HomeCancerStage 3 Metastatic Prostate Cancer

Stage 3 Metastatic Prostate Cancer

How To Find Support

Healing my Metastatic Prostate Cancer at Paracelsus Clinic

You may be overwhelmed with organizations offering support, or you may be confused as to how to enroll or whether youre eligible. Though some of these support options happen outside of your care teams facility, speak openly with them about what kind of support you need and any questions to start.

Stay connected with your care team: They know you and they know the battle ahead. They also know which resources have been helpful for other patients, and which resources they may be able to offer. They know that factors such as stress, nutrition and sleeping problems affect your health. Theyre there to help you get what you need.

Lean on friends and family: Interactions with friends and family may be different when a cancer diagnosis is involved. Odds are that your support system wants to help, but theyll know the best ways to help if you tell them yourself. Dont be afraid to ask for what you need, whether its company on the ride to an appointment or help with household chores.

Look for support groups: If you have stage 3 cancer, youre joining a host of others who have walked a similar path. Youre not alone. Participating in a support group may help you feel more connected and understood. Both the American Cancer Society and the National Cancer Institute have tools to help you find resources for cancer support in your area.

Prostate Cancer Stages Based On Standard Scores

After calculating the TNM categories, your doctors will combine your TNM score, Gleason score and PSA levels to assign of a specific stage to your prostate cancer. Keep in mind that every case is different, and statistics and other recommendations are purely general guidelines.

Stage 1
10 years15 years

*Percentages factor in all stages of prostate cancer. Relative survival rate means the percentage of patients who live x number of years after their initial diagnoses, not after stoppage of treatment.

What Treatments Are Available

If you have advanced prostate cancer, treatment wont cure your cancer. But it can help keep it under control and manage any symptoms.

If youve just been diagnosed with advanced prostate cancer, you may be offered the following treatments:

Research has found that having radiotherapy together with one of the main treatments listed above can help some men with advanced prostate cancer to live longer. But radiotherapy isnt suitable for all men with advanced prostate cancer.

If you live in Scotland, you may also be offered a type of hormone therapy called abiraterone acetate together with standard hormone therapy. In the rest of the UK, abiraterone is currently only given to men with advanced prostate cancer that has stopped responding to other types of hormone therapy. The National Institute for Health and Care Excellence is currently deciding whether to make it available for men who have just been diagnosed with advanced prostate cancer.

Before you start treatment

Before you start any treatment, make sure you have all the information you need. Its important to think about how you would cope with the possible side effects. Speak to your doctor or nurse about this.

It can help to write down any questions you want to ask at your next appointment. It may also help to take someone with you, such as your partner, a family member or friend.

If you have any questions, speak to our Specialist Nurses.

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Watchful Waiting Or Active Surveillance

Prostate cancer treatments can have side effects. If you’re worried about these risks, you can decide to hold off on these treatments and see if your tumor grows. Waiting is also an option if youâre older, your cancer is growing slowly, or you don’t have symptoms that bother you.

Waiting does not mean that you do nothing about your cancer. Your doctor will keep a close eye on the tumor and watch for any signs that itâs getting worse.

Watchful waiting means you and your doctor will look out for symptoms. The doctor may do tests from time to time to make sure the cancer hasn’t grown.

Active surveillance means your doctor will do tests, including PSA blood tests and rectal exams, usually about every 3-6 months to check on it. You may also have a biopsy, when a doctor takes a small piece of tissue from your prostate and checks it for cancer.

Active Surveillance And Watchful Waiting

Where prostate cancer spreads in the body affects survival ...

If prostate cancer is in an early stage, is growing slowly, and treating the cancer would cause more problems than the disease itself, a doctor may recommend active surveillance or watchful waiting.

Active surveillance. Prostate cancer treatments may seriously affect a person’s quality of life. These treatments can cause side effects, such as erectile dysfunction, which is when someone is unable to get and maintain an erection, and incontinence, which is when a person cannot control their urine flow or bowel function. In addition, many prostate cancers grow slowly and cause no symptoms or problems. For this reason, many people may consider delaying cancer treatment rather than starting treatment right away. This is called active surveillance. During active surveillance, the cancer is closely monitored for signs that it is worsening. If the cancer is found to be worsening, treatment will begin.

ASCO encourages the following testing schedule for active surveillance:

  • A PSA test every 3 to 6 months

  • A DRE at least once every year

  • Another prostate biopsy within 6 to 12 months, then a biopsy at least every 2 to 5 years

Treatment should begin if the results of the tests done during active surveillance show signs of the cancer becoming more aggressive or spreading, if the cancer causes pain, or if the cancer blocks the urinary tract.

