Advanced prostate cancer is cancer that has spread outside the prostate to other parts of the body, such as the bones. You might hear cancer that has spread called metastatic or secondary prostate cancer, metastases, mets or secondaries. It is still prostate cancer, wherever it is in the body.

It's not possible to cure advanced prostate cancer, but treatments can keep it under control, sometimes for several years.

If the cancer starts to grow again and cause symptoms, there are treatments available to help manage them.

This information is for men who have symptoms.

Where does prostate cancer spread to?

Prostate cancer most commonly spreads to the bones and lymph nodes. It can also spread to, or press on, the tube that carries urine through the penis (the urethra), the bladder, the tubes that carry urine from the kidneys to the bladder (ureters) and part of the bowel (rectum).

Where Pc Might Spread

 More rarely, prostate cancer may spread to other parts of the body including the lungs and liver. Macmillan Cancer Support has more information about this.

What is my outlook?

Many men want to know how successful their treatment is likely to be in controlling their cancer. This is sometimes called your outlook or prognosis.

No one can tell you exactly what your outlook will be, as every cancer is different and will affect each man differently. And not everyone wants to know about their outlook. But some men find it helpful to discuss their outlook so they can make plans for the future.

Not all men with advanced prostate cancer will die from their cancer. Hormone therapy can keep it under control, sometimes for several years. And when hormone therapy stops working, there are other treatments available to keep the cancer under control for longer.

It can be very difficult living with the uncertainty of cancer, but there is support available if you need it. This includes help to manage symptoms, and emotional and practical support.

What is palliative care?

You may hear the term palliative care. Palliative care aims to manage pain and other symptoms. It also aims to provide emotional, physical, practical and spiritual support. 

Palliative care can be provided at any stage of advanced prostate cancer and isn't just for men in the final stages of life. Men with advanced prostate cancer might have palliative care for many months or years.

What symptoms might I get?

The symptoms you have will depend on where the cancer has spread to. You might get only a few symptoms, but the cancer may spread further over time, causing more symptoms. This doesn't always happen and not all cancer that has spread will cause symptoms that affect you day to day. There are treatments available to help manage your symptoms.

You might also get side effects from the treatments you are having or from treatments you have had in the past.

You may have the following symptoms:

  • Fatigue (extreme tiredness)
  • Pain
  • Urinary problems
  • Bowel problems
  • Broken bones (fractures)
  • Sexual problems
  • Lymphoedema
  • Anaemia
  • Metastatic spinal cord compression
  • Hypercalcaemia
  • Eating problems

Fatigue (extreme tiredness)

Fatigue is a range of feelings from tiredness to exhaustion, which makes it hard to carry out your daily activities. It can affect your energy levels, motivation, ability to concentrate, emotions and sex drive. Fatigue isn't always relieved by rest alone and many men find it difficult to cope with.

Fatigue might be caused by the cancer itself, by treatments, or by other conditions such as anaemia, anxiety and depression. 

What can help?
Let your doctor or nurse know if you're feeling very tired. They can look into what's causing it and look for ways to help.

There are things you can do to help manage fatigue.

  • Plan your day. Do important things first and make time for rest.
  • Stay active. Gentle physical activity such as walking or swimming can help reduce tiredness.
  • Eat well and drink lots of fluids. If you're struggling to eat enough and you're losing weight this can add to your tiredness.
  • Sort out your sleep. Your doctor can give you advice on what could help you sleep and may sometimes prescribe sleeping pills.
  • Get support. Feeling low or anxious can make you feel tired.
  • Try complementary therapies. Acupuncture, massage, yoga or meditation may help with tiredness.

Some of these changes may be difficult to make, so take things gradually. 

Our Fatigue support service can help you find ways to manage fatigue. Speak to our Specialist Nurses to find out more.

Pain

Pain is a common problem for men with advanced prostate cancer, but not all men will have pain. The cancer can cause pain in the areas that it has spread to, for example the bones. And if cancer has spread to several places, you may only have pain in a few of these areas.

The most common cause is cancer that has spread to the bones. Bone pain is a very specific feeling. Some men describe it as feeling similar to a toothache but in the bones, or like a dull aching or stabbing.

You might get other types of pain. For example, if the cancer presses on a nerve, you might feel shooting, stabbing, burning, tingling or numbness.

Pain can also be a symptom of a more serious condition called metastatic spinal cord compression

What can help?
With the right treatment, cancer pain can usually be managed. You shouldn't have to accept pain as a normal part of having cancer. If you have pain, speak to your doctor or nurse. Th earlier pain is treated, the easier it will be to control.

