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This topic is about prostate cancer that has spread or come back after treatment. For information on prostate cancer that has not spread outside the prostate (localized prostate cancer), see the topic Prostate Cancer.
Prostate cancer is a group of cells that grows faster than normal in a man's prostate gland. It can spread into other areas and kill normal tissue.
The prostate gland sits just below a man's bladder. It makes part of the fluid for semen. In young men, the prostate is about the size of a walnut. It usually grows larger as you grow older.
The cancer may be one of these types:
Experts don't know what causes prostate cancer. But they believe that getting older and having a family history of prostate cancer raise your chance of getting it.
Sometimes there are no symptoms of either locally advanced or metastatic prostate cancer.
When they do appear, symptoms of locally advanced prostate cancer include:
Symptoms of metastatic prostate cancer may include:
A blood test called a prostate-specific antigen (PSA) test is the most common way to check for prostate cancer. A higher level of PSA may mean that you have prostate cancer or that your prostate cancer has come back.
Your doctor also may do a biopsy. In this test, your doctor takes samples of tissue from your prostate gland or from the area where the cancer may have spread and sends the samples to a lab for testing. A biopsy is the only way to know for sure that you have prostate cancer.
If you have had prostate cancer before, your doctor may also order a bone scan, CT scan, or MRI to see if it has come back or spread.
Learning that you have cancer that has spread or come back can be very hard. Some people find that it helps to talk about their feelings with their family and friends. You may also want to talk with your doctor or with other people who have had this kind of cancer. Your local Canadian Cancer Society chapter can help you find a support group.
Your treatment choices depend on your overall health, how fast the cancer is growing, and how far it has spread.
Locally advanced prostate cancer may be treated with surgery, radiation therapy, hormone therapy, or a combination of these.
Treatment of metastatic cancer focuses on slowing the spread of the cancer and relieving symptoms, such as bone pain. It also can help you feel better and live longer. Treatment may include hormone therapy, radiation therapy, chemotherapy, or immunotherapy.
Men over age 80 or those with other serious health problems may decide not to have treatment except for what is needed to treat any symptoms (watchful waiting).
Health Tools help you make wise health decisions or take action to improve your health.
The exact cause of prostate cancer is not known, but experts believe your age and family history may have something to do with your chances of getting the disease. Prostate cancer is very common and is an older man's disease. Most men who get it are older than 65.
Prostate cancer may not cause noticeable symptoms. Possible symptoms of locally advanced prostate cancer are:
These symptoms also may be caused by:
Symptoms that may mean the cancer has spread to other parts of the body, or metastasized, include:
Prostate cancer is a common cancer affecting older men. About 21,000 men are diagnosed with prostate cancer in Canada every year.footnote 1 In the United States, about 12 out of 100 men will be diagnosed with prostate cancer sometime during their lifetime.footnote 1 But most men who are diagnosed with prostate cancer don't die from prostate cancer.
When prostate cancer grows large enough, it begins to fill the prostate and often can be felt by your doctor during a digital rectal examination. As it continues to grow, it breaks through the outer rim of the prostate and into nearby tissues, such as the seminal vesicles. At this point, the disease is called locally advanced prostate cancer.
Locally advanced prostate cancer is usually not curable. But there are treatments that can help you live longer and feel better.
After the cancer has broken through the prostate, it may move into nearby lymph nodes. From the lymph node system, the cancer can spread to other areas of the body. Most often, prostate cancer spreads to the bones. It also may spread to the lungs or other organs. When it has spread to the lymph nodes, the disease is called metastatic prostate cancer.
Metastatic prostate cancer is not curable. But a number of treatments are available that may help you live longer and make you feel better.
A risk is anything that makes you more likely to get a particular disease. Being older than 50 is the main risk for prostate cancer. About 6 out of 10 new prostate cancers are diagnosed in men who are 65 and older.footnote 3
Your chances of getting the disease are higher if other men in your family have had it. Your risk is doubled if your father or brother developed prostate cancer. Your risk also depends on the age at which your relative was diagnosed. Most men who get prostate cancer have no family history of the disease.
Men of African descent have a greater chance of developing the kind of prostate cancer that grows and spreads. Researchers are not sure why there is a difference in disease and death rates among different races. Some experts think there may be a genetic link.footnote 4
Be sure to follow your doctor's instructions about calling when you have problems, new symptoms, or symptoms that get worse.
