How Quickly Does Prostate Cancer Spread

How Is Prostate Cancer Diagnosed

Screenings are the most effective way to catch prostate cancer early. If you are at average cancer risk, youll probably have your first prostate screening at age 55. Your healthcare provider may start testing earlier if you have a family history of the disease or are Black. Screening is generally stopped after age 70, but may be continued in certain circumstances.

Screening tests for prostate cancer include:

• Digital rectal exam: Your provider inserts a gloved, lubricated finger into the rectum and feels the prostate gland, which sits in front of the rectum. Bumps or hard areas could indicate cancer.
• Prostate-specific antigen blood test: The prostate gland makes a protein called protein-specific antigen . Elevated PSA levels may indicate cancer. Levels also rise if you have BPH or prostatitis.
• Biopsy: A needle biopsy to sample tissue for cancer cells is the only sure way to diagnose prostate cancer. During an MRI-guided prostate biopsy, magnetic resonance imaging technology provides detailed images of the prostate.

Future Predictors Of Prostate Cancer

Researchers are seeking more accurate ways of diagnosing, monitoring, and treating prostate cancer. Many of the studies focus on genes and genetic abnormalities of a cancer. Scientists have found that the product of a certain gene appears more often in advanced prostate cancers than in early stage prostate cancers. Now the goal is to determine if the presence of this gene product means that a cancer is more aggressive. Knowing this information can help doctors decide which patients may benefit from immediate treatment, and of what type. This and other genetic research will pave the way for earlier, more accurate predictors of cancer growth.

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What Will This Summary Tell Me

This summary will tell you about:

• What localized prostate cancer is
• Common treatment options for localized prostate cancer
• What researchers found about how the treatments compare
• Possible side effects of the treatments
• Things to talk about with your doctor

This summary does not cover:

• How to prevent prostate cancer
• Less common treatments for localized prostate cancer, such as high-intensity focused ultrasound , cryotherapy , proton-beam radiation therapy , and stereotactic body radiation therapy
• Herbal products or vitamins and minerals
• Treatments for cancer that has spread outside the prostate gland

*In this summary, the term doctor refers to your health care professional, including your primary care physician, urologist, oncologist, nurse practitioner, or physician assistant.

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If Treatment Does Not Work

Recovery from cancer is not always possible. If the cancer cannot be cured or controlled, the disease may be called advanced or terminal.

This diagnosis is stressful, and for many people, advanced cancer may be difficult to discuss. However, it is important to have open and honest conversations with your health care team to express your feelings, preferences, and concerns. The health care team has special skills, experience, and knowledge to support patients and their families and is there to help. Making sure a person is physically comfortable, free from pain, and emotionally supported is extremely important.

People who have advanced cancer and who are expected to live less than 6 months may want to consider hospice care. Hospice care is designed to provide the best possible quality of life for people who are near the end of life. You and your family are encouraged to talk with the health care team about hospice care options, which include hospice care at home, a special hospice center, or other health care locations. Nursing care and special equipment, including a hospital bed, can make staying at home a workable option for many families. Learn more about advanced cancer care planning.

After the death of a loved one, many people need support to help them cope with the loss. Learn more about grief and loss.

• Handling insurance and billing issues

Learn more about caregiving.

What Questions Should I Ask My Healthcare Provider

If you have prostate cancer, you may want to ask your healthcare provider:

• Why did I get prostate cancer?
• What is my Gleason score? What is my Grade Group? What do these numbers mean for me?
• Has the cancer spread outside of the prostate gland?
• What is the best treatment for the stage of prostate cancer I have?
• If I choose active surveillance, what can I expect? What signs of cancer should I look out for?
• What are the treatment risks and side effects?
• Is my family at risk for developing prostate cancer? If so, should we get genetic tests?
• Am I at risk for other types of cancer?
• What type of follow-up care do I need after treatment?
• Should I look out for signs of complications?

A note from Cleveland Clinic

Prostate cancer is a common cancer that affects males. Most prostate cancers grow slowly and remain in the prostate gland. For a small number, the disease can be aggressive and spread quickly to other parts of the body. Men with slow-growing prostate cancers may choose active surveillance. With this approach, you can postpone, and sometimes completely forego, treatments. Your healthcare provider can discuss the best treatment option for you based on your Gleason score and Group Grade.

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What Are The Signs And Symptoms Of Prostate Cancer

Prostate cancer may not cause any signs and symptoms in the early stages. Hence, it is advisable for men over 50 years of age with or without other risk factors to consult with a doctor to be screened for prostate cancer.

Prostate cancer can cause the following signs and symptoms in the later stages

What Happens Without Treatment

Physicians will sometimes talk about a particular diseases natural history or typical progression if it is left untreated indefinitely.

With regard to prostate cancer, most cases of the disease are discovered while the cancer is still confined to the prostate itself. This is called local disease or localized disease.

