Advanced (metastatic) prostate cancer is cancer that has spread from the prostate to other parts of the body, most commonly the bones. It's not possible to cure advanced prostate cancer, but hormone therapy and other treatments can keep it under control, sometimes for several years.

Advanced prostate cancer can cause symptoms, but there are treatments available to help manage these. This information is for men who have symptoms.

Where does prostate cancer spread to?

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

Where Pc Might Spread

More rarely, prostate cancer may spread to the lungs, liver and brain. Macmillan Cancer Support has more information about this.

What is palliative care?

You may hear the term palliative care. Palliative care aims to relieve pain and other symptoms.  It also provides men with emotional, physical, practical and spiritual support to help deal with advanced prostate cancer. 

Palliative care can be provided at any stage of advanced prostate cancer. It is not 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. However, this doesn't always happen and not all cancer that has spread will cause symptoms that affect you day to day.

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. Many men find it difficult to cope with. And it is not always relieved by rest alone. 

Fatigue might be caused by the cancer itself, by treatments, or by other conditions such as anaemia. Anxiety and depression can also cause fatigue. 

What can help?

Tell your doctor or nurse if you have fatigue. Depending on the cause, fatigue can be managed, for example, by controlling pain. 

You can also try making changes to your lifestyle including:

  • being physically active
  • organising your day
  • planning activities for when you know you will have more energy
  • dealing with any problems sleeping
  • eating healthily
  • complementary therapies. 

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

Our telephone support service, Get back on track, can help with managing fatigue. Or speak to our Specialist Nurses over the phone or speak to a nurse online.

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, lymph nodes or other areas of the body. The most common cause is cancer that has spread to the bones, but even then more than a quarter (more than 25 per cent) of men don't have any pain. And if cancer has spread to several places, men often only have pain in a few of these.

The type of pain depends on what is causing it. Bone pain, caused by cancer which has spread to the bones, 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.

If the cancer presses on a nerve it can cause neuropathic pain.The pain can come and go and people have described it as a shooting, stabbing, burning or tingling pain, or the damaged area could feel numb. 

If cancer has spread to the lymph nodes, it can cause a blockage  and might make them swollen and uncomfortable or painful.

Pain can also be a symptom of a more serious condition called metastatic spinal cord compression (MSCC). 

Don't suffer in silence. You shouldn't have to accept pain as a normal part of having cancer. If you're in pain or your pain relief isn't working well, tell your doctor or nurse. Don't think that you are complaining too much or that you should put up with it. With the right treatment, pain can usually be relieved or controlled well.

What can help?

The best way to manage your pain can depend on a number of things, including what is causing the pain, your general health and how you are feeling emotionally. Treating pain often involves using a few different approaches. 

Pain may be a sign that your prostate cancer treatment is not working as well as it was and a different treatment may help. 

  • Hormone therapy shrinks or slows down the growth of the cancer, and so can prevent or relieve your pain.
  • Steroids. If your cancer has spread to the bones it could cause swelling and press on the nerves in the bone, causing pain. Steroids can help to reduce swelling, and so reduce the pain.
  • Chemotherapy shrinks or slows down the growth of the cancer, and so controls pain. 

You may need one or more of the following treatments to help the pain itself.

  • Pain-relieving drugs can help. These include mild pain-relieving drugs such as paracetamol or ibuprofen, weak opioids such as codeine, and stronger opioids such as morphine.
  • Pain-relieving radiotherapy shrinks the cancer cells in the bones and stops them pressing on nerves. 
  • Medicines called bisphosphonates can bind to damaged areas of bone and help to prevent and slow down further damage, this helps relieve pain.
  • You might be able to have surgery to support damaged bone, but this is not often used.
  • Transcutaneous electrical nerve stimulation (TENS), which uses a small, portable machine to send small electrical currents to nerves in your body through pads placed on your skin. Doctors think that the currents may block the pain signals caused by the cancer.
  • Nerve block, which is an injection that changes what you feel in a particular part of the body. It can reduce pain in that area.

