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Stage 4 Prostate Cancer
What is stage 4 prostate cancer?
Prostate cancer is one of the most common types of cancer that affects men [1], and it occurs when cells in the prostate gland grow and divide uncontrollably. In the early stages, prostate cancer may not cause any symptoms and is often detected through a routine screening test. However, if prostate cancer is not diagnosed early, it can progress to later stages, where it may cause more significant symptoms and become more challenging to treat.
Prostate cancer is typically staged based on the extent of the disease, and stage 4 prostate cancer is the most advanced and is a last stage cancer. Stage 4 prostate cancer is a term used to describe cancer that has spread beyond the prostate gland and has metastasized to other parts of the body. This is also known as advanced prostate cancer or metastatic prostate cancer. The cancer cells may have spread to nearby lymph nodes, bones, or other organs, such as the lungs or liver.
What are the subtypes of stage 4 prostate cancer?
Prostate cancer can be classified based on the aggressiveness of the cancer cells, which is determined by the Gleason score. The Gleason score is a grading system that helps predict how likely the cancer will spread and how aggressive it may be. The higher the Gleason score, the more aggressive the cancer cells [2].
Metastatic prostate cancer, which has spread to other parts of the body and is classified as stage 4, can also be classified based on the location of the metastases [3]. This includes:
- M1a: The cancer has spread to lymph nodes near the prostate gland.
- M1b: The cancer has spread to bones.
- M1c: The cancer has spread to other organs, such as the lungs, liver, or brain.
Based on the metastases, stage-iv cancer is divided into two main categories:
- Stage 4A cancer
In stage 4A prostate cancer, the cancer has spread to nearby tissues and organs, such as the bladder, rectum, or pelvic wall. The cancer has not yet spread to other body parts, such as bones or lymph nodes.
- Stage 4B cancer
In stage 4B prostate cancer, the cancer has spread beyond the prostate gland and nearby tissues to other body parts, such as bones or lymph nodes.
Stage 4 prostate cancer staging and diagnosis
Prostate cancer staging
The American Joint Committee on Cancer (AJCC) and the Union for International Cancer Control (UICC) categorize cancer into four main stages using the TNM system [4]. The TNM system consists of the following:
- T (tumor) describes the size and location of the tumor and can either be TX (no information), T0 (no evidence), Tis (the pre-cancer stage where cancer is growing in the tissue it was found), and any number between one to four after the T (The higher the number, the bigger the tumor or, the more it has spread).
- N (nodes) indicates whether it has spread to nearby lymph nodes and can either be NX (no information about nearby lymph nodes), N0 (no cancer in nearby lymph nodes), or any number between one to four after N (the higher the number, the bigger the tumor or, the more it has spread to nearby lymph nodes).
- M (metastasis) describes if and how far the cancer has spread from its origin and can either be M0 (the cancer did not spread) or M1) the cancer has spread to distant organs.
How common is stage 4 pancreatic cancer?
According to the Centers for Disease Control and Prevention, 12 out of a hundred American men will get prostate cancer in their lifetime [5]. Moreover, the American Cancer Society estimates that there will be around 288,300 new prostate cancer cases, and the incidence rate of advanced-stage cancer has increased by 5% a year [6].
The Surveillance, Epidemiology, and End Results (SEER) program by the National Cancer Institute reports that prostate cancer makes up 14% of all new cancer cases, with more than 12.6% of men diagnosed with prostate cancer. Moreover, more than 7% of prostate cancer cases were distant (stage iv), meaning the cancer has metastasized to distant organs [7].
How is stage 4 prostate cancer diagnosed?
Prostate cancer may not cause any noticeable symptoms when it is in its early stages. However, as the cancer progresses, symptoms may become more apparent. When the cancer reaches stage 4, it has spread to other body parts, and the prognosis may be more serious [8]. Some of the most common tests to diagnose stage 4 prostate cancer include the following:
- Medical history and physical exam: The first step in diagnosing prostate cancer is a medical history and physical exam. The healthcare provider will ask about any symptoms the patient may be experiencing and any risk factors for prostate cancer, such as age, family history, and race. During the physical exam, the healthcare provider will check for any abnormalities in the prostate gland, such as lumps or swelling [9].
- PSA test: The prostate-specific antigen (PSA) test is a blood test that measures the level of PSA in the blood. PSA is a protein produced by the prostate gland, and elevated levels of PSA can indicate prostate cancer or other prostate conditions [10]. However, PSA levels can also be elevated due to other factors, such as age or an enlarged prostate gland.
- Biopsy: If the PSA test results are elevated or if there are abnormalities in the prostate gland during the physical exam, the next step is usually a biopsy. During a biopsy, a small sample of prostate tissue is removed and examined under a microscope for cancer cells [11].
- Imaging tests: If prostate cancer is diagnosed, imaging tests may be performed to determine the extent of the cancer's spread. Common imaging tests for prostate cancer include bone scans, CT scans, and MRI scans [12] [13] [14].
Stage 4 prostate cancer symptoms
Some of the most common stage 4 cancer symptoms for prostate cancer include [15]:
- Pain: Pain in the bones, especially the spine, hips, and pelvis, is a common symptom of stage 4 prostate cancer. The pain may be persistent or intermittent and may be worse at night.
- Urinary symptoms: Prostate cancer that has spread to the bladder or urethra can cause urinary symptoms, such as difficulty urinating, frequent urination, or a weak stream.
- Bowel symptoms: Prostate cancer that has spread to the rectum or anus can cause bowel symptoms, such as constipation, diarrhea, or rectal bleeding.