The disease is easiest to treat while it is confined to the prostate. At this stage, surgery and radiation are most likely to be curative and completely kill or remove whatever cancer cells are present.

If left untreated, however, prostate cancer can proceed on a number of different paths.

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Looking For More Of An Introduction

If you would like more of an introduction, explore these related items. Please note that these links will take you to other sections on Cancer.Net:

• ASCO Answers Fact Sheet:Read a 1-page fact sheet that offers an introduction to prostate cancer. This free fact sheet is available as a PDF, so it is easy to print.

• ASCO Answers Guide:Get this free 44-page booklet that helps you better understand the disease and treatment options. The booklet is available as a PDF, so it is easy to print.

• Cancer.Net Patient Education Video:View a short video led by an ASCO expert in prostate cancer that provides basic information and areas of research.

• Cancer.Net En Español: Read about prostate cancer in Spanish or read a 1-page ASCO Answers Fact Sheet in Spanish. Infórmase sobre cáncer de próstata en español o una hoja informativa de una página, Respuestas sobre el cáncer.

The next section in this guide is Statistics. It helps explain the number of people who are diagnosed with prostate cancer and general survival rates. Use the menu to choose a different section to read in this guide.

ON THIS PAGE: You will find information about the number of people who are diagnosed with prostate cancer each year. You will also read general information on surviving the disease. Remember, survival rates depend on several factors. Use the menu to see other pages.

Statistics adapted from the American Cancer Societyâs publication, Cancer Facts & Figures 2021, and the ACS website .

What Determines Treatment For Prostate Cancer

If prostate cancer is detected, treatment might not be recommended right away. This is because the prostate cancer cells normally grow so slowly. In this case you might be a candidate for active surveillance. This means that you and Dr. Steven Gange will work together to track the growth of your cancer rather than proceeding to radiation or surgery.

Tests will be conducted periodically to watch the growth. This is an effective plan if there are no symptoms and as long as the cancer continues to grow slowly.

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Active Surveillance And Watchful Waiting

If prostate cancer is in an early stage, is growing slowly, and treating the cancer would cause more problems than the disease itself, a doctor may recommend active surveillance or watchful waiting.

Active surveillance. Prostate cancer treatments may seriously affect a person’s quality of life. These treatments can cause side effects, such as erectile dysfunction, which is when someone is unable to get and maintain an erection, and incontinence, which is when a person cannot control their urine flow or bowel function. In addition, many prostate cancers grow slowly and cause no symptoms or problems. For this reason, many people may consider delaying cancer treatment rather than starting treatment right away. This is called active surveillance. During active surveillance, the cancer is closely monitored for signs that it is worsening. If the cancer is found to be worsening, treatment will begin.

ASCO encourages the following testing schedule for active surveillance:

• A PSA test every 3 to 6 months

• A DRE at least once every year

• Another prostate biopsy within 6 to 12 months, then a biopsy at least every 2 to 5 years

Treatment should begin if the results of the tests done during active surveillance show signs of the cancer becoming more aggressive or spreading, if the cancer causes pain, or if the cancer blocks the urinary tract.

How Soon Can We Detect This

One of the main advantages of surgery over radiotherapy for prostate cancer is that following prostate removal, the PSA should be very low , which we can of course detect with blood tests. If metastasis occurs, because the metastatic cells originated in the prostate and therefore make PSA, the PSA level in the blood starts to rise. Once it has reached a given threshold additional or salvage treatment will be discussed.

A PSA level of more than 0.2 ng/ml defines biochemical recurrence. At this stage the cancer is still much too small to be seen on scanning. If it can be seen on a scan it is termed clinical recurrence, which generally does not occur until the PSA level is more than 0.5 ng/ml. Symptoms, such as bone pain, dont usually occur until the PSA is more than 20 ng/ml.

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How Can I Prevent Prostate Cancer

The best way to try and prevent prostate cancer is to modify the risk factors for prostate cancer that you have control over. Eat a low-fat diet that is rich in fruits and vegetables and low in animal fats. It is always a good idea to maintain a healthy weight, get plenty of exercise and not to smoke or to quit smoking.

What Are The Signs Of Prostate Cancer

Most early prostate cancers are detected with PSA tests or digital rectal exams before they cause any symptoms. However, more advanced prostate cancers can cause a variety of symptoms including:

• Trouble starting to urinate .
• Urinating much more often than usual.
• The feeling that you canât release all of your urine.
• Pain with urination or ejaculation.
• Blood in your urine or semen.
• Impotence/erectile dysfunction.
• Numbness in the lower extremities.
• Loss of bladder or bowel control.

All of these symptoms can be caused by things other than prostate cancer, so experiencing them doesnât necessarily mean you have prostate cancer. When older men have problems urinating, it is usually caused by a problem called benign prostatic hyperplasia , which is not prostate cancer. If you have any of these symptoms, you need to see your provider for testing.

