Advanced prostate cancer

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What is advanced prostate cancer?

Advanced prostate cancer is cancer that has spread from the prostate to other parts of the body. It develops when prostate cancer cells move through the blood stream or lymphatic system.

Watch our video about advanced prostate cancer.

You might hear cancer that has spread described as metastatic prostate cancer, secondary prostate cancer, secondaries, metastases or mets. It is still prostate cancer, wherever it is in the body.

Prostate cancer can spread to any part of the body, but most commonly to the bones and lymph nodes. Lymph nodes (sometimes called lymph glands) are part of your lymphatic system, which is part of the body’s immune system. Lymph nodes are found throughout the body including in the pelvic area, near the prostate.

Advanced prostate cancer can cause symptoms, such as fatigue (extreme tiredness), bone pain, and problems urinating.

The symptoms you have will depend on where the cancer has spread to. Speak to your doctor or nurse if you have any symptoms. There are treatments available to help manage them.

It’s not possible to cure advanced prostate cancer. But treatments can help keep it under control and manage any symptoms.

How is advanced prostate cancer diagnosed?

Advanced prostate cancer is diagnosed using the results of some or all of the following tests:

What do my test results mean?

Your results will give your doctor an idea of where your cancer has spread to. This will help you and your doctor to discuss which treatments might be suitable for you.

What treatments are available?

If you have advanced prostate cancer, treatment won’t cure your cancer. But it can help keep it under control and manage any symptoms.

If you’ve just been diagnosed with advanced prostate cancer, you may be offered the following treatments:

chemotherapy with hormone therapy
hormone therapy alone
clinical trials.

Research has found that having radiotherapy together with one of the main treatments listed above can help some men with advanced prostate cancer to live longer. But radiotherapy isn’t suitable for all men with advanced prostate cancer.

If you live in Scotland, you may also be offered a type of hormone therapy called abiraterone acetate (Zytiga®) together with standard hormone therapy. In the rest of the UK, abiraterone is currently only given to men with advanced prostate cancer that has stopped responding to other types of hormone therapy. The National Institute for Health and Care Excellence (NICE) is currently deciding whether to make it available for men who have just been diagnosed with advanced prostate cancer.

Before you start treatment

Before you start any treatment, make sure you have all the information you need. It’s important to think about how you would cope with the possible side effects. Speak to your doctor or nurse about this.

It can help to write down any questions you want to ask at your next appointment. It may also help to take someone with you, such as your partner, a family member or friend.

It can also help to write down or record what’s said to help you remember it. You have the right to record your appointment because it’s your personal data. You could use your phone or another recording device to do this. Let your doctor or nurse know why you are doing this, as not everyone is comfortable being recorded.

If you have any questions, speak to our Specialist Nurses.

If you don’t have any symptoms and want to avoid or delay treatment and its side effects, you might be able to have your cancer monitored instead. This is known as watchful waiting. It isn’t usually recommended for men with advanced prostate cancer, because it won’t control the cancer and it won’t stop the cancer from growing or spreading. Your doctor or nurse can help you think about the advantages and disadvantages.

How will my cancer be monitored?

Your doctor will talk to you about how often you should have check-ups. At some hospitals, you may not have many appointments at the hospital itself. Instead, you may talk to your doctor or nurse over the telephone. You might hear this called self-management.

You will have regular PSA tests. This is often a useful way to check how well your treatment is working. You’ll also have regular blood tests to see whether your cancer is affecting other parts of your body, such as your liver, kidneys or bones.

You might have more scans to see how your cancer is responding to treatment and whether your cancer is spreading.

Your doctor or nurse will also ask you how you’re feeling and if you have any symptoms, such as pain or tiredness. This will help them understand how you’re responding to treatment and how to manage any symptoms. Let them know if you have any side effects from your treatment. There are usually ways to manage these.

What happens if my cancer starts to grow again?

Your first treatment may help keep your cancer under control. But over time, the cancer may change and it may start to grow again.

You will usually stay on your first type of hormone therapy, even if it’s not working so well. This is because it will still help to keep the amount of testosterone in your body low. But there are other treatments that you can have alongside your usual treatment, to help control the cancer and manage any symptoms. Other treatments include:

Which treatments are suitable for me?

Which treatments are suitable for you will depend on many things, including your general health, how your cancer responds to treatment, and which treatments you’ve already had. Talk to your doctor or nurse about your own situation, or speak to our Specialist Nurses.

Treatments to help manage symptoms

Advanced prostate cancer can cause symptoms, such as bone pain. Speak to your doctor or nurse if you have symptoms – there are treatments available to help manage them. The treatments above may help to delay or relieve some symptoms. There are also specific treatments to help manage symptoms – you may hear these called palliative treatments. They include:

Your multi-disciplinary team (MDT)

This is the team of health professionals involved in your care. It is likely to include:

a specialist nurse
a chemotherapy nurse
a urologist (a surgeon who specialises in diseases of the urinary and reproductive systems, including prostate cancer)
an oncologist (a doctor who specialises in cancer treatments other than surgery)
a diagnostic radiographer (a person who takes X-rays and scans of the body)
a therapeutic radiographer (a person who gives radiotherapy treatment)
a radiologist (a doctor who reads scans such as MRI, CT and bone scans)
other health professionals, such as a dietitian or physiotherapist.

Your MDT will meet to discuss your diagnosis and treatment options. You might not meet all the health professionals straight away.

Your main point of contact might be called your key worker. This is usually your clinical nurse specialist (CNS), but might be someone else. The key worker will co-ordinate your care and help you get information and support. You may also have close contact with your GP and the practice nurses at your GP surgery.

What is my outlook?

If you’re diagnosed with advanced prostate cancer, you may want to know how well your treatment is likely to control your cancer and for how long it will control it. This is sometimes called your outlook or prognosis. But not all men will want to know this.

While it isn’t possible to cure advanced prostate cancer, treatments can help keep it under control, often for several years. Treatments will also help manage any symptoms, such as pain.

No one can tell you exactly what your outlook will be, as it will depend on many things such as where the cancer has spread to, how quickly it has spread, and how well you respond to treatment. Some men may not respond well to one treatment, but may respond better to another. And when your first treatment stops working, there are other treatments available to help keep the cancer under control for longer. Speak to your doctor about your own situation and any questions or concerns you have.

Questions to ask your doctor or nurse

What type of hormone therapy are you offering me and why?
Are there other treatments I can have?
What are the advantages and disadvantages of my treatment?
What treatments and support are available to help manage side effects?
Are there any lifestyle changes that might help me manage my cancer, symptoms, or side effects?
How often will I have check-ups and what will this involve?
How will we know if my cancer starts to grow again?
What other treatments are available if that happens?
Can I join any clinical trials?
If I have any questions or get any new symptoms, who should I contact?

References

Updated: August 2019｜To be reviewed: August 2021

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List of reviewers

Vanessa Basketter, Urology Lead Nurse, University Hospital Southampton
Maggie Bingle, Prostate Cancer Clinical Nurse Specialist, East Suffolk and North Essex NHS Foundation Trust
Ann French, Lead Urology Oncology Clinical Nurse Specialist, Southend University Hospital
Sidath Liyanage, Consultant Radiologist, Southend University Hospital
Lisa Pickering, Consultant Medical Oncologist, St George's University Hospitals Foundation Trust and Royal Marsden NHS Trust
Our Specialist Nurses
Our Volunteers.