Metastatic Prostate Cancer – Symptoms and Causes

Overview

Metastatic prostate cancer occurs when cancer cells that began in the prostate spread to other areas of the body. This condition is also known as advanced prostate cancer or stage 4 prostate cancer.

The prostate is a small gland in the male reproductive system located just under the bladder. It produces fluid that forms part of semen. When abnormal cells grow uncontrollably in this gland, prostate cancer develops.

Most cases of prostate cancer remain confined to the prostate gland at diagnosis. Metastatic prostate cancer is less common as an initial diagnosis. It more frequently develops in individuals who previously received treatment for prostate cancer.

Several treatment options exist for metastatic prostate cancer. While these treatments typically cannot cure the cancer completely, they can effectively slow cancer progression and manage symptoms.

Common sites where prostate cancer spreads:

• Bones
• Lymph nodes
• Lungs
• Liver
• Brain

Signs of Advanced Prostate Cancer

Advanced prostate cancer may not always show symptoms right away. As the cancer progresses, you might notice certain changes in your body. These may include:

• Extreme fatigue
• Frequent urination or pain when urinating
• Unexplained weight loss
• Feeling sick to your stomach or throwing up
• Pain in the back, hips, pelvis, or bones that gets worse over time

When prostate cancer spreads to other organs, additional symptoms can occur depending on the area affected:

• Bones: Severe and persistent bone pain, increased risk of fractures
• Lymph Nodes: Swelling in the legs or pelvic area due to lymphatic blockage
• Lungs: Shortness of breath, persistent cough, or chest pain
• Liver: Yellowing of the skin or eyes (jaundice), abdominal swelling
• Brain: Headaches, dizziness, vision changes, or seizures

When You Should Contact a Doctor

If you notice any worrying symptoms, schedule an appointment with your healthcare provider promptly. This is especially important if you’ve had prostate cancer treatment before. Don’t wait until symptoms become severe.

Causes

The exact cause of metastatic prostate cancer remains unknown. This advanced cancer develops when prostate cancer cells break free from the original tumor and travel to other parts of the body through the bloodstream or lymphatic system.

Most commonly, metastatic prostate cancer spreads to:

• Bones
• Lymph nodes
• Liver
• Lungs

Less frequently, metastatic prostate cancer may spread to:

• Adrenal glands
• Brain
• Pancreas

Metastatic prostate cancer is classified as stage 4 cancer. When cancer cells travel to distant organs, they can establish new tumors and continue to grow, creating serious health problems beyond the prostate.

Risk Factors

Several factors can increase the chance of developing prostate cancer, including metastatic forms. Understanding these risks can help with early detection and prevention efforts.

Age plays a significant role in prostate cancer risk. Men over 50 years old face a much higher risk, with chances increasing as they age.

Race and ethnicity affect risk levels differently. In the U.S., Black men have higher prostate cancer rates than other racial groups. Their cancers often grow faster and may be discovered at more advanced stages.

Family history is an important consideration in two ways:

• Having a father, brother, or other close blood relative with prostate cancer increases your risk
• Extended family history (grandparents, uncles) also matters when assessing risk

Genetic factors contribute to some prostate cancer cases. Inherited DNA changes, particularly the BRCA1 and BRCA2 mutations, raise prostate cancer risk. These same genetic changes are known to increase breast and ovarian cancer risks.

Obesity appears to affect prostate cancer in several ways:

• Research shows mixed results about obesity increasing initial risk
• Men with obesity tend to develop more aggressive forms of the disease
• Cancer recurrence after treatment is more common in men with obesity

Smoking has connections to prostate cancer development and progression. While not all studies agree on smoking as a direct cause, research indicates that smokers face:

• Higher chances of cancer spreading beyond the prostate
• Greater risk of cancer returning after treatment

Complications

Treatments for metastatic prostate cancer can lead to bone thinning, which increases the risk of fractures. This condition makes bones more fragile and prone to breaking from even minor injuries.

Preventing Bone Loss

Healthcare providers recommend several strategies to protect bone health during prostate cancer treatment:

Lifestyle Changes:

• Reduce alcohol consumption
• Quit smoking
• Engage in weight-bearing exercise for 30 minutes most days

Diet and Supplements:

• Consume calcium-rich foods like dairy products (cheese, milk, yogurt)
• Include calcium-containing vegetables (bok choy, broccoli, kale)
• Take vitamin supplements as recommended by your healthcare team

Weight-bearing exercises are particularly important because they help maintain bone density. These activities require your legs to support your body weight.

Examples of Weight-Bearing Exercises:

• Walking
• Running
• Strength training
• Basketball
• Pickleball
• Lifting weights

Monitoring Bone Health

Patients typically undergo bone density testing when starting treatment for metastatic prostate cancer. This important screening helps establish a baseline measurement of bone strength.

Follow-up bone density tests may be scheduled every one to two years. These regular assessments allow healthcare providers to:

1. Monitor changes in bone density
2. Detect early signs of bone thinning
3. Adjust treatment plans accordingly

Medication Options

When bone thinning occurs, healthcare providers may prescribe medications to strengthen bones. These medications work through different mechanisms:

Medication Type	How It Works	Common Side Effects
Bisphosphonates	Slow bone breakdown	Flu-like symptoms, digestive issues
RANK ligand inhibitors	Block cells that break down bone	Low calcium levels, jaw problems
Selective estrogen receptor modulators	Mimic estrogen effects on bone	Hot flashes, blood clot risk

These medications can help rebuild bone density and reduce fracture risk when used appropriately.

Pain Management

Bone-related complications often cause pain. This can significantly impact quality of life for patients with metastatic prostate cancer.

Effective pain management typically involves:

• Over-the-counter pain relievers
• Prescription medications
• Physical therapy
• Hot/cold therapy
• Relaxation techniques

Radiation Therapy

For patients with painful bone metastases, radiation therapy can provide relief. This treatment targets cancer cells in the bones and can:

• Reduce pain
• Decrease tumor size
• Lower the risk of fractures

Both external beam radiation and radiopharmaceuticals (drugs containing radioactive elements) may be used, depending on how widespread the bone metastases are.

Surgery

In some cases, surgery may be needed to:

• Stabilize bones at high risk of fracture
• Repair bones that have already fractured
• Relieve pressure on the spinal cord

Other Potential Complications

Beyond bone issues, patients with metastatic prostate cancer may experience:

Urinary Problems:

• Difficulty urinating
• Increased frequency
• Blood in urine

Bowel Issues:

• Constipation
• Diarrhea
• Rectal bleeding

Fatigue and Weakness:

• Energy depletion
• Muscle weakness
• Reduced stamina

Nerve Compression:

• Pain, numbness, or tingling in arms/legs
• Weakness in limbs
• Balance problems

Working closely with your healthcare providers helps ensure complications are identified and treated early, improving quality of life during treatment.