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How Can You Detect Prostate Cancer Early

Testing healthy men with no symptoms for prostate cancer is controversial. However, many doctors do recommend asymptomatic men over the age of 50 years old, especially those with other risk factors, to get screened for prostate cancer routinely because there are often no symptoms in the early stages. The advantage of routine screening is early detection of cancer and treatment with the possibility of complete cure.

Prostate screening tests might include the following

Digital rectal exam : This is a part of a physical examination performed by a doctor on an outpatient basis. The doctor, with gloves on, inserts a finger into the rectum to examine the prostate to feel the texture and assess the shape and size. The prostate is situated adjacent to the rectum. The doctor uses a numbing lubricant while performing the exam to reduce discomfort.Prostate-specific antigen test: This is a blood test to detect the level of PSA, a substance that is naturally produced by the prostate gland. If the PSA level is higher than normal, it indicates prostate abnormalities. PSA levels are usually also increased in cases of prostate infection or benign enlargement of the prostate. The PSA test is also done to monitor disease progress and response to treatment.

Diagnostic tests for prostate cancer

If there are abnormal findings in the screening tests, the doctor may advise the following diagnostic tests.

Detection of metastasis

What Is Metastatic Prostate Cancer

Metastatic prostate cancer is the clinical description of an advanced stage of the disease. In this phase, cancer is not limited to the initial tumor. Instead, this primary tumor grows, spreading to nearby organs, and then to distant areas.

Initially, prostate cancer will remain in a localized tumor. It could stay like this for many years in most patients. But then, it continues growing, and new cancer cells adopt new gene mutations.

Such changes include lower adhesion between nearby cells. Cancer is no longer anchored to the prostate gland and ultimately migrates through the blood or lymph.

That is how metastatic prostate cancer initiates, and we can detect it through imaging techniques. For many years, CT scans were used to detect this type of spread. Now it is diagnosed through more advanced techniques: MRI and PET.

An essential aspect we should highlight about metastatic prostate cancer is resistant to treatment. This type of advanced prostate cancer may not respond to usual cancer treatments. It requires systemic therapy and it can develop resistance to hormone therapy .

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Talking With Your Health Care Team About Side Effects

Before starting treatment, talk with your doctor about possible side effects. Ask:

• Which side effects are most likely?

• When are they likely to happen?

• What can we do to prevent or relieve them?

Be sure to tell your health care team about any side effects that happen during treatment and afterward, too. Tell them even if you do not think the side effects are serious. This discussion should include physical, emotional, social, and financial effects of cancer.

Also, ask how much care you may need at home and with daily tasks during and after treatment. This can help you make a caregiving plan. Create a caregiving plan with this 1-page fact sheet that includes an action plan to help make caregiving a team effort. This free fact sheet is available as a PDF, so it is easy to print.

What Will Happen In The Last Few Days

It can help to know what is normal in the last few days of life so that you know what to expect. You might not be aware of these changes when they happen because you may be drowsy or unconscious.

If youre supporting someone who is dying, read about what you can do to help and how you can get support.

Pain

Many people worry about being in pain when they are dying. Some people do get pain if their prostate cancer presses on their nerves or makes their bones weak. But not everyone dying from prostate cancer has pain. And if you are in pain, there are things that can help to reduce and manage pain.

You should tell your doctor or nurse if youre in pain or if your pain gets worse. They can talk with you about how best to manage your pain and can help keep it under control.

You may find sitting or lying in some positions more comfortable than others, so ask if you need help getting into a different position.

Your doctor can give you medicines to help manage pain. The type of medicines they give you will depend on what is causing the pain and which medicines are suitable.

Your doctor will monitor how the pain medicines are working and may change the type of medicine or the dose. If youre still in pain or get pain in between taking medicines, its important to tell your doctor or nurse.

Sleeping and feeling drowsy

Changes in skin temperature or colour

Changes in breathing

Changes in urinating or bowel movements

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Hormonal Therapy For Aggressive Prostate Cancer: How Long Is Enough

• By Charlie Schmidt, Editor, Harvard Medical School Annual Report on Prostate Diseases

Men weighing treatment options for intermediate- or high-risk cancer that is still localized to the prostate can face a tricky question. A standard approach in these cases is to give radiation to the prostate along with drugs that block testosterone, a hormone that makes the cancer cells grow faster. For how long should this hormone therapy last? Thats not entirely clear. The drugs have side effects, such as fatigue, impotence, and a loss of muscle mass. But radiation doesnt control prostate cancer effectively without them. Doctors therefore aim to give hormone therapy only for as long as it takes to help their patients, without causing any undue harm.

Now, newly published results from a phase 3 clinical trial are providing some needed guidance.

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