Call your doctor now if you:
Call your doctor to schedule an appointment if you have unexplained:
Watchful waiting is a wait-and-see approach. If you are older and have other serious health problems, you may choose only those treatments that keep you comfortable (palliative care).
Locally advanced and metastatic prostate cancer are diagnosed through physical examinations and tests, including:
If you have had prostate cancer before, one or more tests will help your doctor see if your cancer has come back or spread. These may include:
If you have been treated for prostate cancer in the past, you've probably been having regular checkups that include PSA tests to check for any signs that the cancer has come back or has spread to other parts of your body. Your doctor will watch for any increases in your PSA level and the speed with which any increases occur. A higher PSA does not necessarily mean your cancer has come back. But it may mean that you need further tests, such as a prostate biopsy, bone scan, CT scan, or MRI.
Your treatment options for prostate cancer that has spread will depend on:
Treatment for locally advanced or metastatic prostate cancer may include hormone therapy, surgery, radiation therapy, chemotherapy, or immunotherapy.
You may want to talk with your doctor about entering a clinical trial of new cancer treatment options.
Prostate cancer that has spread to tissue around the prostate may be treated with radiation therapy, surgery, or hormone therapy. Sometimes two of these treatments are combined.
Radiation therapy uses high-energy X-rays or protons to destroy the cancer. This treatment has improved with newer technologies, so there are fewer side effects and complications than in the past. Radiation therapy usually is combined with hormone therapy.
External beam radiotherapy, or EBRT, uses high-energy rays, such as X-rays, to destroy the cancer. It is usually given in multiple doses over several weeks. Radiation destroys tissue, so it may damage the nerves along the side of the prostate that affect your ability to have an erection. If you already have bowel problems, external radiation may cause your symptoms to get worse.
Two common forms of external radiation are:
The two most common surgeries are:
In some cases, men will have radiation therapy after a prostatectomy, especially if the tumour could not be completely removed by surgery.
Hormone therapy is also called androgen deprivation therapy (ADT). Prostate cancer needs male hormones (testosterone) in order to survive. Hormone therapy decreases the amount of testosterone and other male hormones in your body. This often causes tumours to shrink.
Hormone therapy usually works well at first to stop cancer growth. But in most cases, the cancer begins to grow again within a few years. At this point, the cancer is described as hormone-resistant, meaning it is not responding to standard hormone therapy. When this happens, other kinds of hormone treatments may be tried.
When hormone treatments no longer keep the cancer from growing, the cancer is called castration-resistant prostate cancer (CRPC). Treatments that may be used to help men live longer include chemotherapy, immunotherapy, and medicines like enzalutamide.
Sometimes after surgery or radiation therapy to treat prostate cancer, a man's PSA will start rising even though he has no symptoms and there are no signs that the cancer has spread to another part of his body (metastasized). This is called non-metastatic castration-resistant prostate cancer (nmCRPC). Men with nmCRPC who are already on hormone therapy may also be treated with medicines such as apalutamide, enzalutamide, or abiraterone with prednisone.
Some men choose to start hormone therapy only after they have symptoms. But many doctors recommend starting hormone therapy right away if cancer is found in the lymph nodes during surgery to remove the prostate. Early treatment may allow men to live a little longer. Other doctors say to wait, because waiting delays the bothersome and serious side effects of hormone therapy.
Treatment for prostate cancer that has spread to the bones and/or other organs in the body is aimed at relieving symptoms and slowing the cancer's growth. Treatment may include:
Pain is one of the main concerns of people who have metastatic cancer. But cancer pain can almost always be controlled. You and your doctor have several options to help your pain, including pain-relieving medicines and radiation, such as external beam radiation therapy and bone-targeted radioisotopes.
You can find more information about treating prostate cancer online at the:
Hospice palliative care is a kind of medical care for people who have serious and chronic illnesses. It is different from trying to cure your illness. Hospice palliative care focuses on improving your quality of life—not just in your body but also in your mind and spirit. Some people combine hospice palliative care with curative care.
With prostate cancer, hospice palliative care may involve treatments to reduce tumours or bone pain, such as chemotherapy, radiation therapy, radionuclides (medicine used in external radiation) for bone metastasis, and bisphosphonates, which slow the breakdown of bone and help relieve bone pain. Surgery to relieve bladder problems (transurethral resection of the prostate, or TURP) is also an option.