Treatments to control pain include:

  • treatment for the cancer itself, such as hormone therapy, chemotherapy or steroids
  • treatment for the pain, such as pain-relieving drugs, radiotherapy or bisphosphonates
  • complementary therapies such as acupuncture, aromatherapy, and gentle massage - many men find they can help feel them more relaxed and deal with cancer pain.

Urinary problems

You might get urinary problems if the cancer has spread to areas around the prostate, urethra and bladder. These might include:

  • problems emptying your bladder
  • leaking urine
  • blood in your urine
  • kidney problems. 

Urinary problems can also be caused by other things such as an infection, an enlarged prostate, or prostate cancer treatments. If you have urinary problems, speak to your doctor or nurse. There are lots of things that can help. 

Problems emptying your bladder
If the cancer is pressing on the urethra it might cause problems emptying your bladder fully. This is called urinary retention. Treatments include:

  • a catheter to drain the urine from the bladder
  • drugs called alpha-blockers to relax the muscles around the opening of the bladder, making it easier to urinate
  • an operation called a transurethral resection of the prostate (TURP) - this may not be suitable for all men. 

Acute urine retention
This is when you suddenly and painfully can't urinate - it needs treating straight away. Acute retention isn't very common in men with advanced prostate cancer, but if it happens, call your doctor or go to your nearest accident and emergency (A&E) department. They may need to drain your bladder using a catheter.

Problems leaking urine
Cancer can grow into the bladder and the muscles that control urination. This can make them weaker and could mean you leak urine or need to urinate urgently.

Ways to manage leaking urine include:

Your treatment options will depend on how much urine you’re leaking. If you find you need to rush to the toilet a lot and sometimes leak before you get there, finding out where toilets are before you go out may help you feel more in control of the situation. Get an ‘urgent’ card to show staff in shops, restaurants and other public places.

Blood in your urine
Some men notice blood in their urine. This may be caused by bleeding from the prostate. It can be alarming, but can usually be controlled.

You might need to stop taking medicines that stop the blood clotting, such as aspirin or warfarin. But speak to your doctor or nurse before you stop taking any drugs. You might also be able to have radiotherapy to stop the bleeding.

Kidney problems
The kidneys remove waste products from your blood and produce urine. Prostate cancer may block the tubes that carry the urine from the kidneys into the bladder (the ureters). This can cause problems with how well your kidneys work.

Kidney problems can lead to high levels of waste products in your blood. This can cause a serious condition called kidney failure.

Symptoms of severe kidney problems include tiredness and lack of energy, feeling sick, swollen ankles and feet, and poor appetite. If you have any of these symptoms tell your doctor or nurse.

A simple blood test can check how well your kidneys are working.

Treatments that can help to drain the urine from the kidneys include:

  • a tube put into the kidney to drain urine into a bag outside your body (nephrostomy)
  • a tube (called a stent) put inside the ureters to allow urine to flow from the kidney to the bladder
  • radiotherapy to shrink the cancer and reduce the blockage.

Information and support
Urinary problems might affect how you feel about yourself and your sense of independence. If you are finding it hard to deal with, speak to your doctor or nurse for help and advice.

Your GP can put you in touch with your local NHS continence service. This is run by specialist nurses and physiotherapists. They can give you advice and support about treatments and products that can help.

The Bladder and Bowel Foundation provides information, including details of your local NHS continence service. Visit continenceproductadvisor.org for information about incontinence products.

Bowel problems

Bowel problems can include:

  • passing loose and watery stools (diarrhoea)
  • needing to rush to the toilet (rectal urgency)
  • leaking stools (faecal incontinence)
  • difficulty emptying your bowels (constipation)
  • pain around the stomach area or back passage. 

Speak to your doctor or nurse if you have any of these symptoms. There are treatments available that may help.

Men with advanced prostate cancer might get bowel problems for a variety of reasons, including:

  • radiotherapy to treat the cancer
  • pain-relieving drugs such as morphine and codeine
  • becoming less mobile, changes in your diet or not drinking enough. 

You may also get bowel problems if prostate cancer spreads to part of the bowel (rectum), but this isn’t common. If it happens, it can cause symptoms including constipation, pain and bleeding. Radiotherapy can help with the pain and bleeding. 

Rarely, problems emptying your bowels or having no control over emptying them might be caused by metastatic spinal cord compression

What can help?
Lifestyle changes
If you are having problems with constipation, a diet with plenty of high fibre foods can help. These include fruit and vegetables, wholemeal bread, wholegrain breakfast cereals and porridge. Drink lots of fluids – aim for about two litres (eight glasses) a day. Gentle exercise such as going for a walk can also help.

