatic prostate cancer treatment focuses on slowing the growth or spread of the cancer, relieving symptoms, and helping you live longer and more comfortably. Most people with stage 4 cancer receive multiple types of treatment over time.

Doctors will tailor your treatment plan to several factors, including:

• How large the tumor has grown
• How far the cancer has spread
• How fast the cancer is growing
• How old and healthy you are
• How your cancer responds to hormones
• How you prefer to address quality-of-life issues and side effects

Some common treatment strategies include hormonal therapy, chemotherapy, targeted therapy, immunotherapy, radiotherapy (radiation), and palliative care.

In rare cases, doctors may still recommend surgery even for stage 4 disease. For example, if the tumor is obstructing the urinary tract, then surgery may be necessary.

Hormonal Therapy

Hormonal therapy is often one of the first prostate cancer treatment options. Most prostate cancers need male hormones, including androgens like testosterone, to grow. Hormone therapy lowers the levels of these hormones or blocks their effects in the body. This can slow or shrink advanced cancer of the prostate and may be used alone or in combination with chemotherapy and other strategies.

Common side effects of hormone therapy may include hot flashes, decreased desire for sex, and bone weakening.

Chemotherapy

Another tool to fight advanced cancer of the prostate is chemotherapy, especially in combination with hormonal therapy. Chemo may be recommended when prostate cancer is widespread (especially if it has spread to the liver, lungs, or distant lymph nodes) or if it is growing quickly or not responding well to hormone therapy.

Chemotherapy can reduce symptoms and help people with metastatic disease live longer. However, it comes with a number of side effects, including hair loss, nausea, vomiting, mouth sores, and infections. These symptoms typically go away once chemotherapy is finished.

Targeted Therapy

Targeted therapies attack specific genetic changes in cancer cells. These therapies may be used in people with certain genetic mutations after they try hormone therapy. For example, PARP inhibitors may be used in men whose tumors have certain DNA repair gene mutations, such as BRCA1 or BRCA2.

Immunotherapy

Immunotherapy helps the immune system recognize and attack cancer cells. Immunotherapy options may be used in specific cases of advanced prostate cancer, especially when hormone therapy stops working.

Radiation Therapy

One way to treat tumors in a specific area, such as the prostate or a bone, is targeted radiation to kill cancer cells. External beam radiation therapy, which sends radiation from outside of the body at a tumor, can shrink prostate tumors without causing full-body side effects.

Radiation treatments may be used in combination with other approaches, like hormone therapy. While it doesn’t cure prostate cancer, it can help manage cancer symptoms.

Alpha Emitter Radiation Therapy

Another type of radiation therapy, called alpha emitter radiation therapy, is delivered via an intravenous (IV) line. This therapy injects special radioactive substances to destroy cancer cells in people with metastatic prostate cancer.

Palliative Care and Supportive Treatment

Palliative care focuses on relieving symptoms and side effects, not on curing cancer. It can be given at any stage of prostate cancer and alongside active treatment. One type of palliative surgery is transurethral resection of the prostate (TURP). This removes extra tissue from the prostate to relieve some urinary symptoms caused by the tumor.

Palliative care may address pain, fatigue, emotional distress, and other quality-of-life concerns.

Clinical Trials

Clinical trials for cancer research continue developing new treatments to help improve survival. If you’re interested in finding out more about clinical trials, talk to your cancer care team.

Stage 4 Prostate Cancer Prognosis

Stage 4 prostate cancer usually can’t be cured. However, with modern treatments, many people with metastatic prostate cancer can control their symptoms and improve their quality of life for many years.

Five-year survival rates estimate how many people living with a disease are still alive five years after their diagnosis. They’re based on data from past metastatic prostate cancer cases. Recent research estimates that about 38 percent of people will still be alive five years after being diagnosed with stage 4 prostate cancer.

Five-year survival rates reflect data, but they can’t predict what will happen for any individual person. Several factors can affect your prognosis at stage 4, including your:

• Response to hormonal therapy and other treatments
• Prostate-specific antigen (PSA) level at diagnosis
• Cancer grade (how abnormal the cells look under a microscope)
• Degree of cancer spread to other areas of the body
• Overall health and age at diagnosis
• Access to ongoing treatment and support

Living With Stage 4 Prostate Cancer

Many individuals diagnosed with stage 4 prostate cancer benefit from building a care team that includes oncologists, urologists, pain specialists, and palliative care providers.

Support from loved ones and meeting others who understand life with prostate cancer can also make a meaningful difference. Consider joining a prostate cancer support group, whether it’s in person or online, like MyProstateCancerTeam. Staying informed, asking questions, and discussing goals of care with your healthcare team can help you feel your best as you navigate this diagnosis.

Join the Conversation

On MyProstateCancerTeam, people share their experiences with prostate cancer, get advice, and find support from others who understand.

What tips do you have for others with a stage 4 prostate cancer diagnosis? Let others know in a comment below.