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There Are 2 Types Of Staging For Prostate Cancer:

  • The Clinical StageThe clinical stage is based on the results of tests that can be done prior to the surgery. They include the DRE, biopsy, X-rays, CT and/or MRI scans and bone scans. X-rays, bone scans, CT scans and MRI scans may not always be needed. They are recommended based on the PSA level, the size of the cancer, which is determined by its grade and volume and the clinical stage of the cancer.
  • The Pathologic StageThe pathologic stage is based on information found during surgery, plus the laboratory results referred to as pathology, of the prostate tissue removed during surgery. The surgery often includes the removal of the entire prostate and some lymph nodes.One important part of the staging process is determining the grade of the cancer. The grading system is based on the microanalysis of the prostatic tissue. While the stage of the cancer is determined based on the macro appearance of the tumor, in connection with the nearby organs and tissues, the grade of cancer is usually determined after a biopsy, when the cells are analyzed under a microscope.
  • Staging And Grading For Stage 3 Cancer

    Staging is an important factor in determining cancer treatment options, since it establishes the tumors size and spread within the body. Staging is used for most cancers, but not all. Cancers in and near the brain, for example, dont use a defined staging system because their likelihood of spreading is low.

    In general, cancer falls within stages 1 through 4. Some types may be stage 0, meaning there are cancerous cells in a layer of tissue, but they havent grown or spread.

    Most cancers are staged using some form of the TNM system. Doctors may also use the TNM system to help determine the extent of certain cancers in each stage. The TNM system stands for:

    • T , for the size of the original tumor
    • N , whether the cancer is present in the lymph nodes
    • M , whether the cancer has spread to other parts of the body

    Some cancers, especially liquid cancers, are staged using different established protocols. The Binet and Rai systems, for example, are used to stage certain types of leukemia. Cancers of the female reproductive system, such as cervical cancer and ovarian cancer, are staged using the FIGO staging system, designed by the International Federation of Gynecology and Obstetrics .

    Regardless of the system used, the first step for doctors staging cancer is to gather information about it. Some tests or procedures that may be involved as your care team is staging your cancer include:

    When it comes to grading, tumors generally may be referenced in the following ways.

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    Questions To Ask Your Doctor

    To help understand the progression of prostate cancer, discuss these questions with your doctors:

    • What is my Gleason score?
    • Has the cancer spread outside my prostate?
    • Whats my prostate cancer stage?
    • Are other tests needed to determine my cancer stage?
    • What are the treatment options for my stage of cancer?
    • Can I avoid treatment right now and go on active surveillance?

    Determining The Stage Of Your Prostate Cancer

    Prostate cancer stage in advanced prostate cancer

    Using the results of your tests, your doctor will calculate a score based on four main components. Namely your: 1) PSA level, 2) Gleason score , 3) T-stage and 4) whether the cancer has metastasized. The information below breaks down each component so you have a better understanding of what your results mean and where they land in the spectrum of cancer prognoses.

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    Addressing All Of Your Healthcare Needs

    We understand that a diagnosis of cancer can be challenging for you and your loved ones. That’s why we offer psychosocial, nutritional, and other support services for people with urologic cancers. Your team includes palliative care physicians as well, ensuring that your quality of life is the best it can be from the moment of diagnosis and throughout your treatment. As a major medical center, we can also address your other healthcare concerns and connect you with the specialists you need.

    Contact Us

    How Is Prostate Cancer Staged

    Prostate cancer is one of the most common types of cancer that develops in men and is the second leading cause of cancer deaths in American men, behind lung cancer and just ahead of colorectal cancer. The prognosis for prostate cancer, as with any cancer, depends on how advanced the cancer has become, according to established stage designations.

    The prostate gland is a walnut-sized gland present only in men, found in the pelvis below the bladder. The prostate gland wraps around the urethra and lies in front of the rectum. The prostate gland secretes part of the liquid portion of the semen, or seminal fluid, which carries sperm made by the testes. The fluid is essential to reproduction.

    The term to stage a cancer means to describe the evident extent of the cancer in the body at the time that the cancer is first diagnosed.

    • Clinical staging of prostate cancer is based on the pathology results, physical examination, PSA, and if appropriate, radiologic studies.
    • The stage of a cancer helps doctors understand the extent of the cancer and plan cancer treatment.
    • Knowing the overall results of the different treatments of similarly staged prostate cancers can help the doctor and patient make important decisions about choices of treatment to recommend or to accept.

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    Physical Emotional And Social Effects Of Cancer

    Cancer and its treatment cause physical symptoms and side effects, as well as emotional, social, and financial effects. Managing all of these effects is called palliative care or supportive care. It is an important part of your care that is included along with treatments intended to slow, stop, or eliminate the cancer.

    Palliative care focuses on improving how you feel during treatment by managing symptoms and supporting patients and their families with other, non-medical needs. Any person, regardless of age or type and stage of cancer, may receive this type of care. And it often works best when it is started right after a cancer diagnosis. People who receive palliative care along with treatment for the cancer often have less severe symptoms, better quality of life, and report that they are more satisfied with treatment.

    Palliative treatments vary widely and often include medication, nutritional changes, relaxation techniques, emotional and spiritual support, and other therapies. You may also receive palliative treatments similar to those meant to get rid of the cancer, such as chemotherapy, surgery, or radiation therapy.

    Before treatment begins, talk with your doctor about the goals of each treatment in the treatment plan. You should also talk about the possible side effects of the specific treatment plan and palliative care options.