Depending on the cause of your constipation, your GP or nurse may prescribe laxatives to help you empty your bowels.

If you are having problems with diarrhoea, cutting down on fibre in your diet for a short time may help. Low fibre foods include white rice, pasta and bread, potatoes (without the skins), cornmeal, eggs and lean white meat. Drink plenty of fluids, but avoid alcohol, coffee and fizzy drinks. Avoiding spicy food and reducing the amount of dairy products, such as milk and cheese, may also help.

Information and support
Living with bowel problems can be distressing and, for a lot of men, it’s not an easy thing to talk about. But remember, doctors and nurses are used to discussing these problems and finding ways to deal with it. You could also ask your GP to refer you to your local continence service. Their specialist nurses can give you further advice and support on products that can help.

Macmillan Cancer Support and the Bladder and Bowel Foundation have more information about coping with bowel problems.

Broken bones (fractures)

The most common place for prostate cancer to spread to is the bones. The cancer can damage bones, making them weaker and increasing your risk of broken bones (fractures). Some types of hormone therapy can also make your bones weaker and can lead to a condition called osteoporosis, which can increase your risk of broken fractures. 

Damage to the bones can make it difficult or painful to move around. If you’re used to being active, this can be hard to accept.

What can help?
You might be given radiotherapy to slow down the growth of the cancer. This can help control damage to the bones and bone pain.

Your doctor may give you drugs called bisphosphonates to help treat bone pain. Sometimes they are also used to help manage bone thinning.

If there is an area of bone that has been badly damaged, surgery might help to strengthen it. A metal pin or plate is put inside the bone. Surgery isn’t suitable for all men with advanced prostate cancer. This will depend on where the damaged bone is, and other things such as whether you are well enough for surgery. If you have an operation, you may have radiotherapy afterwards to help stop the cancer growing in that area.

The National Osteoporosis Society provides more information and support about fragile bones. 

 

Sexual problems

Coping with advanced prostate cancer and living with the side effects of treatment can have an impact on your sex life. Treatments for prostate cancer such as surgery and radiotherapy can affect your ability to get an erection. All types of hormone therapy can reduce your desire for sex (libido).

Because getting an erection also relies on your thoughts and feelings, feeling low, anxious or tired can also affect your sex life. You might lose interest in sex or not have enough energy for it.

What can help?
You can get treatment and support for sexual problems. Speak to your GP, nurse or hospital doctor to find out more. They can offer you treatment or refer you to a specialist service.

You can get free medical treatment for erection problems or other sexual problems on the NHS. Some of these may help, even if your sex drive is reduced. Tackling any worries or relationship issues as well as having medical treatment for erection problems often works well.

Even though your sex life might not be the same as it was before cancer, you don’t have to give up on having pleasure, closeness or fun. It’s often helpful to explore other ways of having an intimate relationship, without having penetrative sex. Sometimes just holding hands or cuddling can be enough.

If you have a catheter, it is still possible to have sex. Speak to your nurse about this. The Bladder and Bowel Foundation have information about having sex if you have urinary problems.

If you are in a relationship you may need to have time alone together, whatever your situation. If you are in a hospital, hospice or have carers coming to your house, make sure they know when you need some private time together.

Lymphoedema

If the cancer spreads to the lymph nodes it could lead to a condition called lymphoedema – caused by a blockage in the lymphatic system. The lymphatic system is part of your body’s immune system, carrying fluid called lymph, around your body. If it is blocked, the fluid can build up and cause swelling (lymphoedema). Cancer itself can cause the blockage, but so can some treatments such as surgery or radiotherapy.

Lymphoedema in prostate cancer usually affects the legs, but it can affect other areas, including the penis or scrotum (which contains the testicles). Symptoms in the affected area can include:

  • swelling
  • pain, discomfort or heaviness
  • inflammation, redness or infection
  • tight, sore skin.

Lymphoedema can affect your daily life. You might find that you are less able to move around and it’s harder to carry out everyday tasks. Some men find it knocks their confidence.

What can help?
Speak to your nurse or GP if you have any symptoms. There are treatments that can help to manage them. Treatments aim to reduce or stop the swelling and make you more comfortable and they are most effective if started when symptoms first start. If you have lymphoedema, you may be referred to a specialist lymphoedema nurse. They can show you how to manage the swelling and are often based in hospices.

There are a variety of treatments which might help.

