When is prostate cancer considered advanced?

Prostate cancer is a type of cancer that originates in the prostate gland, a small walnut-shaped gland that is part of the male reproductive system. Like many other forms of cancer, prostate cancer begins when normal cells become mutated, begin to grow and divide in an uncontrolled way, and form tumors.

Prostate cancer is the second most common cancer among men in the United States (skin cancer is the most common) and the second leading cause of cancer deaths among men (lung cancer is the leading cause).

When is prostate cancer advanced?

Prostate cancer can be described as localized, locally advanced, or advanced. Key questions to answer during diagnosis are: 1) whether the cancer is still confined to the prostate or if it has spread beyond the prostate; and 2) if the cancer has spread beyond the prostate, where has it spread to.

• Prostate cancer is localized if cancerous cells are only located within the prostate.
• Locally advanced prostate cancer refers to cancers that have grown outside the prostate but are still confined to the general area of the prostate. A locally advanced prostate cancer may have spread to an adjacent structure like the seminal vesicles (glands located just above the prostate), but it has not spread to other organs, like the bladder or rectum.
• The term advanced prostate cancer refers to cancer that has spread beyond the prostate. This is referred to as metastatic prostate cancer, where cancerous cells have broken away from the original tumor and spread to other parts of the body. This can include nearby organs like the bladder and rectum, as well as more distant sites like the lymph nodes, bones, lungs, and liver.

These terms are related to the staging system used for prostate cancer. Prostate cancer is staged using the TNM staging system, which stands for tumors/nodes/metastases. Prostate cancer is given a stage between I and IV based on the size of the tumors, lymph node involvement, and metastases. There are many substages within the I through IV stages, which also take into account PSA levels and Gleason grade:

• PSA is a measure of the amount of prostate-specific antigen in the blood. Elevated levels are associated with prostate cancer.
• Gleason score is a comparison between cancerous cells and healthy cells. The more abnormal cancerous cells appear by comparison, the higher the grade. Higher grades are typically found with more aggressive cancers.

Localized prostate cancer typically refers to stages I and II, while stage III refers to locally advanced prostate cancer, and stage IV refers to advanced prostate cancer.

What other information is important?

It is also important to determine whether a cancer is hormone-sensitive or castration-resistant. Hormone-sensitive prostate cancers grow in the presence of the male sex hormone testosterone. If a prostate cancer is hormone-sensitive, it can be treated by depriving the cancer of this hormone. Castration-resistant prostate cancers grow even when deprived of testosterone. Knowing this information is essential to determining what treatment options can be used.

What is the goal of treating advanced prostate cancer?

Advanced prostate cancer cannot be cured, and treatment focuses on slowing progression, managing symptoms, improving a person’s quality of life while living with cancer, and helping a person live longer.

There are many factors to consider when determining the best approach to achieving these goals, including the side effects of different treatments. While there are many people living with prostate cancer, prostate cancer is a different experience for every person. Discussions with a healthcare team and loved ones are essential when making treatment decisions. It can also help to talk to other people who are living with prostate cancer—for example, by participating in a support group.