Stage 4 Prostate Cancer

The prostate gland is a part of the male reproductive system that makes a component of the seminal fluid. It is usually in the shape of a walnut. However, if it increases in size, it may press the urethra that would obstruct the flow of urine out of the bladder. Cancer refers to the uncontrolled cell division that leads to tumorous growth. Such growths cause enlarged prostate that may cause problems in urination, sexual intercourse and erectile dysfunction. There are various stages of prostate cancer, which is a measure of the spread and growth of the cancer. Stage 4 prostate cancer refers to the stage when the cancer has moved out of the seminal vesicles and invaded the surrounding tissues like the rectum, bladder, and even the bones and the lymph nodes.

Different Stages of Prostate Cancer

Cancer in the prostate gland may spread out from its original location. This is known as metastasis. Identifying the stage (staging) is important so that the doctor knows how far the cancer has spread, and according to the stage can decide upon the relevant treatment. These are the following stages of prostate cancer:

• Stage I Prostate Cancer: Cancer at this stage can't be detected either by a sonogram or a digital rectal exam. It is discovered in the body during a surgery carried out for another reason or by a needle biopsy which is carried out when a raised PSA (an abnormal protein formed due to cancerous prostate cells) level is detected.
• Stage II Prostate Cancer: The cancer can be detected by a digital rectal exam or sonogram, but hasn't spread out of the prostate gland.
• Stage III Prostate Cancer: The cancerous cells have moved out of the prostate gland and spread into the seminal vesicles. However, they have not reached the lymph nodes.
• Stage IV Prostate Cancer: The tumor has spread out of the seminal vesicles into the nearby structures like the bladder and the rectum. In the stage four cancer, the lymph nodes, bones and other parts of the body may also be raided by the cancerous cells.

Classification of Stage IV Prostate Cancer

Stage 4 prostate cancer may be further divided into the following two groups depending upon the extent to which it has spread:

• Localized Stage IV (D1): Cancer has spread to the pelvic lymph nodes or is obstructing the ureters, or both.
• Metastatic Stage IV (D2): Cancer has spread to the lymph nodes outside the pelvic region. It may have spread to the bones and to other parts further away from the prostate gland.

Symptoms of Stage IV Prostate Cancer

• Trouble urinating
• Blood in urine even if there is no problem in urination
• Severe pain in the lower abdomen and lower back
• Nausea
• Weakness

Treatment of Stage IV Prostate Cancer

For Localized Stage IV (D1): Cancer that is still in the pelvic region or in the close by organs like the bladder and the rectum is treated by the external beam radiation therapy (EBRT) and hormone therapy. In most cases, these are administered together. Radiation therapy followed by hormonal therapy has been found to improve one's chances of survival and also restrict localized stage IV from developing into metastatic stage IV cancer. Hormone therapy involves the removal of the male hormones important for the growth of prostate cancer. In ERBT, the patient is given a beam of high energy X-ray that destroys the cancerous cells.

For Metastatic Stage IV (D1): Hormonal treatment has been used for long as a standard mode of treatment for metastatic stage IV cancer. It may control metastatic stage IV prostate cancer for several years. However, cancerous growth can spread despite hormonal therapy. Recent trials have shown that chemotherapy can kill cancerous cells is patients with problem of recurrent cancer.

For Bone Complications: If the cancer has reached the bones, it can increase risk of bone fractures and a life-threatening condition called hypercalcemia, in which the levels of calcium in blood is very high. Bone complications can be treated by giving patients bisphosphonate drugs and radiation therapy, directed to the affected bones.

Surgery (radical prostatectomy): Sometimes, removal of the prostate gland by surgical means may be done. In case the tumor can't be removed completely and some amount of cancerous cells are left behind, surgery may be followed by radiation therapy. Side effects of surgery involve impotence and incontinence (inability to control urination).

Although the mode of treatments listed above are the ones that have been followed for long, recent research into the treatment have made other modes of treatment available. These involve the nerve-sparing radical prostatectomy in which the prostate gland is surgically removed without severing the nearby nerves that carry signals between the brain and the penis. This ensures normal sexual functioning. Other more recent methods of treatment are conformal external beam radiation therapy, image-guided radiation therapy, proton beam therapy and brachytherapy.

What treatment should be taken for stage four prostate cancer is decided by the physician after he has carried on a number of tests. It is advisable to go for a second opinion. Do your own research about the disease and its possible methods of treatment. Have a clear idea of all the pros and cons. Discuss any doubts you have with your physician, and agree to the treatment that both you and your physician feel would work the best for you.

Stage 4 prostate cancer is an advanced stage of prostate cancer. It might be difficult to cure the cancer when it is detected at this stage. However, with effective treatment, some patients can live for several years.