    How Will I Know That My Hormone Therapy Is Working

    New Subtype of Treatment

    Doctors cannot predict how long hormone therapy will be effective in suppressing the growth of any individual mans prostate cancer. Therefore, men who take hormone therapy for more than a few months are regularly tested to determine the level of PSA in their blood. An increase in PSA level may indicate that a mans cancer has started growing again. A PSA level that continues to increase while hormone therapy is successfully keeping androgen levels extremely low is an indicator that a mans prostate cancer has become resistant to the hormone therapy that is currently being used.

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    What Happens If My Cancer Starts To Grow Again

    Your first treatment may help keep your cancer under control. But over time, the cancer may change and it may start to grow again.

    You will usually stay on your first type of hormone therapy, even if its not working so well. This is because it will still help to keep the amount of testosterone in your body low. But there are other treatments that you can have alongside your usual treatment, to help control the cancer and manage any symptoms. Other treatments include:

    Which treatments are suitable for me?

    Which treatments are suitable for you will depend on many things, including your general health, how your cancer responds to treatment, and which treatments youve already had. Talk to your doctor or nurse about your own situation, or speak to our Specialist Nurses.

    What Does Your Tnm Prostate Cancer Stage Mean

    The TNM system for describing prostate cancer uses the letters T, N, and M, which stand for tumor, nodes, and metastasis.

    Specifically, stage 3 prostate cancer has extended through the capsule that surrounds the prostate but has not spread to distant sites in the body.

    There are two sub-stages of stage 3 prostate cancer.

    • T3a: The tumor has only gone through the capsule without invading the seminal vesicles.
    • T3b: The tumor has invaded the seminal vesicles.

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    What Is Intermittent Adt

    Researchers have investigated whether a technique called intermittent androgen deprivation can delay the development of hormone resistance. With intermittent androgen deprivation, hormone therapy is given in cycles with breaks between drug administrations, rather than continuously. An additional potential benefit of this approach is that the temporary break from the side effects of hormone therapy may improve a mans quality of life.

    Randomized clinical trials have shown similar overall survival with continuous ADT or intermittent ADT among men with metastatic or recurrent prostate cancer, with a reduction in some side effects for intermittent ADT .

    How Prostate Cancer Staging Is Done

    What are the Treatment Options for Stage 4 Prostate Cancer?

    Initial staging is based on the results of PSA blood tests, biopsies, and imaging tests. This is also called clinical staging.

    PSA refers to a protein made by the prostate measured by a lab test.

    • A higher level of PSA can indicate a more advanced cancer.
    • The doctors will also look at how fast the PSA levels have been increasing from test to test. A faster increase could show a more aggressive tumor.

    A prostate biopsy is done in your doctor’s office. The results can indicate:

    • How much of the prostate is involved.
    • The Gleason score. A number from 2 to 10 that shows how closely the cancer cells look like normal cells when viewed under a microscope. Scores 6 or less suggest the cancer is slow growing and not aggressive. Higher numbers indicate a faster growing cancer that is more likely to spread.

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    What Is Stage 3 Cancer

    Stage 3 cancer is sometimes referred to as locally advanced cancer. In this stage, the tumor may have grown to a specific size, the cancer may consist of multiple tumors, and/or the cancer may have spread to adjacent lymph nodes, organs or tissue. In some cases, stage 3 cancers may be considered metastatic cancers, meaning they may have spread beyond their organ of origin.

    Many stage 3 cancers have multiple subcategories, usually designated as stages 3A, 3B and 3C. These subcategories are often determined by the size of the tumors, whether multiple tumors are present and the degree to which the cancer has spread locally.

    Liquid cancers, or blood cancers, such as leukemia, lymphoma or multiple myeloma, are staged differently than most other cancers because they may not always form solid tumors. Liquid cancers may be staged by a variety of factors, including:

    • The ratio of healthy blood cells to cancerous cells
    • Whether cancer cells are found in lymph nodes or the diaphragm
    • The degree to which lymph nodes, the liver or spleen may be swollen

    Stage 3 cancer is determined in the five most common cancers this way:

    What Are The Side Effects Of Hormone Therapy For Prostate Cancer

    Because androgens affect many other organs besides the prostate, ADT can have a wide range of side effects , including:

    • loss of interest in sex
  • Studer UE, Whelan P, Albrecht W, et al. Immediate or deferred androgen deprivation for patients with prostate cancer not suitable for local treatment with curative intent: European Organisation for Research and Treatment of Cancer Trial 30891. Journal of Clinical Oncology 2006 24:18681876.

  • Zelefsky MJ, Eastham JA, Sartor AO. Castration-Resistant Prostate Cancer. In: Vincent T. DeVita J, Lawrence TS, Rosenberg SA, eds. DeVita, Hellman, and Rosenberg’s Cancer: Principles & Practice of Oncology, 9e. Philadelphia, PA: Lippincott Williams & Wilkins 2011.

  • Smith MR, Saad F, Chowdhury S, et al. Apalutamide and overall survival in prostate cancer. European Urology 2021 79:150158.

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