What is advanced prostate cancer?

Advanced prostate cancer is when cancer cells have spread from the prostate to other parts of the body. It is not possible to cure advanced prostate cancer. But there are treatments that can help to keep it under control.

Prostate cancer may be early, locally advanced or advanced. This information is about advanced prostate cancer.

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Symptoms of advanced prostate cancer

If you are worried about prostate cancer, we have more information about the signs and symptoms.

Symptoms of prostate cancer may not develop for many years. The symptoms of advanced prostate cancer may be caused by an enlarged prostate. Or symptoms may be a sign of secondary cancer, where the cancer has spread to another part of the body.

Causes of advanced prostate cancer

Prostate cancer is the most common cancer in men in the UK. It is more common over the age 65. Although it can happen at a younger age it is uncommon under 50. People who have a prostate include men, transwomen and people assigned male at birth. If you are a trans woman and have had genital gender affirming surgery as part of your transition, you still have a prostate. Trans men do not have a prostate. It is important to talk to your GP or nurse if you are worried about prostate cancer or have symptoms.

We have more information about the risk factors of prostate cancer.

Diagnosis of advanced prostate cancer

You may be diagnosed with advanced prostate cancer:

  • after previous treatment for early or locally advanced prostate cancer – possibly many years ago
  • after being diagnosed with cancer in the prostate, if further tests show the cancer is advanced
  • after tests to check symptoms of bone pain, with no previous diagnosis of prostate cancer.

The most common places for prostate cancer to spread to is to the bones and lymph nodes outside the pelvis.

If you have had prostate cancer before and have symptoms

You usually have tests to check whether the cancer has spread. These include:

  • PSA test

    If cancer is present, you may have a PSA test to check your PSA level. 

  • Bone scan

    When you have a bone scan, a radioactive substance is injected into a vein. A special camera is then used to take a scan of your bones.

If you have just been diagnosed with prostate cancer

You will have further tests to see if the cancer is advanced. These include:

  • Bone scan

    When you have a bone scan, a radioactive substance is injected into a vein. A special camera is then used to take a scan of your bones.

  • CT scan

    A CT scan takes a series of x-rays which build up a three-dimensional picture of the inside of the body.

  • MRI scan

    You may have an MRI scan before you have a biopsy. Specialised scans called multi-parametric MRI scans can give more detailed images of the body. Depending on the results of the scan you may not need a biopsy.

If you were diagnosed with secondary cancer in the bones

You will need tests to find out if it started in the prostate. These include a PSA test.

Depending on your situation, you may be offered a biopsy of the prostate, where samples of tissue are taken. You may also have x-rays of the bones in a painful area, to find out if there are any abnormal areas.

Most prostate cancers grow very slowly. Even if it takes a couple of weeks to get your results, it is unlikely that the cancer will change during this time.

Waiting for test results can be a difficult time, we have more information that can help.

Staging and grading of advanced prostate cancer

The stage of a cancer describes its size and how far it has spread, based on your test results. Doctors often use the TNM staging system or a number staging system.

A doctor decides the grade by how the cancer cells look under the microscope. This gives an idea of how quickly the cancer might grow or spread. You and your doctors can then talk about the best treatment choices for you.

Find out more about staging and grading for prostate cancer.

Treatment for advanced prostate cancer

Although advanced prostate cancer cannot be cured, it can be controlled with treatment, sometimes for several years. Treatments can also help relieve symptoms and improve your quality of life.

A multidisciplinary team (MDT) will meet to discuss the best possible treatment for you. This will depend on different factors, like your general health. Your cancer doctor will talk to you about the advantages and disadvantages of these treatments.

The main treatments are:

  • Hormonal therapy

    Hormonal therapies reduce the amount of testosterone in the body. This may slow the growth of the cancer or stop it growing for a while.

