By: Scott Sellinger, M.D., F.A.C.S.
Advanced prostate cancer is a more aggressive form of prostate cancer that requires an intensification of treatment efforts.
However, advanced prostate cancer does not always mean metastatic prostate cancer, which is prostate cancer that has spread to other parts of the body. We consider five categories advanced, and I’ll discuss them shortly.
First, you should know the frequency of prostate cancer. Approximately 1 in 8 men will be diagnosed with prostate cancer in their lifetime, and about 20-30% of these men will be diagnosed with advanced prostate cancer at the outset. With advanced prostate cancer cases on the rise for the first time in 20 years, according to the American Cancer Society, it’s essential to understand what this diagnosis means.
How Advanced Prostate Cancer Progresses
The prostate is a small gland below the bladder and in front of the rectum. Prostate cancer occurs when abnormal cells in the gland begin to divide uncontrollably, forming an invasive tumor.
Frequently, prostate cancer is slow-growing and unlikely to cause a man any harm during his lifetime. However, for some men, the cancer cells are more aggressive.
Whether your prostate cancer is advanced will be something your doctor will determine based on the results of tests such as a prostate biopsy, imaging and PSA tests, and your personal medical history. These are the five categories we define as advanced prostate cancer, requiring an intensification of treatment.
- Very High Risk, Clinically Localized: While this type of cancer has not spread beyond the prostate, it is categorized as advanced because your physician believes it has a very high risk of doing so or reoccurring following a primary treatment.
- High-risk, Biochemical Reoccurrence (BCR): This is when a measurable and increasing PSA occurs following previous treatments.
- Non-Metastatic Castration-Resistant Prostate Cancer (nmCRPC): This cancer no longer responds to hormone treatment. It keeps growing even though the body’s testosterone levels have been reduced to very low levels. Non-metastatic means it is still localized.
- Metastatic Castration-Sensitive Prostate Cancer (mCSPC): Cancer has spread from the prostate into other body regions. It remains responsive to hormone therapy.
- Metastatic Castration-Resistant Prostate Cancer (mCRPC): Metastatic prostate cancer that no longer responds to hormone therapy.
How is Advanced Prostate Cancer Treated?
The treatments for advanced prostate cancer are progressing all the time. Hormone therapy medication is frequently used to block the production of testosterone. When prostate cancer cells are denied testosterone, the cancer cells are starved of their fuel source. It’s not a cure for prostate cancer, but it can slow cancer growth. Hormone therapy is frequently used in men with high-risk prostate cancer pursuing radiation therapy.
Evolving therapies include chemotherapy and immunotherapy (which boosts the body’s immune system to destroy cancer cells), as well as new drugs such as Radium-223 (which delivers radiation particles directly to bone tumors) and lutetium Lu 177 vipivotide tetraxetan, which delivers radiation directly to cancer cells.
Clinical trials for experimental new therapies are also an option for patients to consider.
Advanced prostate cancer often is not curable, but today’s treatments can help keep it under control and manage symptoms.
Prostate Cancer Awareness Month
September is Prostate Cancer Awareness Month. This year, we are stressing an important point—0.75. If your PSA increases by 0.75 or more in one year, it could be prostate cancer.
We are encouraging men to know their PSA level and better understand it, aiming to empower them with prostate health knowledge.
If you have questions about your risk or treatments for advanced prostate cancer, we encourage you to schedule an appointment with a urologist today. Professional advice and early detection can significantly improve your chances of successful treatment.