Diagnosis

Metastatic prostate cancer diagnosis often involves blood tests and imaging tests. A metastatic prostate cancer is an advanced cancer that has spread to other parts of the body. This makes it a stage 4 prostate cancer.

PSA test for metastatic prostate cancer

A prostate-specific antigen test measures the amount of prostate-specific antigen in the blood. Prostate-specific antigen, also called PSA, is a substance that prostate cells make. Some PSA circulates in the blood. A PSA test detects the PSA in a blood sample. Having a high level of PSA in your blood can be a sign of prostate cancer.

Many people have regular PSA tests after prostate cancer treatment. A rising PSA level may be the first sign that the cancer has come back. If your PSA level has been going up, your healthcare team might recommend imaging tests to look for signs of metastatic prostate cancer.

Imaging tests for metastatic prostate cancer

Imaging tests make pictures of the body. For metastatic prostate cancer, imaging tests can make pictures that might show the places where the cancer has spread.

Imaging tests used to detect metastatic prostate cancer include:

  • A bone scan. A bone scan uses nuclear imaging to make pictures. Nuclear imaging involves using small amounts of radioactive substances, called radioactive tracers. A special camera that can detect the radioactivity also is used along with a computer. The tracer may highlight areas of cancer within the bones. A bone scan may be used to detect prostate cancer that spreads to the bones.
  • A computerized tomography scan. A computerized tomography scan, also called a CT scan, is a type of imaging that uses X-ray techniques to create detailed images of the body. Then a computer creates cross-sectional images, also called slices, of the bones and soft tissues inside the body. A CT scan can detect prostate cancer that has spread to the lymph nodes, organs or other places in the body.
  • Magnetic resonance imaging. Magnetic resonance imaging, also called MRI, uses a magnetic field and radio waves to create pictures of the inside of the body. MRI can detect cancer in the prostate. It also can detect cancer that has spread to the lymph nodes or other places in the body.
  • A positron emission tomography scan. A positron emission tomography scan, also called a PET scan, is a nuclear imaging test. It uses a radioactive tracer that's injected into a vein. The tracer contains a substance that helps it stick to the cells that the test is looking for. The PET images show the places where the tracer builds up. A PET scan can look at the whole body to detect metastatic prostate cancer.
  • A prostate-specific membrane antigen PET scan. The prostate-specific membrane antigen PET scan also is called a PSMA PET scan. Like other PET scans, this test uses a radioactive tracer. The tracer contains a substance that helps the tracer stick to prostate cancer cells. The substance attaches to a protein that's found on the surface of prostate cancer cells. The protein is called prostate-specific membrane antigen. A PSMA PET scan can detect prostate cancer that has spread anywhere in the body.
  • A choline C-11 PET scan. A choline C-11 PET scan is a kind of PET scan. Like other PET scans, this test uses a radioactive tracer. Prostate cancer cells take up more of the tracer than do most other cells in the body. This test might be used if other imaging tests haven't found the metastatic prostate cancer.

Metastatic prostate cancer biopsy

A biopsy is a procedure to remove a sample of tissue for testing in a lab. For metastatic prostate cancer, the kind of biopsy you have depends on where the cancer has spread. Often a healthcare professional puts a needle through the skin and into the cancer to get some cells.

In the lab, tests can show whether the concerning growth of cells is made up of prostate cancer cells. Other tests on the cells might give more information. Tests called biomarker tests can help the healthcare team decide which treatments are most likely to work.

Genetic testing for metastatic prostate cancer

Genetic testing uses a sample of blood or saliva to look for variations in the DNA. Some metastatic prostate cancer treatments work better in people who are born with or who develop certain DNA variations. Sometimes genetic tests provide information about cancer risk that can be helpful for blood relatives.

