Stage 4 prostate cancer is the most advanced stage of the disease. It means that cancer has spread beyond the prostate to distant areas of the body. Learn more about this stae, what treatments are available, and the prognosis. Understanding Staging The most common staging system used with prostate cancer is the TNM staging system. Another system used by some hospitals and doctors is the Jewett staging system which breaks down tumors into stage A to stage D. With the TNM system, letters stand for: T is for tumor size. N is for lymph node involvement. N0 means cancer has not spread to any lymph nodes. N1 means the tumor has spread to nearby lymph nodes. N2 means the tumor has spread to distant lymph nodes. M is for metastases. M0 means that a prostate cancer has not spread to distant organs. M1 means that a prostate cancer has spread to distant organs—the bones are the most common area of prostate cancer metastases. Prostate cancer is considered stage 4 in three different ways: A T4 tumor with no lymph node involvement and no metastases.
Advances in Urology. 2012;2012:1-8. doi:10. 1155/2012/893193 Hsiao W, Moses KA, Goodman M, Jani AB, Rossi PJ, Master VA. Stage IV prostate cancer: survival differences in clinical T4, nodal and metastatic disease. Journal of Urology. 2010;184(2):512-518. 1016/ Johns Hopkins Medicine. Prostate cancer symptoms. Centers for Disease Control and Prevention. How Is prostate cancer diagnosed? Updated July 31, 2019. American Cancer Society. Initial treatment of prostate cancer, by stage. Updated August 1, 2019. NIH National Cancer Institute. Hormone therapy for prostate cancer. Updated February 28, 2019. Sanford MT, Greene KL, Carroll PR. The argument for palliative care in prostate cancer. Translational andrology and urology. 2013;2(4):278-80. doi:10. 3978/ Boyer MJ, Salama JK, Lee WR. Palliative radiotherapy for prostate cancer. Oncology. 2014;28(4):306-12. American Cancer Society. Treating prostate cancer spread to bones. Updated August 1, 2019. American Cancer Society. Chemotherapy for prostate cancer.
Other causes of prostate cancer There are no other established causes of prostate cancer. Pathogenesis The disease usually develops slowly and dysplastic lesions may precede cancer by many years or even decades. The prevalence of latent prostate cancer at autopsy is high and increases with age. Overt and clinically relevant disease is less common. The introduction of PSA screening has contributed to the detection of cancer at an earlier stage. Although this likely contributes to a reduction in mortality, because a significant number of indolent lesions that might never progress to become clinically overt are also detected, many of which are treated, it also leads to the phenomenon of over treatment. Adenocarcinoma of the prostate is thought to arise primarily from an in situ proliferation of neoplastic prostatic epithelial cells. Metastasis of prostatic adenocarcinoma is mainly to the lymph nodes and to bone. Non-modifiable risk factors are age, race and familial history. Elevated blood concentrations of insulin-like growth factor (IGF)-1 have been implicated as a potentially modifiable risk factor.
Normal PSA values do not exclude the diagnosis of prostate cancer. Inflammation, manipulation of the prostate, and other malignant or benign prostate disease causing elevated enzyme levels may lead to false-positive PSA results. Other blood tests Alkaline phosphatase: ↑ in bone metastases ↑ Prostatic acid phosphatase (PAP) Urine Prostate biopsy Histological confirmation of suspicious findings on DRE Suspicious PSA levels or velocities Clinically suspicious prostate cancer Technique: ∼ 12 prostate samples are taken from different areas of the prostate guided by transrectal ultrasonography ( TRUS) under local anesthesia and prophylactic antibiotics. Interpretation:: When prostate cancer is present in the biopsy, the tumor is graded using the Gleason score. Complications UTI Prostatitis Hematuria Hematospermia Acute urinary retention Psychological effects The Gleason scoring system is used to grade the metastatic potential of adenocarcinoma of the prostate according to gland-forming differentiation.
Indication Modalities Abdominal ultrasound and CT/ MRI Spinal x-ray: detection of bone metastases ( hyperdense osteoblastic lesions in vertebral bodies) Bone scintigraphy ( technetium-99m): detection of bone metastases Pathology Most common type: adenocarcinoma expressing PSA [10] Most common localization: peripheral zone ( posterior lobe) of prostate [11] P rostate cancer is commonly localized in the P eripheral zone ( P osterior lobe). Differential diagnoses The differential diagnoses listed here are not exhaustive. Treatment Active surveillance [12] Watchful waiting [12] Radiation therapy [13] Radical prostatectomy [13] Radical prostatectomy involves removal of the vas deferens, resulting in infertility. Antiandrogen therapy [13] Indication: androgen sensitive localized high-grade or metastatic prostate cancer Methods Medical castration: gonadotropin-releasing hormone (GnRH) agonists (e. g., leuprolide) or antagonist (e. g., degarelix) May be combined with an antiandrogen (e. g., flutamide, bicalutamide) for complete androgen blockade.
Nevertheless, it can affect your life. As well as the possible side effects of treatment, a diagnosis of prostate cancer can understandably make you feel anxious or depressed. You may find it beneficial to talk about the condition with your family, friends, a family doctor and other men with prostate cancer. Financial support is also available if prostate cancer reduces your ability to work. Find out more about living with prostate cancer Video: prostate cancer In this video, an expert talks about the diagnosis and treatment of prostate cancer. Media last reviewed: 12 January 2021 Media review due: 12 January 2024 Page last reviewed: 12 June 2018 Next review due: 12 June 2021
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