There are other things which may also help. These include:

  • complementary therapies such as acupuncture, aromatherapy, and gentle massage - many men find they can help feel them more relaxed and deal with cancer pain
  • getting emotional support
  • treatments for other causes of pain, for example, antibiotics to treat infection.

By using a combination of these, pain can usually be managed well. If one type of treatment does not work for you, then you may be able to try something else. You can read more in our Tool Kit fact sheet, Managing pain in advanced prostate cancer.

Urinary problems

You might get urinary problems if the cancer has spread to areas around the prostate, urethra and bladder (the urinary system). 

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 or previous treatments for prostate cancer. Speak to your doctor or nurse if you have any of the symptoms described below. 

Problems emptying your bladder

If the cancer is pressing on the urethra, causing it to narrow, you might have problems emptying your bladder fully. This is called urinary retention. 

Treatments for retention include:

If you are suddenly unable to pass urine (acute retention) you should get treatment straight away, for example at a hospital A&E department. Acute retention is extremely painful and needs urgent treatment. Otherwise urine will build up in the bladder and may cause problems. 

Problems leaking urine

If the cancer has grown into the bladder or any of the muscles that control urination, it can weaken them, and you might leak urine (incontinence) or need to urinate urgently. 

If you leak urine there are things that can help. These include:

  • incontinence products such as absorbent pads
  • pelvic floor muscle exercises to strengthen the muscles that control urination
  • medicines called anti-cholinergics, such as solifenacin succinate (Vesicare®)
  • some men may need to have a catheter

Rarely, problems emptying your bladder or having no control over when you empty it may be caused by a condition called metastatic spinal cord compression (MSCC). 

Blood in your urine

Some men notice blood in their urine (haematuria). This may be caused by bleeding from the prostate. This can be alarming, but it can usually be controlled. 

Speak to your GP or hospital doctor or nurse. Treatments include surgery or radiotherapy to stop the bleeding. 

Kidney problems

The kidneys remove waste products from the blood and produce urine. If prostate cancer spreads to the nearby lymph nodes or the bladder, it can cause problems with your kidneys. 

Kidney problems can lead to high levels of waste products in your blood. This can cause kidney failure, which is a serious condition. Symptoms of severe kidney problems include tiredness and lack of energy, feeling sick, swollen ankles and feet from fluid retention, and poor appetite. Tell your doctor or nurse if you have any of these symptoms. They can also be caused by other things.   

Treatments help to drain urine from the kidneys, and include:

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

What else can help with urinary problems?

Urinary problems might affect your self-esteem and sense of independence. Speak to your nurse or GP 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 to help. 

Read more about managing these problems, or speak to our Specialist Nurses. The Bladder and Bowel Foundation also provides information, including details of your local NHS continence service.

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), or
  • pain around the stomach area (abdomen) or back passage. 

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

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

Prostate cancer can spread to part of the bowel (rectum) but this is uncommon. If this does happen, it can cause a blockage in the bowel which causes 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 (MSCC). 

What can help?

If you have constipation, try:

  • a high fibre diet with fruit and vegetables and whole grain foods
  • drinking plenty
  • gentle exercise such as going for a walk
  • your GP or nurse may prescribe laxatives to help empty your bowels. 

If you have diarrhoea, try:

  • cutting down on fibre for a short time
  • low fibre foods include white bread, rice and pasta, potatoes (without the skins) and cornmeal
  • drinking plenty but avoid alcohol, coffee and fizzy drinks
  • try avoiding spicy food and cut down on dairy foods. 

Remember that GPs and nurses see many people with these problems. Your GP can also refer you to your local continence service, where you can get further advice and support. 

Macmillan Cancer Support and the Bladder and Bowel Foundation provide more information.

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 cause bone thinning which increases your risk of broken bones. 

What can help?

If an area of bone has been badly damaged, surgery might help to strengthen it. A metal pin or plate is inserted into the bone. Surgery is not suitable for everyone. If you have an operation, you may have radiotherapy afterwards to help prevent the cancer growing in that area. 

Some doctors give drugs called bisphosphonates to reduce the risk of broken bones. 

Damage to the bones can make it difficult or painful to move around. The information here might be helpful.  