  • Caring for the skin, such as regular cleaning and moisturising. It can help to keep your skin soft and reduce the chance of it becoming cracked and infected.
  • Special massage (manual lymphatic drainage) can help to increase the flow of lymph. Your nurse might be able to show you or your partner how to do this.
  • Gentle exercise may help to improve the flow of lymph from the affected area of the body. For example, doing simple leg movements, similar to those recommended for long aeroplane journeys, may help with leg lymphoedema.
  • Using compression bandages or stockings can help to encourage the lymph to drain from the affected area. Your nurse will show you how to use them.
  • Wearing supportive underwear may help control any swelling in your penis or scrotum. Lycra cycling shorts might also help in a similar way.

Try to maintain a healthy weight as being overweight can make lymphoedema harder to manage.

Information and support
Living with lymphoedema can be difficult. If you need more support, speak to your specialist nurse or GP. They can provide practical and emotional support. Your GP can also refer you to a counsellor to help you deal with how you’re feeling.

Macmillan Cancer Support and the Lymphoedema Support Network provide more information and can put you in touch with local support groups.

Anaemia

Some men with advanced prostate cancer may develop anaemia. This is when your blood can’t carry enough oxygen to meet your body’s needs. Symptoms include feeling tired or weak, out of breath and looking pale.

Anaemia occurs when your blood has fewer red blood cells than usual. Red blood cells carry oxygen around the body and are made by the bone marrow. Anaemia can happen when your bone marrow is damaged – either by the prostate cancer or by treatment such as chemotherapy or radiotherapy.

Sometimes anaemia is caused by a lack of iron in your diet. You might be more at risk of this if you have problems eating. 

What can help?
Speak to your doctor or nurse if you have symptoms of anaemia. You will have a blood test to check your red blood cell levels. The right treatment will depend on what’s causing your anaemia. 

If the anaemia is caused by the cancer, treating the cancer can sometimes help.

If you have very low levels of red blood cells, you may need to have a blood transfusion. This can be a quick and effective way of treating anaemia. 

Your doctor may recommend you take iron supplements to help with anaemia. These can cause constipation.

Macmillan Cancer Support and Cancer Research UK provide more information about anaemia.

Metastatic spinal cord compression (MSCC)

Prostate cancer can spread to the bones of the spine. This can lead to a condition called metastatic spinal cord compression (MSCC). This happens when the cancer presses on the spinal cord. This can cause problems with how the nerves in the spinal cord carry messages to the rest of the body. This can cause a range of symptoms which can get worse if left untreated. For example, it can make you less able to walk and move around.

MSCC isn’t common but you need to be aware of it if you have prostate cancer that has spread to the bones. Speak to your doctor or nurse for more information about your risk.

MSCC can cause any of the following symptoms.

  • Pain or soreness in your lower, middle or upper back or neck which is severe or different from usual pain. The pain might get worse when you cough, sneeze, lift or strain, or go to the toilet. It might get worse when you are lying down and it might wake you at night or stop you from sleeping.
  • A narrow band of pain around your stomach area or chest which can move towards your lower back, buttocks or legs.
  • Pain that moves down your arms or legs.
  • Weakness in your arms or legs, or difficulty standing or walking. You may feel unsteady on your feet or feel like your legs are giving way. Some people say they feel clumsy.
  • Numbness or pins and needles in your legs, arms, fingers, toes, buttocks, stomach area or chest, that doesn't go away.
  • Problems controlling your bladder or bowel. You might be unable to empty your bladder or bowel, or you might have no control over emptying them.

Don't wait - get it checked out

These symptoms can also be caused by other conditions. But it’s very important to get medical advice straight away.

Don’t wait to see if it gets better and don’t worry if it’s an inconvenient time, such as the evening or weekend. It’s very important you have treatment as soon as possible. At its worst, MSCC can cause paralysis. Getting treatment straight away can lower the risk of this happening or it being permanent.

Contact your doctor or nurse, or if you can’t reach them, go to your nearest accident and emergency (A&E) department.

Hypercalcaemia

Hypercalcaemia is a high level of calcium in your blood. Calcium is usually stored in the bones, but the cancer can cause calcium to leak into the blood. This isn't common in men with advanced prostate cancer. Bit if it happens, it's important that it's treated so it doesn't develop into a more serious condition. 

Symptoms of hypercalcaemia include:

  • tiredness and lack of energy
  • loss of appetite and weakness
  • difficulty emptying your bowels (constipation)
  • confusion
  • feeling and being sick (nausea and vomiting)
  • pain in your stomach area
  • thirst
  • needing to urinate often (frequency).