For some people who have advanced cancer, a time comes when treatment to cure cancer no longer seems like a good choice. This can be because the side effects, time, and costs of treatment are greater than the promise of cure or relief. But this isn't the end of treatment. Hospice palliative care providers will work to help manage pain and other symptoms or side effects. They may help you decide what treatment you want or don't want. And they can help your loved ones understand how to support you.
If you are interested in hospice palliative care, talk to your doctor. He or she may be able to manage your care or refer you to a doctor who specializes in this type of care.
For more information, see the topic Hospice Palliative Care.
You may wish to discuss health care and other legal issues that arise near the end of life with your family and your doctor. You may find it helpful and comforting to state your health care choices in writing—with an advance care plan—while you are still able to make and communicate these decisions.
You may want to choose a substitute decision-maker to make and carry out decisions about your care if you should become unable to speak for yourself. Be sure to share your wishes with your family or close friends. If you have not made an advance care plan, talk to your doctor. He or she can help you get the right forms for your province or territory. You may also find these forms in a doctor's office, hospital, or your local health unit.
For more information, see the topic Care at the End of Life.
Prostate cancer can't be prevented. But there are steps you can take to reduce your risk for this disease. For more information, see the topic Prostate Cancer.
During medical care for any stage of prostate cancer, there are things you can do at home to help manage symptoms of prostate cancer or side effects of treatment:
During medical treatment for prostate cancer, you may experience emotional problems. See the following tips for managing:
Having cancer can change your life in many ways. For help with managing these changes, see the topic: Getting Support When You Have Cancer.
Medicines may be used to slow the growth of prostate cancer and to relieve your symptoms.
Prostate cancer needs the male hormone testosterone to grow. Hormone therapy uses special drugs to block the production or action of testosterone and may cause the cancer to shrink. This can improve your symptoms. Hormone therapy may be given before or after radiation or surgery to remove the prostate.
Hormone therapy usually works well at first to stop cancer growth. But in most cases the cancer returns in a few years. At this point, the cancer is called hormone-resistant. This means it will no longer get better with hormone therapy. When this happens, other kinds of hormone treatment may work. If the cancer continues to grow, chemotherapy or immunotherapy may be the next choice.
Chemotherapy is the use of drugs to control cancer's growth or relieve pain. Often the drugs are given through a needle in your vein, and your blood vessels carry the drugs through your body. Sometimes the drugs are available as pills you can swallow. Sometimes they are given through a shot, or injection.
Chemotherapy usually involves two or more drugs given together. Combinations may work better than a single medicine. That's because each drug can attack the cancer cells in a different way. This is most often used when prostate cancer is hormone-resistant.
Immunotherapy is treatment that uses the body's immune system to destroy the cancer cells. This is used for prostate cancer that is hormone-resistant.
Hormone therapy is commonly used with radiation therapy. It may be used alone with metastatic cancer.
Chemotherapy may be helpful when prostate cancer no longer responds to hormone therapy.
Medicines to treat CRPC include:
Vaccines to keep prostate cancer from coming back after it has been treated are being tested. This type of treatment encourages the body's immune system to destroy cancer cells that remain after prostate cancer surgery. One vaccine, Provenge, was recently approved for use in the United States. It is not currently available in Canada.
Pain-relief and appetite-stimulant drugs may be used when prostate cancer has spread to other parts of the body.
Pain medicines are made that specifically treat mild, moderate, and severe pain, as well as different types of pain such as burning and tingling. To learn more, see:
For more information, see the topic Cancer Pain.
Hormone therapy can cause loss of sexual desire, hot flashes, enlarged and painful breasts, and erection problems.
Antiandrogen hormone therapy also may cause diarrhea, breast tenderness, and nausea. Cases of liver problems, some serious, have been reported.
Hormone therapy can also affect the bones, making them thin and brittle and more likely to break. Medicines such as bisphosphonates and denosumab may help prevent bone loss during long-term hormone therapy.
Surgery to treat prostate cancer is usually reserved for men in good health who are younger than 70 and who choose to have surgery. Surgery may be done to relieve symptoms and to slow the growth of cancer.
Surgical removal of the testicles (orchiectomy) and hormone therapy medicines have some of the same side effects, including hot flashes, larger breasts, loss of sexual desire, and the inability to have an erection.
