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Advanced-Stage Prostate Cancer: NCCN Guidelines for Patients

September 9, 2022 - read ≈ 10 min



The NCCN Guidelines for Patients were developed by the National Comprehensive Cancer Network (NCCN). NCCN is an organization that unites leading cancer care centers in the United States of America. Its activities are focused on scientific research, treatment and education of patients.

Prostate cancer basics

The prostate is a gland located deep inside the lower abdomen. Anyone with a prostate has a chance of getting prostate cancer. This chapter offers an overview of this common cancer.

What is prostate cancer?

Prostate cancer develops in a small gland called the prostate. The prostate gland is part of the male reproductive system. The prostate is located deep inside the lower part of the trunk of the body, just below the bladder. Prostate cancer develops when cells in the gland start to grow out of control.

What is cancer?
Cancer is a disease where cells — the building blocks of the body — grow out of control. This can end up harming the body. There are many types of cells in the body, so there are many types of cancers.

Cancer cells don’t behave like normal cells. Normal cells have certain rules. Cancer cells don’t follow these rules.

• Cancer cells develop genetic errors (mutations) that allow them to multiply and make many more cancer cells. The cancer cells crowd out and overpower normal cells. Cancer cells take away energy and nutrients that normal cells need.
• Normal cells live for a while and then die. Cancer cells avoid normal cell death. They survive much longer than normal cells do.
• Cancer cells can spread to other areas of the body. They can replace many normal cells and cause organs to stop working well.
• Treatment may get rid of cancer at first but sometimes the cancer comes back later.
• Cancer can stop responding to treatment that worked before.

Scientists have learned a great deal about cancer. As a result, today’s treatments work better than treatments in the past. Also, many people with cancer have more treatment choices now than they had before.

What causes prostate cancer?

Doctors don’t know exactly what causes prostate cells to grow out of control (become cancerous). But several factors are linked to a higher risk of prostate cancer. These are called risk factors. A risk factor is anything that increases your chance of getting cancer. Risk factors don’t necessarily cause prostate cancer, but people with prostate cancer usually have one or more of these risk factors:

  • Age – The biggest risk factor for prostate cancer is age. Prostate cancer is diagnosed most often in those aged 65 years and above. Your chances of getting prostate cancer increase as you become older.
  • Family history – Your family health history is information about the diseases and health conditions in your family. A family history reflects a pattern of certain diseases among family members. Males who have a close family member (a brother or father) with prostate cancer have a greater chance of getting it themselves. Those with a family history of certain other cancers (breast, ovarian, colon, pancreatic, and other cancers) are also at a higher risk for prostate cancer.
  • Genetic factors – Genetic testing can find specific inherited genetic abnormalities (mutations) known to be linked with prostate cancer or other cancers. For instance, a man with an inherited genetic abnormality in the BRCA2 gene likely has a higher risk of prostate cancer. Inherited mutations are passed down a generation from either parent. Genetic abnormalities that aren’t inherited can occur, too.
  • Race – Black males are more likely than White males to develop prostate cancer. Prostate cancer in Black males is also more likely to occur at an earlier age and be more aggressive and more advanced when diagnosed. Lack of equal access to health care is a major factor contributing to these differences.
  • Diet and lifestyle – Eating food that’s high in fat, such as meat and dairy products, has been linked with an increased risk for prostate cancer. Smoking may also increase the risks of developing prostate cancer and of dying from it. Eating more fruits and vegetables may reduce this risk. Exercise also likely decreases the likelihood of dying from prostate cancer.

These risk factors aside, anyone with a prostate has a risk of getting prostate cancer. Prostate cancer is the most common cancer in American males besides skin cancer.

The prostate enlarges with age
A young man’s prostate is said to be the size of a walnut or a ping-pong ball and weigh about the same as an AA battery. As you grow older, your prostate gradually grows larger, possibly reaching the size of a lemon or an orange.

Having an enlarged prostate is a condition called benign prostatic hyperplasia (BPH). Benign means it’s not cancerous. An enlarged prostate doesn’t cause prostate cancer or increase your risk of getting it. However, it’s common to have an enlarged prostate and prostate cancer at the same time. Notably, an enlarged prostate can cause the same symptoms as those caused by prostate cancer.

Doctors aren’t sure what causes the prostate to grow as men get older. A common theory is that levels of hormones (like testosterone) change with age, which affects the size of the prostate.

In many individuals, the prostate grows large enough to squeeze the urethra — a tube that passes through the prostate. The urethra allows urine to flow out of the bladder. This squeezing can narrow the urethra, which slows down or stops the flow of urine when you try to pee. Although prostate cancer usually doesn’t cause any symptoms, it also can slow the flow of urine if it grows large enough. That’s why it’s important to get these problems checked out.

Are there different types of prostate cancer?

Prostate cancer can be grouped into early-stage cancer or advanced-stage cancer.

Early stage

Prostate cancer usually grows slowly and stays in the prostate. Early stage means the cancer has not spread beyond the prostate. Cancer that is contained entirely within the prostate is called localized prostate cancer.