These symptoms can be quite common in men with advanced prostate cancer and might not be caused by hypercalcaemia. Tell your doctor or nurse if you have any of these symptoms so that they can find the cause. They will do a blood test to check levels of calcium in your blood. They may also do other tests and ask you about your symptoms.

What can help?
If you have hypercalcaemia, you may go into hospital or a hospice for a couple of days. You will be given fluid through a drip in your arm. This will help to flush calcium out of your blood and bring your calcium levels down. 

Drugs called bisphosphonates are the main treatment for hypercalcaemia. They are very effective at lowering the calcium in your blood. They will usually start to work in two to four days. If your blood calcium levels are still high, you may be given a another dose of the drug after a week.

Once your calcium levels are back to normal, you will have regular blood tests to keep an eye on them. Tell your doctor or nurse if your symptoms come back.

As your cancer becomes more advanced, you may get hypercalcaemia more often, and treatment may not work as well. Your doctors should control any symptoms you have.   

Cancer Research UK provides more information about hypercalcaemia.

Eating problems

Some men with advanced prostate cancer have problems eating, or have a poor appetite. You might feel or be sick because of your cancer or as a side effect of some treatments. These can include pain-relieving drugs, chemotherapyradiotherapy and bisphosphonates. Worrying about things can also affect your appetite. 

Problems eating or loss of appetite can lead to weight loss and can make you feel very tired and weak. 

What can help?
If you feel sick because of your treatment, your doctor can give you anti-sickness drugs. Steroids can also increase your appetite and are sometimes given along with other treatments.

Try to eat small amounts regularly. If the smell of food is putting you off, try to avoid strong smelling foods and if possible, ask someone else to cook your food.

Try to eat when you feel less sick, even if these are not your usual mealtimes. Fatty and fried foods can make sickness worse. Drink plenty of water, but drink slowly and try not to drink too much before you eat. 

Tell your doctor if you are losing weight. They can refer you to a dietitian, who can provide advice about high calorie foods and any supplements that might help. It can be upsetting for your family to see you lose weight, and they may need support to help you with eating.

Macmillan Cancer Support and Marie Curie both provide information and support about eating problems in advanced prostate cancer.

Your health and social care professionals

You might see a range of different professionals to help manage your symptoms and offer emotional and practical support. Some may have been treating you since your diagnosis. Others provide specific services or specialise in palliative care.

Your multidisciplinary team (MDT)
The team of health professionals or specialists involved in your care.Your MDT is likely to include a clinical nurse specialist, oncologist, urologist, radiologist, and a palliative care doctor or nurse. Service vary depending on were you live.

Clinical nurse specialists (CNS)
A nurse who specialises in caring for men with prostate cancer. they may be the health professional you see most. They provide care and offer advice on managing prostate cancer and side effects. They also provide emotional support.

Urologist and oncologist
Aurologist is a surgeon who specialises in conditions affecting the urinary system, including the prostate. An oncologist is a doctor who specialises in cancer treatments other than surgery, such as radiotherapy or chemotherapy. There both treat prostate cancer with hormone therapy and will be in your multi-disciplinary team.

Your GP and district nurse
Your GP and district  or community nurse will work with other health professionals to co-ordinate your care and offer you support and advice. They can also refer you to local services. They can visit you in your home and also help support your family.

Palliative care team
This includes specialist doctors and nurses who provide treatment to manage pain and other symptoms of advanced cancer. They also provide emotional, physical, practical and spiritual support for you and your family. They work in hospitals and hospices, but they might be able to visit you at home. Your hospital doctor, nurse or GP can refer you to a palliative care team.

Hospices
Hospices provide a range of services to men living with advanced prostate cancer and their families. They can provide treatment to manage symptoms as well as emotional, spiritual, psychological and practical support.

Hospices don't just provide care for people at the end of their life. Some people go into a hospice for a short time to get their symptoms under control then go home again. 

Some hospices have nurses who can visit you at home, and some provide day therapy. This means you can use their services while still living at home.

Your GP, doctor or district nurse can refer you to a hospice service. find out more from Hospice UK, Marie Curie and Sue Ryder.

Social Services
There are a range of support services which your local council might be able to provide through its social services department. What's available varies from place to place, but can include practical and financial advice and access to emotional support.

Your GP might be able to refer you to some services, and some may be linked to hospital departments. You can also contact your local social services department yourself. Their telephone number will be in the phone book under the name of your local authority, on their website and at the town hall.

References

Updated: February 2015 | Due for Review: February 2017

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