Prostate Cancer Metastasis: What Every Man Should Know
While it is often slow-growing, prostate cancer can unfortunately spread to other parts of the body if left undetected or untreated. "Locally advanced prostate cancer" means that the tumor has grown or extended beyond the outer covering (capsule) of the prostate gland into nearby structures like the seminal vesicle, rectal wall, or bladder. Additionally, the term "metastatic prostate cancer" means that cancer has spread beyond the prostate tissue to bones, lymph nodes, or other organs of the body, such as the brain or lungs.
As a urologist, I've seen firsthand the devastating impact this disease can have on men and their loved ones. Understanding how prostate cancer spreads is crucial for early detection, effective treatment, and, ultimately, improving a man's prognosis. In this article, I'll delve into the ways that prostate cancer metastasizes (spreads), discuss the places in the body it most commonly spreads to, and explore the latest advancements in diagnosis and treatment that can help in preventing and managing the spread of the disease.
How Does Prostate Cancer Spread to Other Parts of the Body?
There are three ways that prostate cancer spreads to other parts of the body:
- Prostate cancer directly extends from the prostate gland into adjacent structures in the body.
- Prostate cancer spreads through the lymph nodes (lymphatic spread). Individual cancer cells or small clusters of cells enter the lymph vessels and travel to the lymph nodes throughout the body.
- Prostate cancer experiences a hematogenous spread, whereby the cancer cells enter the bloodstream and house themselves inside the bones or other organs, such as the lungs, liver, adrenal glands, and brain.
How Do Doctors Determine the Risk of Prostate Cancer Spread?
There are three primary mechanisms by which doctors determine prostate cancer risk:
- Staging of Cancer – The "stage" of any cancer is generally intended to indicate how advanced it is when it is diagnosed. Prostate cancer has four stages. The higher the stage is at the time of diagnosis, the higher the chance the cancer has of spreading. When prostate cancer is diagnosed at stage 1 or 2 and treated early, the risk of it spreading to other areas is negligible. If prostate cancer is diagnosed at stage 3 or 4, however, then the chance of it spreading is greater.
- Gleason Score – The Gleason Score for prostate cancer is based on the physical appearance and nuclei of the cancer cells, as well as the architectural patterns of the cancer cells under a microscope. Higher Gleason Scores indicate a higher level of prostate cancer aggressiveness and a higher risk that the cancer may spread.
- Molecular Testing – DNA testing performed on a patient's previously removed prostate cancer cells can look for the presence of specific genetic mutations that are associated with a higher risk of spreading. Molecular testing is one of the newest ways to predict the chance of future prostate cancer spread.
What are the Risk Factors for Developing Metastatic Prostate Cancer?
Several risk factors can impact a man's likelihood of developing prostate cancer, but the two most significant include:
- Time – The longer any type of cancer has to grow, undiagnosed, unchecked, and untreated, the more likely it will spread.
- Degree of Aggressiveness – Prostate cancer is diagnosed using a grading system called the Gleason Score. The higher the grade, or Gleason Score, of prostate cancer at diagnosis, the more virulent and aggressive it is likely to be. Higher Gleason Score cancers have cellular features that tend to divide faster, attack tissue more aggressively, and enter the bloodstream and lymph vessels more easily. These aggressive prostate cancers also tend to be more resistant to treatment.
Can Prostate Cancer that is Diagnosed and Treated "Early" Still Spread?
When prostate cancer is diagnosed in its earliest stages, the cure rate is relatively high – up to 95 percent in many cases. As the stage and grade of the prostate cancer increase, however, the cure rate begins to decline. Additionally, prostate cancers that are diagnosed early but have a higher Gleason Score may still recur and spread more easily and rapidly than other less aggressive prostate cancer types.
Understanding the intricate pathways through which prostate cancer spreads is crucial in the fight against this disease. While advancements in early detection and treatment offer hope, ongoing research is vital to illuminate the mechanisms of metastasis further and develop novel therapies to prevent and combat its spread. I am dedicated to staying at the forefront of these advancements and providing my patients with the most up-to-date information and the highest quality of care.
Sources:
- Dr. Ramin’s email answers provided on 12/2/24
- American Cancer Society - Prostate Cancer Staging