Radiation therapy for prostate cancer may be used alone or combined with hormone treatment. Radiation therapy also is used to relieve pain from metastatic cancer or cancer that comes back after surgery.
Radiation therapy for locally advanced prostate cancer is often combined with hormone treatment. Using both together may improve your chances of being disease-free for longer and living longer.footnote 5
External-beam radiation therapy uses a large machine to aim a beam of radiation at your tumour to destroy cancer cells. The radiation damages the genetic material of the cells so that they can't grow. Although radiation damages normal cells as well as cancer cells, the normal cells can repair themselves and function, while the cancer cells cannot. If cancer has spread to your bones, radiation treatment may be given to specific areas to relieve pain.
People sometimes use complementary therapies along with medical treatment to help relieve symptoms and side effects of cancer treatments. Some of the complementary therapies that may be helpful include:
Mind-body treatments like those mentioned above may help you feel better and cope better with treatment. These treatments also may reduce chronic low back pain, joint pain, headaches, and pain from cancer treatments.
Before you try a complementary therapy, talk to your doctor about the possible value and potential side effects. Let your doctor know if you are already using any such therapies. Complementary therapies are not meant to take the place of standard medical treatment, but they may improve your quality of life and help you deal with the stress and side effects of cancer treatment.
You may be interested in taking part in research studies called clinical trials. Clinical trials are designed to find better ways to treat prostate cancer patients and are based on the most up-to-date information. People who do not want standard treatments or are not cured by standard treatments may want to take part in clinical trials.
Check with your doctor to see whether clinical trials are in your area and whether you might be eligible.
CitationsNational Cancer Institute (2017). SEER cancer stat facts: Prostate cancer. National Cancer Institute. www.seer.cancer.gov/statfacts/html/prost.html. Accessed July 10, 2017. Canadian Cancer Society's Advisory Committee on Cancer Statistics (2017). Canadian Cancer Statistics 2017. Toronto, ON: Canadian Cancer Society. Available online: http://www.cancer.ca/~/media/cancer.ca/CW/cancer%20information/cancer%20101/Canadian%20cancer%20statistics/Canadian-Cancer-Statistics-2017-EN.pdf?la=en. American Cancer Society (2012). Cancer Facts and Figures 2012. Atlanta: American Cancer Society. Available online: http://www.cancer.org/Research/CancerFactsFigures/CancerFactsFigures/cancer-facts-figures-2012.Robbins C, et al. (2007). Confirmation study of prostate cancer risk variants at 8q24 in African Americans identifies a novel risk locus. Genome Research, 17(12): 1717–1722.National Cancer Institute (2012). Prostate Cancer Treatment (PDQ)—Health Professional Version. Available online: http://www.cancer.gov/cancertopics/pdq/treatment/prostate/HealthProfessional.Other Works ConsultedLeBlanc TW, Abernethy AP (2015). Management of cancer pain. In VT DeVita Jr et al., eds., DeVita, Hellman, and Rosenberg's Cancer Principles and Practices of Oncology, 10th ed., pp. 2084–2104. Philadelphia: Walters Kluwer.Loblaw DA, et al. (2007). Initial hormonal management of androgen-sensitive metastatic, recurrent, or progressive prostate cancer: 2007 update of an American Society of Clinical Oncology practice guideline. Journal of Clinical Oncology, 25(12): 1596–1605.National Cancer Institute (2011). Prostate Cancer Treatment (PDQ)—Patient Version. Available online: http://www.cancer.gov/cancertopics/pdq/treatment/prostate/patient.National Comprehensive Cancer Network (2012). Prostate cancer. NCCN Clinical Practice Guidelines in Oncology, version 2.2012. Available online: http://www.nccn.org/professionals/physician_gls/f_guidelines.asp.Nelson JB (2012). Hormone therapy for prostate cancer. In AJ Wein et al., eds., Campbell-Walsh Urology, 10th ed., vol. 3, pp. 2934–2953. Philadelphia: Saunders.Rosenberg JE, Kantoff PW (2011). Prostate cancer. In EG Nabel, ed., ACP Medicine, section 12, chap. 9. Hamilton, ON: BC Decker.
Adaptation Date: 2/28/2022
Adapted By: Alberta Health Services
Adaptation Reviewed By: Alberta Health Services
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