What is late stage prostate cancer?

Late stage prostate cancer is a term that is often used to describe Stage IV prostate cancer, which means a man’s cancer has metastasized (spread) to lymph nodes either near or far from the prostate gland. It is also used to describe prostate cancer that has spread to other parts of a man’s body, such as the rectum, bladder, lungs, liver, or bones (it is common for metastatic prostate cancer to spread to a man’s bones).

Later-stage prostate cancer used to be referred to as D1 or D2 stage prostate cancer, based on the older Whitmore-Jewitt staging system. But now most healthcare professionals use the TNM staging system. With this system, late stage prostate cancer typically refers to prostate cancers that range from N1 to M1c.

To make things a bit more confusing, sometimes late stage prostate cancer is referred to as advanced prostate cancer. In that case, men with T3/N0/M0 cancers might also fit into the “late stage” category. Advanced prostate cancer basically means that the cancer has moved beyond the prostate gland. It may be further defined as locally advanced, regionally advanced, or metastatic prostate cancer. You might think that all men who have advanced prostate cancer will have a very high Gleason score, but that’s not always the case.

Treatment options

If your loved one has been told he has late stage prostate cancer, his cancer is generally not considered to be curable (at least not with the treatments that are available today). Surgery is usually not an option because the cancer has already spread beyond the prostate gland. But there are still many treatments available to try to keep the prostate cancer from progressing, and there are many men who are living with late stage prostate cancer.

These treatment options may include:

• External beam radiation (which is sometimes combined with hormonal therapy)
• Hormonal therapy (such as androgen suppression therapy)
• Chemotherapy (which may be used to suppress the cancer or try to lessen bone pain
• Experimental therapies that are being studied in clinical trials (such as immunotherapies)

Hormone therapy is a very common treatment and it has been shown to help some men live longer. The challenge is that at some point the cancer stops responding to hormone treatment. When this happens it is called hormone-refractory prostate cancer or androgen-independent cancer.

There has been some debate about whether men with advanced prostate cancer should have early hormone therapy (particularly if they have no symptoms) or delay their therapy until symptoms become troublesome. Because of the side effects of hormone therapy (both short- and long-term), this is something that your loved one should thoroughly discuss with his physician. The decision may also be based on how fast your loved one’s cancer is progressing.

7/09

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References:

The American Cancer Society. Prostate Cancer. http://www.cancer.org. Accessed July 23, 2009.

Moul JW. The Evolving Definition of Advanced Prostate Cancer. Rev Urol. 2004;6(Suppl 8):S10–S17.

Miyamoto H, Messing EM. Early versus late hormonal therapy for prostate cancer. Curr Urol Rep. 2004 Jun;5(3):188-96.