Prostate Cancer
Treatment Guide™

Advanced Prostate Cancer

If the disease has reached clinical stageⁱ T3 or T4, it is classified as advanced prostate cancer. Advanced prostate cancer with bone metastasis or lymph node metastasis is more likely to cause Prostate Cancer Symptoms than is an early stage of the disease. Doctors usually check for bone metastasis and lymph node metastasis which are denoted respectively by M and N in clinical staging.

In clinical stage T3, the tumor has extended beyond the prostatic capsule, possibly into the seminal vesicles, and is specifically called extraprostatic extension. Extraprostatic means ‘independent of the prostate gland.’ In clinical stage T4, the disease invades surrounding organs (other than the seminal vesicles) such as the bladder neck, external sphincter, or rectum.

Metastasis is more likely to occur during advanced prostate cancer. Metastatic disease refers to prostate cancer that has left the prostate gland and its neighboring organs. Advanced prostate cancer bone metastasis and lymph node metastasis, which can be local or distant, and bone metastasis are both associated with advanced prostate cancer. Metastases may involve symptoms that are not in the Prostate Cancer Treatment Guide.

What causes Prostate Cancer Metastasis?
Metastasis occurs through a process called angiogenesis. Angiogenesis is the process by which new blood vessels are formed; malignant cells are capable of ‘hitching a ride’ into another part of the body. The malignant cells can commonly become lodged in the bones or lymph nodes. From there, the cells “take root” and start dividing uncontrollably.

Prostate Cancer Lymph Node Metastasis
The body produces a fluid called lymph which contains white blood cells and circulates through the lymphatic system. Lymph nodes are small oval or circular organs that filter this fluid. Cancerous cells that circulate through the body can become trapped in the lymph nodes. Once trapped, cancerous cells can begin their cycle of unhealthy division and result in lymph node metastasis.

There are two types of lymph node metastasis: local and distant. Local lymph node metastasis is designated by clinical stage N1. Two lymph nodes lie on either side of the bladder. Because these nodes are close to the prostate gland, metastasis is considered local. If cancerous cells begin to grow in any other lymph node, the metastasis is considered distant. Distant lymph node metastasis is denoted by clinical stage M1a.

Prostate Cancer Bone Metastasis
Primary cases of bone cancer are relatively rare. Patients who develop bone cancer are more likely to develop the disease as a result of advanced prostate cancer metastasis. In prostate cancer, extension leading to bone disease is designated by a clinical stage M1b. If a person develops bone disease as a result of prostate cancer, he does not now have bone cancer. Because the cancer is classified according to where it originated, he has prostate cancer with bone metastasis.

Symptoms of advanced prostate cancer bone metastasis may cause stiffness or frequent soreness in areas such as the lower back, hips, and thighs. Some patients will experience more severe pain than others. As the disease progresses, some prostate cancer patients begin chemotherapy or external radiation therapy to alleviate the pain associated with bone cancer.

The Growth of Prostate Cancer to Advanced Stages
Most cases of prostate cancer, however, usually grow very slowly. Many men die with prostate cancer rather than from prostate cancer and never reach the stages of advanced prostate cancer. The slow growth of the disease is one of the reasons why treatments such as watchful waiting are viable options, and why treatments such as chemotherapy are not. Watchful waiting monitors the disease for sudden progression instead of starting an invasive treatment. Chemotherapy on the other hand indiscriminately kills quickly dividing cells. If the malignant cells in the gland are not dividing quickly, treatment will not be effective.

The Prostate Cancer Treatment Guide uses the Clinical and Pathological staging created by the American Joint Committee on Cancer (AJCC). To read more about prostate cancer clinical staging and pathological staging, please go to Prostate Cancer Staging.

ⁱThe Prostate Cancer Treatment Guide uses the Clinical and Pathological staging created by the American Joint Committee on Cancer (AJCC). To read more about prostate cancer clinical staging and pathological staging, please go to Prostate Cancer Staging.