Metastatic prostate cancer prognosis

Metastatic prostate cancer typically can't be cured. But treatments can slow the growth of the cancer and extend your life. Some people with cancer want to know their prognosis. For an advanced cancer that can't be cured, the prognosis refers to how long you can expect to live with your cancer. Things that can affect your personal prognosis for metastatic prostate cancer might include:

  • Your age.
  • Your overall health.
  • Whether this is your first prostate cancer diagnosis or whether the cancer has come back after treatment.
  • PSA test results.
  • Whether your cancer is causing symptoms.
  • Where the cancer spreads.
  • How many different places the cancer spreads.
  • Whether your cancer cells are sensitive to hormone therapy treatments.
  • The genetic makeup of your cancer.

If you're interested in knowing your prognosis, talk about it with your healthcare team. Your healthcare team can explain what is considered when thinking about your prognosis.

Treatment

Treatment for metastatic prostate cancer often starts with hormone therapy. This treatment blocks the effects of hormones that prostate cancer cells use to help them grow. If the cancer starts growing again, other treatments may be used.

Eventually most metastatic prostate cancers find ways to grow without hormones. When this happens, healthcare professionals call these advanced cancers castration-resistant prostate cancers. Hormone therapy treatments usually continue. But other medicines might be added to the treatment plan. These other treatments might include chemotherapy, targeted therapy, immunotherapy and radiopharmaceutical treatments.

Many treatments are available for metastatic prostate cancer, which also is called stage 4 prostate cancer. If one treatment stops working, there often are other options. Metastatic prostate cancer treatments may slow the cancer and extend your life. But metastatic prostate cancer often can't be cured.

Hormone therapy for metastatic prostate cancer

Hormone therapy for prostate cancer is a treatment that stops the hormone testosterone either from being made or from reaching prostate cancer cells. Prostate cancer cells rely on testosterone to help them grow. Cutting off the supply of testosterone may cause cancer cells to die or to grow more slowly.

Hormone therapy treatments for metastatic prostate cancer include:

  • Medicines that stop the body from making testosterone. Some medicines stop cells from getting the signals that tell them to make testosterone. These medicines are called luteinizing hormone-releasing hormone agonists and antagonists. Another name for these medicines is LHRH agonists and antagonists. Medicines that work in this way include degarelix (Firmagon), leuprolide (Camcevi, Eligard, Lupron Depot) and other medicines.
  • Medicines that stop testosterone from acting on cancer cells. These medicines, known as antiandrogens, are often used with LHRH agonists. That's because LHRH agonists can cause a brief rise in testosterone levels before testosterone levels go down. Medicines that work in this way include bicalutamide (Casodex) and other medicines.
  • Newer hormone therapy medicines. Newer forms of antiandrogen medicines are sometimes called androgen receptor pathway inhibitors or androgen receptor signaling inhibitors. They also stop testosterone from acting on the cancer cells. Medicines that work in this way include apalutamide (Erleada), darolutamide (Nubeqa) and enzalutamide (Xtandi).
  • Other medicines that block hormones. Other parts of the body can help make testosterone. Some people need medicine to block these other sources of hormones in order to control the cancer. One example of a medicine that works like this is abiraterone (Yonsa, Zytiga).
  • Surgery to remove the testicles, called orchiectomy. Surgery to remove both testicles lowers testosterone levels in the body quickly.

For metastatic prostate cancer, hormone therapy often involves two kinds of hormone therapy treatments. If the prostate cancer has spread to many places in the body, treatment also might involve chemotherapy.

Side effects of prostate cancer hormone therapy include hot flashes, body hair loss, loss of muscle and increase in body fat. There may be a loss of sex drive, and it can be more difficult to get an erection. Other hormone therapy risks include an increased chance of getting diabetes and heart disease.

Chemotherapy for metastatic prostate cancer

Chemotherapy treats cancer with strong medicines. Chemotherapy medicines are sometimes used with hormone therapy medicines for metastatic prostate cancer. Chemotherapy also helps treat advanced prostate cancer when hormone therapy isn't working.

Chemotherapy medicines commonly used for prostate cancer include docetaxel (Beizray, Docivyx, Taxotere), cabazitaxel (Jevtana) and other medicines. A healthcare professional gives these medicines through a vein. The treatments typically happen once every three weeks. Side effects of these medicines include feeling very tired, easy bruising and more-frequent infections. They also can damage the nerves in the fingers and toes, a condition called peripheral neuropathy. This can cause numbness, tingling or pain in the fingers and toes.