A book about early-stage prostate cancer, NCCN Guidelines for Patients: Prostate Cancer, Early Stage, can be found at NCCN.org/patientguidelines

Advanced stage

This book is all about advanced-stage (metastatic) prostate cancer.

Advanced stage means that the cancer has spread beyond the prostate to other areas in the body. This spreading is called metastasis or metastatic cancer.

Cancer cells can use the bloodstream like a highway to travel to distant areas in the body. Cancer cells can also spread through the lymphatic system.

The lymphatic system is a network of organs and vessels that fights infections and circulates a clear fluid called lymph throughout the body. Lymph nodes are a normal and important part of this system. Lymph nodes are small, disease-fighting clusters that filter the lymph fluid to remove germs. Lymph vessels and nodes are found everywhere in the body.

Prostate cancer can metastasize to the lymph nodes, bones, liver, lungs, and other organs. Some men have advanced-stage prostate cancer when they’re first diagnosed. Others develop advanced-stage cancer after having treatment for early-stage cancer.

Sometimes prostate cancer is found without even looking for it. It might be discovered by chance during medical testing for another health issue. This is called an incidental finding.

Where does the prostate fit in?
The prostate is located deep inside the lower body. It makes semen and is important for sexual reproduction.

Prostate: A gland in the male reproductive system. A gland is an organ that makes fluids or chemicals the body needs. The prostate gland makes a liquid that nourishes and helps transmit semen.

Semen: A fluid made up of liquids from the prostate and the seminal vesicles as well as sperm from the testicles. During ejaculation, semen is released from the body through the urethra and out through the penis.

Urethra: A tube that carries urine from the bladder and out of the body. The prostate wraps around the urethra just beneath the bladder.

Seminal vesicles: Two glands that make another part of the fluid that becomes semen. The seminal vesicles are located above the prostate and behind the bladder.

Bladder: An organ that holds urine.

What are symptoms of prostate cancer?

A symptom is a feeling or problem that can be a sign of a disease or condition. Prostate cancer often grows slowly and shows no symptoms for a long time. You don’t have to have symptoms to have prostate cancer. This is true in the early stages of the disease and even advanced prostate cancer may have few or mild symptoms.

Some symptoms that may occur include:

  • Urinating (peeing) frequently, especially at night
  • Weak or intermittent urine stream
  • Trouble urinating or straining to urinate
  • Trouble holding in urine
  • Feeling like your bladder hasn’t fully emptied
  • Blood in the urine or semen
  • Erectile dysfunction (dificulty getting an erection)
  • Dull pain in the groin or pelvis
  • Burning or pain while urinating
  • Unexplained weight loss
  • Bone, hip, or back pain
  • Weakness of the knees or legs
  • Feeling dizzy or lightheaded

It’s important to know that prostate cancer has many of the same symptoms as a condition called enlarged prostate (also called benign prostatic hyperplasia, or BPH). It’s dificult to tell the difference between the two conditions based on symptoms alone, and BPH is much more common than prostate cancer. Be sure to tell your doctor about any symptoms you have because you may need specific testing.

Can prostate cancer be cured?

Advanced-stage prostate cancer isn’t curable, but treatment can slow down its growth, reduce its symptoms, and prolong your life. Treatments for advanced prostate cancer include hormone therapy, chemotherapy, immunotherapy, surgery, radiation therapy, radiopharmaceuticals, and targeted therapy.

Prostate cancer in the advanced stage can be fatal. But in the past few decades, better detection and treatments have been reducing the number of fatalities from prostate cancer in men of all races and ethnicities. Many patients with advanced-stage prostate cancer continue to live with the cancer and, in the end, may die from something else.

Key points

  • Prostate cancer develops when cells in the prostate gland grow out of control.
  • Age is the biggest risk factor for prostate cancer. As you age, your chances of developing prostate cancer increase.
  • The majority of prostate cancers are diagnosed in males over the age of 65.
  • Males who have a close family member (brother, father) with prostate cancer have a greater chance of getting it themselves.
  • All males are at risk for prostate cancer but Black males are at greater risk.
  • Advanced-stage prostate cancer has spread beyond the prostate to other areas in the body. This spread is called metastasis.
  • Cancer cells can spread to other body parts through blood or lymph.
  • You don’t have to have symptoms to have prostate cancer.
  • Advanced-stage prostate cancer isn’t curable, but treatment can slow it down, reduce its symptoms, and improve longevity.
  • Advanced-stage prostate cancer can be dificult to treat. Seek out a medical center that specializes in prostate cancer.
  • Better detection and treatments for prostate cancer have reduced the number of fatalities in men of all races and ethnicities.

Advanced prostate cancer can be difficult to treat. Seek out a medical center that specializes in the diagnosis and treatment of prostate cancer.

You can read more about Advanced-Stage Prostate Cancer, its treatment methods and follow-up after treatment in the full text of the recommendations for patients by downloading it below.

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