Metastatic Prostate Cancer

Uncontrolled growth of prostate cells is referred to as prostate cancer. Depending upon the stage of malignancy, the symptoms and outcome may vary. In most cases, prostate cancer is localized in early stages; whereas, advanced disease is characterized by distant metastasis and involvement of surrounding tissues. Metastatic Prostate Cancer is found further into the disease.Metastatic Prostate cancer:Metastatic prostate cancer is classified under stage IV prostate malignancy. Prostate cancer is mostly a slow-growing malignancy and most patients don’t even realize that they have the disease until surrounding tissues are involved.There are two types of metastatic prostate cancer:

1. Local metastasis: Involvement of surrounding tissues in the pelvic region is referred to as local metastasis. In most cases, only lymph nodes are involved, but any other pelvic organ or tissue can also be involved.
2. Distant metastasis: Spread of cancer cells beyond pelvic region is referred to as distant metastasis. Common sites of distant spread of prostate cancer cells are breast, lungs, brain, bones, and liver.

What are classic symptoms of Metastatic Prostate cancer?

Metastatic prostatic cancer is characterized by peculiar symptoms of prostate cancer such as urinary urgency, burning or painful urination, poor urinary stream, an appearance of blood in the urine or ejaculate, and erectile dysfunction.Besides above-listed symptoms of prostate cancer, there may be other symptoms of a metastatic disease that depends largely on the area of involvement and extent of disease. Other symptoms of a metastatic prostatic disease are:

• Fatigue
• Unexplained weight loss
• Feeling unwell
• Reduced appetite
• Swelling of legs or feet
• Bone pains or aches

Complications of Metastatic Prostate cancer:

As explained previously, metastasis is suggestive of advanced disease and may be associated with varying complications; such as:

• Bowel related complications: Spread of prostate cancer to bowel tissues may present with complications like constipation, diarrhea, weight loss, loss of appetite, incontinence etc.
• Sexual problems: Men with advanced prostate disease almost always complaints of erectile dysfunction, poor libido, and ejaculatory defects
• Hypercalcemia: Spread of cancer to bones can lead to bony erosion and consequently lead to hypercalcemia (high serum levels of calcium due to bone destruction). Hypercalcemia presents with fatigue, increased thirst, vomiting, constipation, persistent need to urinate, nausea, bone aches, increased risk of developing fractures and loss of appetite.

• Anemia: Involvement of bone marrow affects the capacity of marrow to produce normal viable cells that are capable of carrying out normal functions such as delivery of oxygen to peripheral tissues. Anemia may present with fatigue, shortness of breath and pale appearance of skin
• Lymphedema: When prostate cancer cells involve lymph nodes, the lymph carrying ducts may get clogged or obstructed – thereby presenting with lymphedema.

Prognosis of Prostate Cancer:The prognosis of prostate cancer depends on the extent of spread and aggressiveness of the disease.

• The 5-year survival rate of localized disease is almost 100%
• The 5-year survival rate of prostate cancer with local spread is also nearly 100%
• The 5-year survival rate of advanced disease with distant metastasis is only 29%

References:

1. Sartor, O., Flood, E., Beusterien, K., Park, J., Webb, I., MacLean, D., ... & Lin, H. M. (2015). Health-related quality of life in advanced prostate cancer and its treatments: biochemical failure and metastatic disease populations. Clinical genitourinary cancer, 13(2), 101-112.
2. Culp, S. H., Schellhammer, P. F., & Williams, M. B. (2014). Might men diagnosed with metastatic prostate cancer benefit from definitive treatment of the primary tumor? A SEER-based study. European urology, 65(6), 1058-1066.

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