Metastatic prostate cancer

This page was reviewed under our medical and editorial policy by

Maurie Markman, MD, President, Medicine & Science.

This page was updated on May 10, 2022.

In many cases, prostate cancer cells are less aggressive and grow more slowly than cells found in other cancers. As a result, prostate cancer is often diagnosed before it has had a chance to spread, or metastasize, to other parts of the body. In 90 percent of cases, the disease is diagnosed while the cancer is confined to the prostate.

When diagnosed in early stages, prostate cancer is highly treatable. In metastatic or stage 4 prostate cancer, cancer cells break away from the tumor in the prostate and establish new tumors in other parts of the body. An initial diagnosis of metastatic prostate cancer is very rare.

Prostate cancer cells may travel through the lymphatic system or the bloodstream to other areas of the body. Common prostate cancer metastasis sites include:

  • Bones
  • Lungs
  • Liver
  • Brain
  • Lymph nodes outside the pelvis
  • Other organs

This article will cover:

Stage 4 prostate cancer substages

Stage 4 prostate cancer is classified into substages, and the subcategory the oncologist assigns helps guide the treatment options:

  • Stage 4A: Cancer cells have been found in nearby lymph nodes and may have spread into local tissue.
  • Stage 4B: Cancer has spread to areas farther away from the prostate, such as distant lymph nodes or bones.

Metastatic prostate cancer symptoms

With metastatic prostate cancer, the patient may notice different symptoms than those generally associated with other stages of the disease. Some of the most frequently occurring stage 4 prostate cancer symptoms include:

  • Bone pain, particularly in the pelvis, ribs, skull and spine (prostate cancer most commonly spreads to the bones)
  • Unexplained weight loss
  • Fatigue
  • General feeling of being unwell
  • Changes in urinary habits, such as needing to go more often
  • Cough, breathlessness or other changes involving the lungs and chest
  • Constipation

Not everyone with metastatic prostate cancer will experience each of these symptoms, but patients should speak with their care teams if they notice any such changes.

PSA levels in metastatic prostate cancer

As part of patients' ongoing treatment, the care team will regularly test PSA levels. PSA stands for prostate-specific antigen, which can be high in men who have prostate cancer. PSA tests are used not only for the initial cancer diagnosis but also to observe the advancement of the disease over time.

Generally, PSA levels are higher in men with metastatic prostate cancer. However, in rare cases, it’s possible to have a low PSA even if a patient has metastatic disease. For these patients, disease progression is better measured in other ways, such as through imaging tests and biomarker tools.

Metastatic prostate cancer treatment

If a patient has been diagnosed with prostate cancer and he or she is concerned about prostate cancer metastasis, they should talk with a doctor about the risk of prostate cancer metastasis and corresponding treatment options.

Treatments for stage 4 prostate cancer may depend on where in the body the disease has spread. Options include:

Surgery for metastatic prostate cancer

Unlike with localized prostate cancer, surgery isn’t usually used to treat metastatic cancer. However, it may be used in some cases if it can help improve a patient’s quality of life, often to resolve urinary problems or stop bleeding.

If prostate cancer is locally advanced and hasn’t spread far, a radical prostatectomy may still be an option. A radical prostatectomy is a surgical procedure in which the prostate is removed, along with any nearby tissue that contains prostate cancer cells.

Radiation therapy for metastatic prostate cancer

Radiation therapy may be used to treat men with high-risk prostate cancer or stage 4A cancer (in which the cancer has spread to lymph nodes near the prostate but not to other parts of the body).

In these instances, external beam radiation therapy is commonly used, also known as EBRT. Using an external machine, a doctor sends targeted beams of radiation to the cancer site. It’s administered five days a week in an outpatient facility throughout several weeks.

Radiation may be targeted to prostate cancer that has spread to the bones as well, helping reduce pain.

Hormone therapy for metastatic prostate cancer

Metastatic prostate cancer patients may benefit from hormone therapy. Androgen suppression therapy, also known as androgen deprivation therapy (ADT), uses medication to lower androgens (male hormones such as testosterone) created in the testicles, which can fuel cancer growth. Radiation therapy and hormone therapy may be given together.

Chemotherapy for metastatic prostate cancer

Chemotherapy may be used for patients with metastatic prostate cancer, with the aim of slowing any further spread of cancer and improving quality of life.

The most commonly used chemotherapy medications, typically given via an intravenous (IV) line, are docetaxel combined with prednisone. However, there are several chemotherapy drugs available, so ask a doctor which types may be most appropriate as an effective prostate cancer treatment.

In some cases, these treatments are considered palliative, intended to relieve difficult symptoms and improve quality of life.

Metastatic stage 4 prostate cancer prognosis

The metastatic prostate cancer prognosis varies from person to person, as every situation is different.

According to the American Cancer Society, regional cancer (which has spread into nearby parts of the body, such as the lymph nodes), has a five-year relative survival rate of more than 99 percent.

For distant cancer (when prostate cancer metastasizes into distant parts of the body), the five-year relative survival rate drops to 31 percent.

Integrative care

Treatments for metastatic prostate cancer often cause side effects that may impact quality of life. Side effects may include:

  • Digestive issues, such as diarrhea and vomiting
  • Pain
  • Hair loss
  • Fatigue

At City of Hope, our prostate cancer experts work closely with our integrative care team to anticipate potential side effects and work proactively to address issues so patients can better tolerate treatments. Supportive care services designed to help manage side effects include:

Learn more about integrative care

Next topic: What are the stages of prostate cancer?

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Show references
  • Cancer Research UK (2019, June 26). Symptoms of Advanced Prostate Cancer.
  • National Cancer Institute (2021, February 24). Prostate-Specific Antigen (PSA) Test.
  • Lu Y. (2021). Association between low prostate-specific antigen levels and greater disease progression in high-grade locally-advanced prostate cancer. Journal of the Formosan Medical Association, 120(1), Part 2, 483–491.
  • American Cancer Society (2022, January 18). Initial Treatment of Prostate Cancer, by Stage and Risk Group.
  • American Cancer Society (2019, August 1). Chemotherapy for Prostate Cancer.
  • American Cancer Society (2022, March 1). Survival Rates for Prostate Cancer.