Other chemotherapy medicines exist. Your healthcare team picks the best medicines for your cancer.

Targeted therapy for metastatic prostate cancer

Targeted therapy for cancer is a treatment that uses medicines that attack the cancer cells in a specific way that causes the cells to die.

For metastatic prostate cancer, targeted therapy medicines might be used when hormone therapy is no longer working.

Many targeted therapy medicines exist. Targeted therapy medicines sometimes used for metastatic prostate cancer include:

  • Niraparib (Zejula).
  • Olaparib (Lynparza).
  • Rucaparib (Rubraca).
  • Talazoparib (Talzenna).

These targeted therapy medicines come as pills or capsules you swallow. The medicines block the action of enzymes in the cancer cells that help repair breaks in the DNA. These targeted therapy medicines work best in people with certain DNA changes in their cells. To find out if these changes are present in your cells, your healthcare team may test a sample of your blood or saliva, as well as some of your cancer cells.

Side effects of targeted therapy medicines for metastatic prostate cancer include feeling very tired, nausea and loss of appetite. Other side effects include diarrhea, cough, easy bruising and more-frequent infections.

Immunotherapy for metastatic prostate cancer

Immunotherapy for cancer is a treatment with medicine that helps the body's immune system kill cancer cells. The immune system fights off diseases by attacking germs and other cells that shouldn't be in the body. Cancer cells survive by hiding from the immune system. Immunotherapy helps the immune system cells find and kill the cancer cells.

For metastatic prostate cancer, immunotherapy treatments most often involve medicines called immune checkpoint inhibitors. These medicines help immune system cells find cancer cells. Some cells can send signals called immune checkpoints to the immune system. Immune checkpoints tell the immune system cells not to attack. Usually, immune checkpoints help keep the immune system from hurting healthy cells. But some cancer cells also send these signals. Immune checkpoint inhibitor medicines stop cancer cells from sending a signal to not attack.

Immune checkpoint inhibitor medicines only work in people with cancer cells that have certain DNA changes. Most prostate cancers don't respond to this treatment. One example of an immune checkpoint inhibitor used for prostate cancer is pembrolizumab (Keytruda). Side effects can include feeling very tired, itchy skin, diarrhea, loss of appetite and rash. Sometimes this treatment causes the immune system to attack the organs, leading to serious complications.

Radiopharmaceutical treatments for metastatic prostate cancer

Radiopharmaceutical treatments are medicines that contain a radioactive substance. Radiopharmaceutical treatments used for cancer can deliver radiation to cancer cells.

Radiopharmaceutical treatments used for metastatic prostate cancer include:

  • Treatments that target PSMA. Radiopharmaceutical treatments can target a protein that's common on prostate cancer cells called prostate-specific membrane antigen. It's also called PSMA. One radiopharmaceutical medicine that works in this way is lutetium Lu-177 vipivotide tetraxetan (Pluvicto). This medicine contains a molecule that finds and sticks to the PSMA on prostate cancer cells. The medicine also contains a radioactive substance. A healthcare professional gives this medicine through a vein. The medicine finds the prostate cancer cells and releases the radiation directly into the cells. It can treat prostate cancer anywhere in the body. PSMA therapy only works if the prostate cancer cells have the PSMA protein. Side effects include dry mouth, dry eyes, nausea and feeling very tired.
  • Treatments that target the bones. Some radiopharmaceutical medicines contain a radioactive substance that is attracted to bones. When a healthcare professional puts this medicine into a vein, it travels to the bones and releases the radiation. One medicine that works in this way is radium Ra-223 (Xofigo). Healthcare professionals sometimes use it when prostate cancer spreads to the bones, but not to other parts of the body. This treatment can help with bone pain and other symptoms. Side effects include diarrhea and feeling very tired.

Radiation therapy for metastatic prostate cancer

Radiation therapy treats cancer with powerful energy beams. The energy can come from X-rays, protons and other sources. During radiation therapy, you lie on a table while a machine directs radiation to precise points on your body.