  • Chemotherapy

    Chemotherapy uses anti-cancer (cytotoxic) drugs to destroy cancer cells. You may have it with hormonal therapy when you are first diagnosed with advanced prostate cancer. Or, it can be given when hormonal therapy is no longer controlling the cancer.

  • Radiotherapy (including radioisotope therapy)

    Radiotherapy is most often used to shrink cancer that has spread to the bones. External beam radiotherapy uses high energy rays to destroy cancer cells. It’s given using a large machine. Radioisotope therapy is a type of internal radiotherapy given as an injection.

  • Surgery

    Surgery to remove the prostate is not suitable for advanced prostate cancer. Surgery may be used to help control symptoms or to help stabilise a bone that is at risk of breaking.

Your doctor or nurse will usually ask you to sign a form giving your permission (consent) for them to give you the treatment. They cannot give treatment without your consent.

Treatments can help to control the cancer and relieve the symptoms. But there may be a time when the treatment has little effect on the cancer. This means you have the side effects without the benefits.

Making decisions about treatment is always difficult. You may want to talk it over carefully with your cancer doctor, specialist nurse, and family.

If you decide not to have further treatment, you will be given supportive (palliative) care, with medicines to control any symptoms.

Specialist nurses called palliative care nurses can provide help and support. They are experienced in assessing and treating symptoms of advanced cancer.

You may get anxious between appointments. This is natural. It may help to get support from family, friends or a support organisation.

Macmillan is also here to support you. If you would like to talk, you can:

  • Call the Macmillan Support Line on 0808 808 00 00
  • Chat online to our specialists online.
  • Visit our prostate cancer forum to talk with people who have been affected by prostate cancer, share your experience, and ask an expert your questions.

Managing symptoms of advanced prostate cancer

Symptoms can often be improved by treating the cancer, but there are other ways to control symptoms. Tell your doctor or specialist nurse if you have new symptoms or symptoms get worse.

You may see a doctor or nurse who specialises in pain and symptom control. They are sometimes called palliative care specialists.

Some people find complementary therapies such as relaxation, gentle massage, or aromatherapy help you feel better and more in control.

Sex and relationships

Prostate cancer treatments can have a direct effect on your sex life and relationship. They can reduce your sex drive (libido) and cause difficulties getting an erection. This is called erectile dysfunction or ED.

Many sexual difficulties caused by prostate cancer are similar whatever your sexuality. But having your sexual or gender or identity acknowledged may help you feel better supported.

Talk to your doctor or nurse about sexual difficulties or concerns. They will be used to talking about these issues. They can give you advice and offer practical ways to help manage sexual difficulties.

About our information

  • Reviewers

    This information has been written, revised and edited by Macmillan Cancer Support’s Cancer Information Development team. It has been reviewed by expert medical and health professionals and people living with cancer. It has been approved by Senior Medical Editors, Dr Jim Barber, Consultant Clinical Oncologist and Dr Lisa Pickering, Consultant Medical Oncologist.

    Our cancer information has been awarded the PIF TICK. Created by the Patient Information Forum, this quality mark shows we meet PIF’s 10 criteria for trustworthy health information.

Content under review

Due to the pandemic, there have been delays in us updating this information as quickly as we would have wanted. Our team is working hard to put this right.

The language we use

We want everyone affected by cancer to feel our information is written for them.

We try to make sure our information is as clear as possible. We use plain English, avoid jargon, explain any medical words, use illustrations to explain text, and make sure important points are highlighted clearly.

We use gender-inclusive language and talk to our readers as ‘you’ so that everyone feels included. Where clinically necessary we use the terms ‘men’ and ‘women’ or ‘male’ and ‘female’. For example, we do so when talking about parts of the body or mentioning statistics or research about who is affected. Our aims are for our information to be as clear and relevant as possible for everyone.

You can read more about how we produce our information here.

Reviewed: 30 June 2018
Reviewed: 30/06/2018
Next review: 30 June 2021
Next review: 30/06/2021

This content is currently being reviewed. New information will be coming soon.