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Understanding Your Road

You already know about prostate cancer. Now it’s time to talk about living with advanced prostate cancer. Being diagnosed with advanced prostate cancer can stop you in your tracks. You have questions. And these are important questions. You want to know “How bad is it? What are my options? What does this mean for my life and everyone in it?” Explore the site to learn more about these topics, but start by understanding the road you are on.

“We are the same men, but different: we are fundamentally, emotionally and spiritually moved by our experiences. We are making a journey that was not our choice, but on a path that we have chosen for ourselves, and we have a perspective unique to us as individual men.”

Alan W.

What Are the Stages of Prostate Cancer?

Not all prostate cancer is the same. It ranges from cancer confined to the prostate gland to cancer that has spread outside of the prostate to the lymph nodes, bones, or other parts of the body. You can determine the extent or spread of the cancer by knowing the stages of prostate cancer:

Staging Determines the Extent, or Spread, of Prostate Cancer

Stage
I

The tumor is confined to the prostate. 

Stage
II

The tumor is more advanced than Stage I, but doesn’t extend beyond the prostate.

Stage
III

The tumor extends beyond the prostate and may have invaded the seminal vesicles (tubular glands above the prostate), but cancer cells have not spread to the lymph nodes. 

Stage
IV

The tumor may have invaded the bladder, rectum or nearby structures (beyond the seminal vesicles) and may have spread to the lymph nodes, bone or to other parts of the body. 

Stages III and IV are considered to be advanced prostate cancer. Stage III is also known as "locally advanced" and Stage IV as "metastatic" prostate cancer.

There are multiple types of advanced prostate cancer, including:

  • Locally Advanced: 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 lymph nodes.
  • Biochemically Recurrent (Rising PSA): Patients who have a rising prostate-specific androgen (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. 
  • Metastatic (Hormone-Sensitive): Cancer that has spread (metastasized) to the bone, lymph nodes or other parts of the body. 
  • Castration-Resistant Prostate Cancer (CRPC): CRPC is prostate cancer that continues to grow despite the suppression of male hormones that help fuel the growth of prostate cancer cells.
  • Metastatic Castration-Resistant Prostate Cancer (mCRPC): mCRPC is a form of advanced prostate cancer where the cancer has spread to parts of the body other than the prostate, and it is able to grow and spread even though drugs or other treatments to lower testosterone are being used to manage the cancer. That is, the cancer has the ability to thrive in a low testosterone environment. 

Patients who have been treated for prostate cancer in the past will likely attend regular checkups. Your doctor will watch for any increases in your PSA level and the speed with which any increases occur. A higher PSA does not necessarily mean your cancer has come back. But it may mean that you need further tests, such as other imaging tests to help your doctor determine if the cancer has spread.

To find more information and resources on screening, we recommend visiting About Screening from the Prostate Conditions Education Council (PCEC).

What's Fueling the Cancer?

If you have mCRPC, your tumor may be fueled by androgens. Androgens are hormones – primarily produced in the testes, and also made in the adrenal glands – that contribute to male characteristics, like your baritone voice, muscle tone and facial hair. However, for men with mCRPC, androgens can play a negative role by helping to fuel tumor survival.

Research has shown that tumors are capable of producing their own additional androgen to help fuel themselves. Some mCRPC treatments attempt to slow or stop production of the hormones, basically depriving the tumor of the androgens fueling it.

How Is Prostate Cancer Diagnosed?

Most prostate cancers are first found during screening with a PSA blood test and/or a digital rectal exam (DRE). Early prostate cancers usually don’t cause symptoms, but more advanced forms may be found because of symptoms they cause. Whether prostate cancer is suspected based on screening tests or the presence of symptoms, the actual diagnosis is made with a biopsy of the prostate.

A pathologist studies prostate tissue samples collected during a biopsy under a microscope to determine the grade of the tumor (i.e., how different the tumor tissue is from normal prostate tissue).

Sometimes primary cancer is discovered only after the metastatic tumor begins to cause symptoms. For example, if your prostate cancer has spread to the bones in your pelvis, you may have lower back pain. Although not common, this may happen before you experience any symptoms from the primary tumor in your prostate.

What Are Prostate Cancer Risk Factors?

Older men are more likely to develop prostate cancer, as the chance of having prostate cancer rises rapidly after age 50. About six in 10 cases of prostate cancer are found in men over the age of 65.

Family history may be a risk factor. If your father or brother has had prostate cancer, you are about twice as likely to develop this disease compared to a man with no family history of the disease. The risk is even higher for men with several relatives who have or had prostate cancer.

While reasons are unknown, race also plays a role in who is at risk for prostate cancer. African-American men are 1.6 times more likely to get prostate cancer than Caucasian men. Prostate cancer occurs less often in Asian-American and Hispanic/Latino men than in non-Hispanic Caucasian men. 

Risk factors

  • Age 50 or older
  • Family history
    Father or brother has had prostate cancer
  • Race/Ethnicity 
    African-Americans are at higher risk than Caucasians and Hispanics. Prostate cancer occurs less often in Asian-American and Hispanic/Latino men than in non-Hispanic Caucasian men
  • Pre-cancerous prostate changes can be a precursor to cancer
  • Genetic (chromosomal) abnormalities
    Such as a certain altered or missing gene