Understanding Your Road: Stages of Advanced Prostate Cancer

KNOW ABOUT PROSTATE CANCER RISK FACTORS

Older men are more likely to develop prostate cancer, as the chance of having prostate cancer rises rapidly after age 50.

Family history may be a risk factor. If your father or brother has had prostate cancer, you are about twice as likely to develop this disease compared with a man with no family history of the disease. The risk is even higher for men with several relatives who have or had prostate cancer.

While reasons are unknown, race also plays a role in who is at risk for prostate cancer. African American men are 1.6 times more likely to get prostate cancer than Caucasian men. Prostate cancer occurs less often in Asian American and Hispanic/Latino men than in non-Hispanic Caucasian men.

Risk factors

Age
Risk rises after age 50
Race
Increased risk in African American and Caribbean men of African ancestry than in men of other races; occurs less often in Asian American and Hispanic/Latino men than in non-Hispanic white men
Geography
Most common in North America, northwestern Europe, Australia, and on Caribbean islands
Family history
Risk is higher in men with affected relatives
Inherited Gene Changes
OTHER RISK FACTORS
Diet, obesity, smoking, chemical exposures, inflammation of the prostate, sexually transmitted infections, and vasectomy

HOW IS PROSTATE CANCER DIAGNOSED?

If a doctor suspects a patient may have prostate cancer, he or she will ask you about any symptoms, as well as possible risk factors discussed earlier. The following tests can be conducted to inform a doctor whether to carry out a prostate biopsy to confirm a diagnosis of prostate cancer:

Digital rectal examination (DRE): Insertion of a finger into the rectum by a doctor to check for lumps or hard areas in the prostate.

Prostate-specific antigen (PSA): The PSA blood test is used mainly to screen for prostate cancer in men without symptoms but is also one of the first tests done in men who have symptoms that might be caused by prostate cancer.

Prostate biopsy: A biopsy is a definitive way to confirm the presence of cancer cells in the prostate. It involves the insertion of needles through the rectum into the prostate to remove small tissue samples. A pathologist will assess the cancer cells under a microscope and provide a Gleason score. A higher Gleason score indicates a more aggressive cancer that is more likely to spread quickly.

Transrectal ultrasonography: Insertion of a probe that acts as an ultrasound into the rectum to check the prostate for abnormal areas.

Scans and x-rays: Imaging helps determine if the cancer has spread to other parts of the body (or metastasized).

UNDERSTANDING THE DIFFERENT TYPES OF PROSTATE CANCER

Prostate cancer occurs when cells within the prostate grow and divide at a higher rate than normal. Compared to other cancers, prostate cancer can be slow growing in some men and some types of prostate cancer may need minimal or no treatment. However, in others, prostate cancer can grow and spread (metastasize) to other parts of the body.

Not all prostate cancer is the same. It ranges from cancer confined to the prostate gland to cancer that has spread outside of the prostate to the lymph nodes, bones, or other parts of the body. You can determine the extent or spread of the cancer by knowing the stages of prostate cancer.

There are multiple types of prostate cancer, including:

Localized prostate cancer: The prostate cancer is confined with the prostate.
Biochemical recurrence: A rise in the blood level of PSA after treatment with surgery or radiation. Also called PSA failure.
Hormone-sensitive (HS) or castrate-sensitive prostate cancer (CSPC): Prostate cancer that still responds to medical or surgical treatments that lower testosterone.
Castration-resistant prostate cancer (CRPC): Prostate cancer that no longer responds to a medical or surgical treatment that lowers testosterone.
Non-metastatic castration-resistant prostate cancer (nmCRPC): Prostate cancer that has not spread to other parts of the body and no longer responds to a medical or surgical treatment that lowers testosterone.
Metastatic: The spread of cancer from the place where it first formed to another part of the body.
Metastatic castration-sensitive prostate cancer (mCSPC): Prostate cancer that has spread to other parts of the body and still responds to a medical or surgical treatment that lowers testosterone.
Metastatic castration-resistant prostate cancer (mCRPC): Prostate cancer that has spread to other parts of the body and no longer responds to a medical or surgical treatment that lowers testosterone.

What's Fueling the Cancer?

Androgens are male hormones, primarily testosterone, that are needed for the prostate to function normally.

However, when androgens attach to androgen receptors, they can help fuel prostate cancer cell growth.

Medical or surgical treatments that lower testosterone are also referred to as androgen deprivation therapy (ADT). ADT includes treatment to suppress or block the production or action of male hormones called androgens, primarily testosterone.

While ADT is often effective, in certain men prostate cancer adapts to low levels of androgens.

Understanding Non-Metastatic Castration-resistant Prostate Cancer

When a person develops non-metastatic castration-resistant prostate cancer, the cancer no longer responds to medical or surgical treatments that lower testosterone but has not yet spread to other parts of the body. Usually a patient's PSA levels continue to rise, even while on androgen deprivation therapy (ADT) and having low blood levels of testosterone. Learn more about non-metastatic castration-resistant prostate cancer by watching the videos below.

Now that you know about nmCRPC, here are 3 questions to ask your doctor:

Do you have prostate cancer that has not spread to other parts of the body?

have you had a surgical treatment or are you currently on a medical treatment that lowers testosterone?

are your psa levels rising despite having low levels of testosterone in the blood?

If you answered yes to these questions, talk to your doctor about treatment options.

Understanding Metastatic Prostate Cancer

Metastatic prostate cancer is an advanced form of cancer that has spread to other parts of the body outside of the prostate, which can include the bones, lymph nodes, lungs, and liver.

When you are first diagnosed with metastatic prostate cancer, you may feel a range of emotions such as fear or frustration. Learning more about the disease can not only help reduce those fears but also help you take a more active role in the choices about care.

And remember, don’t hesitate to ask for help—or accept it—from friends and loved ones.

Understanding your road