Prostate cancer, advanced or metastatic

Prostate cancer is the abnormal growth of cells in the prostate gland. The prostate is part of the male reproductive system. Locally advanced prostate cancer means that the cancer has spread beyond the prostate and into nearby tissue. Metastatic prostate cancer means that the cancer has spread, or metastasized, to the lymph nodes or other parts of the body.

Recurrent prostate cancer means that the cancer has come back after it was treated. The cancer can come back in the prostate. Or it can come back near the prostate or in another part of the body. If it comes back in another part of the body—often the bones—it is still called prostate cancer because it started in the prostate.

Sometimes there are no symptoms of locally advanced or metastatic prostate cancer.

When there are symptoms of locally advanced prostate cancer, they may include urinary problems, such as:

• Not being able to urinate at all.
• Having a hard time starting or stopping the flow of urine.
• Having to urinate often, especially at night.
• Having pain or burning during urination.

Less common symptoms of locally advanced prostate cancer may include:

• Difficulty having an erection.
• Blood in your urine or semen.
• Deep and frequent pain in your lower back, belly, hip, or pelvis.

These symptoms also may be caused by an enlarged prostate, an infection in the prostate (prostatitis), or a urinary tract infection.

Symptoms of metastatic prostate cancer may include:

• Weight loss.
• Bone pain.
• Swelling in the legs and feet.

Locally advanced and metastatic prostate cancer are diagnosed through physical exams and tests. These include:

• A digital rectal exam.
• Blood tests, including a PSA test. A rising PSA level after treatment for prostate cancer can mean your cancer has come back.
• Imaging tests, such as:
  • A transrectal ultrasound.
  • An MRI called a multiparametric MRI (mpMRI). It provides detailed information about the prostate.
  • A CT scan or a PET-CT.
  • A bone scan.
• A prostate biopsy.
• Genetic tests. These include tests to look for inherited gene changes and tests that look for biomarkers.

If you've had prostate cancer before, other tests can help your doctor see if your cancer has come back or spread. These tests may include:

• PSA tests to check the PSA levels in your blood.
• Imaging tests, such as a bone scan, CT scan, MRI, and PET-CT.
• Biopsies of lymph nodes, bones, or other tissues where the cancer may have spread.

Treatment for metastatic prostate cancer is based on many things. These include your age and overall health, the location of the cancer, and whether you had treatment before. Options may include:

Hormone therapy.

Hormone therapy may help slow the growth of prostate cancer and shrink the tumor. It's also called androgen deprivation therapy (ADT). If one type of hormone therapy stops working, another type may be tried.

Chemotherapy.

These medicines kill fast-growing cells, including cancer cells and some normal cells.

Radiation therapy.

This uses high-dose X-rays to destroy cancer cells and shrink tumors. It may be used to relieve symptoms such as bone pain.

Other treatment options may include targeted therapy or immunotherapy.

Sometimes these treatments may be combined.

A clinical trial may be a good choice. Some people choose observation.

Your doctor will talk with you about your options and then make a treatment plan.

Having cancer is hard. Focus on taking care of yourself. Taking medicines as prescribed, eating healthy food, and getting enough sleep may help you feel better. Get some physical activity each day if you can, and make time for things you enjoy. Consider joining a support group or talking with a counselor.