- Fatigue: Fatigue or weakness may be a symptom of advanced prostate cancer. The cancer can cause the body to produce fewer red blood cells, leading to anemia.
- Weight loss: Unexplained weight loss or loss of appetite may be a symptom of advanced cancer.
- Swelling: Prostate cancer spreading to the lymph nodes can cause swelling in the legs, groin, or pelvis.
Stage 4 prostate cancer treatment
Stage 4 prostate cancer primary/first-line treatment
The first-line treatment for stage 4 prostate cancer depends on several factors, such as the aggressiveness of the cancer cells, stages of cancer, the extent of the cancer's spread, and the individual's overall health. The primary treatment option for stage 4 prostate cancer is hormone therapy.
Hormone therapy, or androgen deprivation therapy (ADT), is often the first-line treatment for stage 4 prostate cancer. This treatment works by blocking the production or activity of male hormones, such as testosterone, that can stimulate the growth of prostate cancer cells [16]. Hormone therapy can be given through injections, pills, or surgical removal of the testicles [17]. Hormone therapy can often slow the growth of the cancer and relieve symptoms.
Other types of treatment for stage 4 prostate cancer
Treatment for cancer stage 4 can be complex and involve multiple approaches. A patient may choose an alternate therapy type for stage four prostate cancer if the primary treatment does not work or shows unfavorable side effects. Some of the common treatments of cancer stage iv include:
- Palliative Chemotherapy: Chemotherapy is a type of treatment that uses drugs to kill cancer cells throughout the body. Chemotherapy is usually reserved for advanced cancer that has spread to other parts of the body [18]. Chemotherapy can be used alone or in combination with other treatments.
- Radiation therapy: Radiation therapy is a type of local treatment that uses high-energy radiation to kill cancer cells. Palliative Radiation therapy can treat prostate cancer that has spread to nearby tissues or bones [19]. Radiation therapy can also be used to alleviate symptoms such as bone pain.
- Surgery: Surgery to remove the prostate gland, radical prostatectomy, may be an option for some individuals with stage 4 prostate cancer, especially if the cancer has not spread extensively [20]. However, surgery is usually not recommended for advanced prostate cancer that has spread to other parts of the body.
- Immunotherapy: Immunotherapy is a newer type of cancer treatment that harnesses the body's immune system to attack cancer cells. Immunotherapy is still being studied for its effectiveness in treating prostate cancer, but it may be an option for some individuals with advanced prostate cancer [21].
- Clinical trials: Clinical trials are studies that test new treatments or treatment combinations for cancer. Clinical trials can offer individuals with stage 4 prostate cancer access to new and potentially more effective treatments.
Is stage 4 cancer curable?
Unfortunately, stage 4 prostate cancer is not among the curable cancers and is considered a terminal cancer. At this stage, the cancer has spread beyond the prostate gland to other body parts, such as the bones, lymph nodes, or other organs. However, treatment options are available to help manage the cancer and its symptoms, potentially slow its progression, and aid stage 4 cancer pain management. The goal of treatment for stage 4 prostate cancer is to extend the stage 4 cancer life expectancy while also maintaining their quality of life [22].
While stage 4 prostate cancer cannot be cured, it is important to remember that everyone's experience with cancer is different. Some individuals with stage 4 prostate cancer may live for many years with the disease, while the metastatic cancer life expectancy in others may be shorter. The most important thing is to focus on the quality of life and to work closely with healthcare providers to manage the cancer and its symptoms.
Prognosis: Stage 4 prostate cancer survival rate
Prostate stage 4 cancer survival rate
According to the SEER cancer statistics, the overall five-year prostate cancer stage 4 survival rate is around 96.8%. However, the prostate metastatic cancer survival rate is relatively low and averages around 32.3%. Moreover, stage 4 cancer survivors are mostly middle-aged, as 33.3% of prostate cancer deaths occur at ages 75-84, and more than 32% of deaths at over 84 years old [7].
Stage 4 prostate cancer recurrence rate
The recurrence rate for stage 4 prostate cancer can vary depending on multiple factors, such as the aggressiveness of the cancer, the extent of the cancer's spread, and the treatments used. It is important to note that stage 4 prostate cancer is considered advanced and is typically not curable. According to Johns Hopkins Medicine, prostate cancer has a recurrence rate of around 20-30% of men [23] in the first five years after treatment.
Stage 4 prostate cancer growth rate
The growth rate of stage 4 metastatic cancer can be influenced by the grade of the cancer, which indicates how abnormal the cancer cells appear when viewed under a microscope. High-grade cancers grow more quickly than low-grade ones and may be more likely to spread to other body parts. Thus, stage 4 cancer is a relatively fast spreading cancer.
However, each cancer patient is different. Some individuals with stage 4 prostate cancer may have slow-growing cancer that progresses slowly over several years, while others may experience more rapid progression.
Lifestyle changes for preventing and managing stage 4 prostate cancer
While lifestyle changes cannot cure stage 4 prostate cancer, they can help improve an individual's overall health and response to treatment. These changes include [24]:
- Eating a healthy diet
- Maintaining a healthy weight
- Getting regular exercise
- Managing stress
- Quitting smoking
- Limiting alcohol consumption
Conclusion
Takeaway
Stage 4 prostate cancer is an advanced form of the disease that has spread to other body parts and is the final stage of cancer. The prognosis for stage 4 prostate cancer varies depending on various factors, but with appropriate treatment, many men can manage their symptoms and live for several years. If you are experiencing any symptoms of prostate cancer, it is important to speak with your healthcare provider and get screened for the disease.