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, including hormone therapy, surgery and radiotherapy, can cause problems getting and keeping an erection (erectile dysfunction). Hormone therapy may also reduce your desire for sex (libido), and there is no treatment to improve this while you are on hormone therapy. 

Because sex is also about how we think and feel, feeling low or anxious can affect your erections and desire for sex. If you are feeling very tired this can also affect your sex life. You might lose interest in sex or not have enough energy for it. 

What can help? 

There are treatments and support available for sexual problems. Speak to your GP or doctor or nurse at the hospital to find out more. 

You could try to find creative ways around these problems - such as trying sex in a different position, where you do not have to move around much. Or you might prefer to have sexual contact for just a few minutes at a time and take breaks. Sometimes just holding hands or cuddling can be enough.

Anaemia

Some men with advanced prostate cancer may develop anaemia. Symptoms include tiredness, lack of energy (lethargy), breathlessness and looking pale. 

Anaemia is when blood has fewer red blood cells than usual. Red blood cells are made by the bone marrow. They carry oxygen around the body. Anaemia can be caused 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. This might be a risk if you have problems eating. 

What can help?

Speak to your doctor or nurse if you have any of the symptoms of anaemia. You will have a blood test to check your red blood cell levels. 

If you have very low levels of red blood cells, you may need to have a blood transfusion. Blood is given through a tube (drip) into a vein in your arm. The transfusion will increase the number of red blood cells and can be a quick and effective way of treating anaemia. 

Occasionally, your doctor may recommend that you take iron supplements to help with anaemia. 

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

Metastatic spinal cord compression (MSCC)

Prostate cancer can spread to, or near to, the bones of the spine (vertebrae). This can lead to a complication called metastatic spinal cord compression (MSCC). This happens when the cancer presses on the spinal cord. You might also hear MSCC called malignant spinal cord compression, or simply spinal cord compression.  

MSCC is not common, but it is important that you are aware of the risk and what symptoms to look out for. If it does happen, you need to get treatment as soon as possible as the symptoms can get worse if left untreated. For example, it can make you less able to walk and move around. At its worst, MSCC can cause paralysis which could mean you can't walk or can't use your limbs normally. The sooner you have treatment, the lower the risk of long term problems.

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 tummy 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 do not go away.
  • Problems controlling your bladder or bowel. You might not be able to empty your bladder or bowel, or you might have no control over emptying them.

Don't wait - get it checked out

If you develop one or more of the symptoms listed above, you should seek medical advice straight away. Don't wait to see if your symptoms get better and don't worry if it is an inconvenient time, such as the evening or weekend. These symptoms can be caused by other conditions, but it is important to get urgent medical advice in case you do have MSCC.

What can help?

While you are waiting for a diagnosis, there are a number of things that can be done to make you more comfortable and to help protect the spinal cord from further harm.

  • You might be asked to lie flat on your back. This helps keep your spine still and reduce the risk of further damage to your spinal cord. Your doctor will tell you it's safe to sit up
  • Pain-relieving drugs can treat pain caused by MSCC.
  • A medicine called dexamethasone (a steroid) can reduce the swelling which will relieve pressure on the spinal cord.

If you are diagnosed with MSCC, you will start your main treatment soon - it could be within 24 hours, and won't be longer than a week. There are several treatments available and you are likely to have a combination of these. 

  • Radiotherapy  to shrink the cancer cells that are pressing on your spinal cord. It can also help to relieve pain.
  • Surgery is sometimes used, usually at a specialist spinal unit. It usually involves reducing the pressure on your spinal cord and supporting your spine.
  • A support brace can be fitted around your back or neck to help keep your spine still and help with pain.

Your doctor or nurse at the hospital will make sure you and your family get all the support you need to help you recover from MSCC.

Read more about MSCC in our fact sheet, Metastatic spinal cord compression.

Hypercalcaemia

Hypercalcaemia is an increase in the amount of calcium in your blood. Calcium is usually stored in the bones, but the cancer can cause too much of it to be released into the blood. Hypercalcaemia is not common in men with advanced prostate cancer. But if you do get it, it's important that it's treated, otherwise it will gradually get worse and may develop into a serious condition. 

