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Stage 4 Prostate Cancer: An Analysis

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Stage 4 prostate cancer is the last stage of cancer of prostate glands that spreads to distant organs in the body. Read more to know details.

Medically reviewed by

Dr. Abdul Aziz Khan

Published At April 30, 2024
Reviewed AtApril 30, 2024


Stage 4 prostate cancer is the last and typically metastatic form of the disease that poses an inferior prognosis to treatment. Cancer cells have spread beyond such bones, lymph nodes, or other organs at this stage. Management of stage 4 prostate cancer often involves a multidimensional approach, incorporating various treatment modalities aimed at controlling symptoms, prolonging survival, and maintaining quality of life. Despite seeing the advancements in the quality of treatment, prostate cancer yet remains a cause of concern, laying the significance of early detection and timely treatment.

What Is Stage 4 Or Metastatic Prostate Cancer?

The prostate is a gland in men that makes the semen containing the sperm. This gland is placed below the bladder and in front of the rectum. Prostate cancer is a malignant tumor of this gland where the gland starts to enlarge. This disease is, however, seen in males above 50 years of age. It is usually a very slow-paced cancer, often showing no symptoms until it reaches the advanced stage. Stage 4 or metastatic prostate cancer indicates the cancer has spread all over from the prostate to distant parts of the body. It is also called advanced prostate cancer. This cancer originates from the prostate and can spread out to the lymph nodes in other parts of the body, to bones, as well as to lungs.

How Does Prostate Cancer Spread?

This happens when the cancer cells are moved to the bloodstream or lymph drainage from the main point of the cancer site. Once there, these cells migrate throughout the body. These cells land up in a thin, distant location within the blood capillaries, break through the walls, and deposit in the tissue they find. At this point, they multiply and grow, taking the nutrition to grow new tumor cells. In the case of advanced prostate cancer, these cells grow in specific areas like lymph nodes, ribs, pelvic bones, and spine.

What Are the Causes of Metastatic Prostate Cancer?

Stage 4 prostate cancers are seen to affect older men, with 80 percent of cases seen in males who are above 65 years of age, and rarely, 1 % of males below 50 years have it. The exact cause of the malignancy is not known. Diet may be another factor or causative agent; men who consume red meat are more likely to have prostate cancer. This disease has shown more prevalence in regions where the consumption of meat and dairy is high in areas where men consume rice, vegetables, and soybean products.

The hormonal imbalance in Testosterone is another reason for this cancer. High levels of testosterone come again from fat consumption. The consumption of fat and a sedentary life is responsible for obesity. Obesity is one driving factor that increases the risk of getting prostate cancer. No exercising further worsens it and increases the risk.

It has also been seen that the various job hazards also contribute to the risk of prostate cancers and hasten up the symptoms to the advanced or metastatic phase. Welders, rubber workers, and workers who are constantly exposed to cadmium metal seem to be more likely to suffer from prostate cancer.

How Is Stage 4 Prostate Cancer Different From Initial Stages of Prostate Cancer?

Various stages of the prostate can be categorized based on what is known as TNM staging.

  1. Stage 1 - This is slow growing and is found only confined to the prostate, can not be felt, and involves only one-half of the gland.

  2. Stage 2 - The tumor cells are found only in the gland. The cancer is small, but at this stage, it has the potential to grow. In this stage, the tumor may or may not be palpated.

  3. Stage 3 - This is a stage where the tumor is high-grade. It involves the tissues around the prostate. It also affects the seminal vesicles, hence blocking semen formation. The cells look very deranged from the normal healthy cells.

  4. Stage 4 -The cancer spreads beyond and distant places from the prostate. It spreads to the local lymph nodes, which is labeled as Stage 4A, or may spread to distant lymph nodes, other body parts, or the bones, termed Stage 4B.

What Are the Symptoms of Stage 4 Prostate Cancer?

The symptoms of metastatic prostate cancer include having bone pain, feeling fatigued all the time, feeling of general sickness, and weight loss for unknown reasons. If the cancer has spread to bones, the symptoms appear dull, aching, or stabbing pain, and bones may become weaker and fragile. The symptoms of cancer spreading to lymph nodes are pain around the prostate where the lymph nodes are seen and lymphedema in the legs due to the collection of fluid that cancer cells might be draining away.

When the cancer spreads to the lungs, the symptoms of cough, breathlessness, and blood with cough may be seen.

The cancer spread to the bladder shows difficulty in passing urine, frequent night urination, urge incontinence, or having blood in semen or urine. The symptoms may also include constipation, stomach ache, and blood in stools when it has invaded the bowels.

What Is the Treatment of Metastatic Prostate Cancer?

The treatment of stage 4 prostate cancer includes chemotherapy and hormonal therapy. The treatment can help with improving the symptoms and make the patients feel better.

Hormonal therapy blocks testosterone. It does not cure prostate cancer, but it controls or shrinks the cancer and reduces the symptoms. The hormonal therapy uses luteinizing hormones, gonadotropin-releasing hormones, and androgenic tablets, all of which block the formation of testosterone in the testicles.

Chemotherapy is a common treatment for stage 4 prostate cancer, which aims at destroying the cancer cells. The most common chemotherapy used to destroy these cells is Docetaxel.

What Can a Male Do to Reduce the Risk of Getting Stage 4 Prostate Cancer?

The evidence to support the prevention of prostate cancer is very rare. However, the risk can be minimized by

  • Consuming a healthy diet that includes vegetables, fruits, and whole-grain products.

  • Frequent ejaculation helps the males to get prostate cancer. Doctors are not sure why it helps, but they think it potentially moves irritating substances out of the prostate.

  • Keeping the lifestyle active.

  • Acting upon obesity as it increases the risk.

  • Avoid smoking and high intake of caffeine.


Stage 4 prostate cancer represents a clinical challenge and requires comprehensive treatment. Educating people about the importance of regular screening and early detection is essential in potentially preventing the progression to stage 4 disease and improving the survival rate. Continued studies have been conducted to understand the metastasis mechanism and prevent it in a timely manner. The prognosis is questionable. However, hormonal therapy and chemotherapy, along with palliative care, have been shown to improve the symptoms and quality of life.

Dr. Abdul Aziz Khan
Dr. Abdul Aziz Khan

Medical oncology


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