If your initial treatment for prostate cancer didn't involve removing your prostate, you might have radiation therapy to the prostate. It might be an option if you have only a few areas of metastatic prostate cancer.

Radiation therapy also can help manage metastatic prostate cancer that spreads to the bones. Radiation to the affected bone can help with pain and lower the chances that the bone might break.

Clinical trials for metastatic prostate cancer

Clinical trials are studies of new treatments. These studies provide a chance to try the latest treatments. The risk of side effects might not be known. Ask your healthcare team if you might be able to be in a clinical trial.

Palliative care for metastatic prostate cancer

Palliative care is a special type of healthcare that helps you feel better when you have a serious illness. If you have cancer, palliative care can help relieve pain and other symptoms. A team of healthcare professionals gives palliative care. This team can include doctors, nurses and other specially trained professionals. Their goal is to improve the quality of life for you and your family.

Palliative care specialists work with you, your family and your healthcare team to help you feel better. They provide an extra layer of support while you have cancer treatment. You can have palliative care at the same time as treatment for cancer, such as surgery, chemotherapy or radiation therapy.

When palliative care is used with all of the other appropriate treatments, people with cancer may feel better and live longer.

Alternative medicine

No alternative medicine treatments have been proved to cure metastatic prostate cancer. But complementary and alternative medicine may help you cope with symptoms of your cancer, such as pain.

Complementary and alternative medicine treatments that may reduce cancer pain include:

  • Acupuncture.
  • Acupressure.
  • Hypnosis.
  • Massage.
  • Relaxation techniques.

If your pain isn't controlled enough, talk with a member of your healthcare team about your options.

Coping and support

People who are diagnosed with a serious illness often say they feel stressed. In time, you'll find ways to help you cope with stress and other feelings that come with a metastatic prostate cancer diagnosis. Until you find what works for you, some of the following suggestions might help.

Learn about your cancer

Learn enough about your cancer to help you make decisions about your care. Ask a member of your healthcare team about the details of your cancer and your treatment options. Ask about trusted sources of more information.

Find a good listener

Finding someone who is willing to listen to you talk about your hopes and fears can be helpful as you manage a cancer diagnosis. This could be a friend or family member. A counselor, medical social worker or clergy member also may offer helpful guidance and care.

Also ask about support groups in your area. Or check with cancer organizations. In the United States, you might start with the National Cancer Institute and the American Cancer Society.

Look for a connection to something beyond yourself

Having a strong faith or a sense of something greater than oneself helps many people cope with advanced cancer.

Preparing for your appointment

Make an appointment with a doctor or other healthcare professional if you have ongoing symptoms that worry you. If you've had prostate cancer in the past, tell your healthcare professional. If your health professional thinks you might have metastatic prostate cancer, that person might refer you to a doctor who specializes in treating cancer, called an oncologist.

Here's some information to help you get ready for your appointment.

What you can do

When you call to make the appointment, ask if there's anything you need to do before you go to the appointment, such as restrict your diet. Ask a family member or friend to go with you to help you remember the information you get.

Make a list of:

  • Your symptoms and when they began. Include symptoms that don't seem related to why you made the appointment.
  • All medicines, vitamins and supplements you take, including doses.
  • Questions to ask your healthcare team.

For metastatic prostate cancer, questions might include:

  • What is likely causing my symptoms?
  • What are other possible causes for my symptoms?
  • What tests do I need?
  • What is the best course of action?
  • I have other health conditions. How can I best manage them together?
  • Are there restrictions that I need to follow?
  • Should I see a specialist?
  • Are there brochures or other printed material that I can have? What websites do you recommend?

Be sure to ask all the questions you have about your condition.

What to expect from your doctor

Be prepared to answer questions about your symptoms and your health, such as:

  • Have your symptoms been ongoing, or do they come and go?
  • Do your symptoms get in the way of your everyday activities?
  • What, if anything, seems to make your symptoms better?
  • What, if anything seems to make your symptoms worse?
By Mayo Clinic Staff