Symptoms of hypercalcaemia include:

  • tiredness (fatigue) and lack of energy (lethargy)
  • loss of appetite
  • weakness
  • difficulty emptying your bowels (constipation)
  • confusion
  • feeling and being sick (nausea and vomiting)
  • pain in your abdomen
  • thirst
  • needing to pass urine frequently. 

Tell your hospital doctor or nurse or your GP if you have any of these symptoms. They can be quite common in men with advanced prostate cancer and might not be caused by hypercalcaemia. 

What can help?

If you have hypercalcaemia you may go into hospital for a couple of days to get your calcium levels down to normal. You will be given fluid through a drip to flush excess calcium out of your blood. 

Medicines called bisphosphonates are the main treatment for hypercalcaemia. 

If your cancer is very advanced, it may not be possible to bring the levels of calcium in your blood back to normal. Your doctors should make you as comfortable as possible by controlling any symptoms you may have.   

CancerHelp UK provides more information about hypercalcaemia.

Lymphoedema

Lymphoedema is caused by a blockage in part of the body's immune system called the lymphatic system. This causes fluid to build up in the body's tissues, causing swelling. This is lymphoedema. 

Some of the lymph nodes are in the groin and pelvic area - near the prostate. The cancer might spread to the lymph nodes or to surrounding tissues and press on the lymph vessels. Treatments for prostate cancer can also affect the lymphatic system. You may be at greater risk of lymphoedema if you have had surgery or radiotherapy to the lymph nodes. 

Symptoms include:

  • swelling in the affected area or limb, for example in the leg
  • pain and discomfort in the affected area
  • tight, sore skin which may crack and become infected. 

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

What can help?

Speak to your nurse or GP if you have any of the symptoms. Treatments can manage it, although they cannot cure it. They are most effective if started early. You may be referred to a specialist lymphoedema nurse. 

There are a variety of treatments which might help.

  • Caring for the skin, such as regular cleaning and moisturising, helps to keep the skin soft and reduces the risk of infection.
  • Avoiding any damage to the skin, such as sunburn or cuts, reduces the risk of infection.
  • Special massage (manual lymphatic drainage) can help to increase the flow of lymph. Your lymphoedema nurse might be able to show you or your partner how to do this.
  • Gentle exercise may help to improve the flow of lymph.
  • Using compression bandages or compression stockings can help to encourage the lymph to drain from the affected area. Your lymphoedema nurse will show you how to use them.
  • Wearing special underwear may support and control the swelling if you have lymphoedema 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. 

Macmillan Cancer Support and the Lymphoedema Support Network provide more detailed information about lymphoedema.

Eating problems

Some men with advanced prostate cancer have difficulties eating, or have a poor appetite. You might feel or be sick (nausea or vomiting) because of your cancer or as a side effect of some treatments, including opioid pain relief (for example, morphine), 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, your doctor can give you anti-sickness medication.
  • 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 nausea worse.
  • Drink plenty, 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 be helpful. 

Macmillan Cancer Support and Marie Curie Cancer Care both provide information and support.

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. 

  • Your multidisciplinary team (MDT) is the team of professionals involved in your care.
  • Your GP and district nurse can offer you support and advice throughout your treatment, and refer you to local services.
  • Urologists are surgeons who specialise in the treatment of diseases of the urinary system.
  • Oncologists specialise in treating cancer with treatments other than surgery, such as chemotherapy or radiotherapy.
  • Clinical nurse specialists (CNS) provide care and advice in managing prostate cancer and side effects, along with emotional support.
  • Palliative care teams include specialist palliative care nurses and doctors. They provide treatment to manage pain and other symptoms, and offer emotional and spiritual support. They work in hospitals and hospices, but might be able to visit you at home.
  • Marie Curie nurses provide nursing care to people in the last few months or weeks of life. They visit people at home and often provide care overnight. They also offer practical advice and emotional support to you and your family.
  • Read about other professionals who can help. 

Hospices

Hospices provide a range of services including treatment to manage symptoms, emotional and spiritual support, practical and financial advice and support for families. 

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

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