Stage 4 prostate cancer is advanced cancer of the male prostate gland which has spread, or metastasized, to other areas of the body. Prostate cancer is most common in men over 55, and risk is influenced by advancing age, genetic predisposition, and a high calorie diet. It is generally considered to be incurable at this advanced stage, although many treatments are available which slow cancer growth, prolong life, and improve the overall quality of life.
Prostate cancer is categorized by stages, ranging from stage 1 to stage 4. Stage 1 prostate cancer involves small tumors in the prostate gland which are considered unlikely to spread aggressively, and stage 2 involves larger or more aggressive tumors that still remain within the prostate gland. Cancer categorized as stage 3 has spread to grow through the capsule around the prostate and possibly into the seminal vesicles. Stage 4 prostate cancer has spread further than in stage 3, to another organ or body structure such as the lymph nodes, bladder, or bones.
The options for treating stage 4 prostate cancer are different than for the earlier stages of the disease. Surgery to remove the prostate, which is common for earlier stage cancers, is usually not effective in stage 4. It is used only if the tumors are causing problems such as obstructing urine flow. Most patients with stage 4 prostate cancer are treated with multiple different treatment methods, and some participate in experimental clinical trials of new treatments.
Hormone therapy is the first line of treatment for stage 4 prostate cancer. It involves either blocking or removing the male hormones necessary for prostate tumors to grow, either through medications or through surgery to remove the testicles. Radiation therapy, which involves using beams of radiation to destroy cancer cells, is often used as a treatment in combination with hormone therapy. Most prostate cancers eventually continue to grow even after hormone therapy, and chemotherapy may then be required.
Side effects of treatment can widely differ in severity. It is important to weigh the risks and benefits of each treatment. Very elderly men and men with other serious illnesses may choose to decline treatment unless symptoms such as pain arise, since the side effects of treating these patients with hormones, radiation, or chemotherapy may cause significant problems.
Pain is more likely to be a problem for patients with stage 4 prostate cancer than for patients with earlier stage cancer, particularly if the cancer has affected the bones. The management of pain is an important part of caring for these patients. Counseling for the patient and his family is likely to be helpful for overall well-being and quality of life.