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Advanced Prostate Cancer

Over 200,000 men are newly diagnosed with prostate cancer annually in the United States. With the likelihood of getting prostate cancer increasing with age, the advent of prostate cancer screening means cancer is being detected and treated earlier; however, approximately 5-10%of newly diagnosed prostate cancer cases involve advanced disease. In addition, some men may develop a recurrence of their cancer despite initial attempts at curative therapy such as surgery or radiation therapy. For more resources on prostate cancer visit our Know Your Stats ® site for the most up-to-date information.

Ideally, doctors prefer to find the disease in its earliest and most treatable stages. But for men diagnosed with advanced prostate cancer, the prognosis is getting better all the time. There are a number of effective treatments available. The information presented is a resource for physicians, patients, and caregivers on advanced prostate cancer and the current available treatment options.

However, before deciding on any treatment options it is important to understand that advanced prostate cancer is a very complex disease. While the following treatment options are available it does not mean they are the best option for you. It is critical that patients and physicians come together to map out a treatment solution that works well for a man’s over health and lifestyle. Prostate cancer and specifically advanced prostate cancer is a very individual disease and before deciding to take any treatment action is important to have a very open and honest discussion with your provider. If you need help finding a physician please use our Find a Urologist feature.

What is cancer?

Cells normally grow and divide in an orderly fashion, with old cells constantly being replaced with new cells. However, in cancer cells, this normally ordered process is interrupted and cells grow and are replaced in a completely unstructured way.

The extra cells form a mass called a growth or tumor. Tumors can be either benign (not cancerous) or malignant (cancerous). Benign tumors do not spread to other parts of the body, and are rarely a threat to life. Malignant tumors can spread (metastasize) and become life threatening.

What is primary cancer?

Cancer can begin in any organ or tissue and the original tumor site is called the primary cancer or primary tumor. It is usually named for the part of the body or the type of cell in which it begins.

What is metastasis, and how does it happen?

Metastasis means the spread of cancer. Cancer cells break away from the primary tumor and enter the bloodstream or lymphatic system (the system that produces, stores, and carries the cells that fight infections).

When cancer cells spread and form a new tumor in a different location, the new tumor is called a metastatic tumor. For example, if prostate cancer spreads to the bones, the metastatic tumor in the bone is made up of cancerous prostate cells (not bone cells). In this case, the disease in the bone is metastatic prostate cancer (not bone cancer).

How does a doctor know whether a cancer is a primary or a metastatic tumor?

A pathologist examines a sample of the tumor under a microscope to determine whether the tumor is primary or metastatic. Cancer cells look like abnormal versions of cells in the tissue where the cancer began. Using specialized diagnostic tests, a pathologist is often able to tell where the cancer cells came from.

Metastatic cancers may be found before or at the same time as the primary tumor, or months or years later. When a new tumor is found in a patient who has been treated for cancer in the past, it is more often a metastasis than another primary tumor.

What are the types of advanced prostate cancer?

The commonly encountered disease categories of prostate cancer are summarized below. They range from prostate cancer that is confined to the prostate gland to prostate cancer that has spread outside of the prostate to the lymph nodes and bone. For more information on general prostate cancer please refer to our A to Z list

  • Locally Advanced Prostate Cancer:
  • Cancer that has grown to fill the prostate or has grown through the prostate and may extend into the glands that help produce semen (seminal vesicles), or the bladder..
  • Biochemically Recurrent Prostate Cancer (Rising PSA):
  • Patients who have a rising PSA after treatment, but do not show any evidence that the disease has spread to bone or other organs. This can occur after local treatment, or after hormone therapy. The management of such patients is controversial, and may include investigational treatments, radiation therapy, salvage surgery, hormone therapy, or chemotherapy.
  • Metastatic Prostate Cancer (Hormone Sensitive):
  • Cancer that has spread (metastasized) to the bone, lymph nodes or other parts of the body. Through the depletion of the male sex hormone, testosterone or medications, improvement in the patient’s urinary function and pain control can be achieved.
  • What is Castrate Resistant Prostate Cancer (CRPC):
  • Castrate Resistant Prostate Cancer (CRPC) is prostate cancer that continues to grow despite the suppression of male hormones that fuel the growth of prostate cancer cells.

What are Hormones and Androgens and their relationship to advanced prostate cancer?

Hormones are chemical messengers that are produced by the body’s glands and cause or control a particular bodily function. The human body produces and uses millions of hormones. In men, a critical class of hormones is called “androgens” and they have a wide range of functions.

Androgens are responsible for many uniquely male features including: lower voice, male hair patterns and the male libido, or sexual drive. In addition, androgens are extremely important in building muscle mass, increasing bone formation and stimulating red blood cell production. In essence, androgens affect every major tissue in the male body.

The two major androgens involved in prostate cancer are:

  • Testosterone
  • dihydrotestosterone (DHT)

Testosterone, which is produced in the testicles, is often referred to as “the male sex hormone.” The male androgens have been shown to stimulate prostate cancer growth. DHT, the androgen that is created due to the metabolism of testosterone, is five times as potent a growth stimulator of prostate cancer when compared to testosterone.

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Information provided by the American Urological Association.