How Quickly Does Prostate Cancer Spread?

Prostate cancer may take up to eight years to spread and metastasize.

The prostate is a small walnut-shaped gland in men, which produces seminal fluid required to nourish and transport the sperm. It is located just below the bladder and in front of the rectum, surrounding the urethra, the tube that carries urine and semen.

Prostate cancer develops in the prostate gland and is one of the most common types of cancer. It is usually diagnosed in men older than age 50.

Metastatic prostate cancer (stage IV prostate cancer) describes cancer that has spread significantly beyond the prostate to nearby lymph nodes or to distant organs like bones, lungs, or liver.

How does prostate cancer spread?

Prostate cancer begins in the cells of the prostate gland. The cancer may grow larger within the prostate, and then may eventually extend beyond the walls of the prostate gland.

1. Local invasion
   • Prostate cancer may grow directly through the prostate capsule into nearby tissues like the seminal vesicles, bladder, or rectum.
2. Lymphatic spread
   • The first sign of spread of metastatic disease occurs when cancer cells break off and travel through lymph vessels to nearby lymph nodes in the pelvis.
3. Hematogenous (bloodstream) spread
   • Prostate cancer cells can enter blood vessels and travel to distant organs, most commonly affecting bones like the spine, pelvis, or ribs, but may also invade the lungs, liver, or brain.

How quickly does prostate cancer spread? Most prostate cancers grow slowly and may take eight years or longer to spread beyond the prostate, if they ever do. Many patients with prostate cancer have their disease remain within the prostate indefinitely and may not require treatment.

Some prostate cancers are aggressive and can metastasize within months to a few years. These cancers can spread early and quickly to lymph nodes, bone, and other organs.

Prostate cancers are assigned a Gleason score, based on how aggressive the cells appear when a pathologist looks at them under the microscope. Cancers with elevated Gleason scores are more likely to spread quickly.

Prostate cancer usually spreads (metastasizes) to distant lymph nodes and organs, which include the following:

• Bone, especially the spine, pelvis, ribs, and femur
• Lymph nodes, in the pelvis, abdomen, chest, and neck
• Liver
• Lungs, leading to shortness of breath, cough, or chest discomfort
• Prostate cancer can spread directly to affect the bladder and rectum

The exact cause of prostate cancer isn't fully known, but it starts when changes (mutations) in the DNA of prostate cells make them grow uncontrollably instead of dying normally. These changes may be influenced by age, genetics, hormones like testosterone, and environmental factors.

What are the risk factors for prostate cancer?

Risk factors for prostate cancer include the following:

• Age: The risk rises after age 50. About 60% of cases are in men over 65.
• Family History: The risk doubles if a father or brother has prostate cancer. It is also higher with inherited genes like BRCA2.
• Race and ancestry: Black men have a two times higher risk and the potential for more aggressive prostate cancer than white men.
• Diet: High consumption of red meat, dairy, or saturated fats in the diet may increase risk.
• Obesity: More advanced prostate cancer and poorer outcomes may be linked to obesity.
• Smoking and chemical exposure: The risk is higher in heavy smokers or exposure to workplace toxins like pesticides.

Prostate cancer may not cause any signs and symptoms in its early stages. Men over 50 years of age, with or without other risk factors, should consult with their healthcare provider to decide whether screening for prostate cancer is appropriate.

Metastatic prostate cancer causes symptoms based on where it has spread. For example, if bone is involved, there may be bone and joint pain, unexplained fractures, or elevated blood calcium levels.

In its later stages, prostate cancer can have symptoms based on its location surrounding the urethra. These may include:

• Difficulty urinating including difficulty initiating urination and a weak urine stream (dribbling urine)
• Blood in the urine
• Blood in the semen
• Erectile dysfunction

Depending on the location or the organs affected, symptoms of prostate cancer that has spread may also include the following:

• Bones: Pain, limited mobility, and fracture
• Lungs: Shortness of breath, cough, and chest discomfort
• Liver: Jaundice, abdominal swelling, easy bruising, or bleeding
• Bladder and rectum: Difficulty urinating, blood in the urine or semen, constipation, change in the caliber, and shape of stool
• General symptoms: Loss of appetite and unexplained weight loss

Testing healthy men with no symptoms of prostate cancer is controversial.

The advantage of routine screening is early detection of cancer when it is most treatable and often curable. It may save lives by reducing the risk of dying from aggressive prostate cancer, and normal results may provide peace of mind for the patient.

However, screening blood tests like PSA can be elevated without cancer being present, leading to unneeded further tests and biopsies. The cancer that is found may be slow growing and may not affect life span but may lead to unnecessary treatments like surgery and radiation, with their potential for complications including urinary incontinence and impotence. PSA tests can also miss some cancers and give false reassurance.

The following are selected recommendations:

The American Cancer Society

The American Cancer Society recommends that men have a chance to have an informed decision with their healthcare provider about whether to be screened for prostate cancer. The decision should be made after getting information about the risks and potential benefits of prostate cancer screening.

This discussion about screening should take place at:

• Age 50 for men who are at average risk for prostate cancer and are expected to live at least 10 more years.
• Age 45 for men at high risk of developing prostate cancer. This includes African Americans, Caribbean men of African ancestry, and men who have a first degree relative (father/brother) diagnosed with prostate cancer at an early age (younger than age 65).
• Age 40 for men at even higher risk (those with more than one first degree relative who had prostate cancer at an early age).

Men who decide to be screened should get a PSA blood test. The DRE may also be done as part of screening. How often you are tested will depend on your PSA level, general health, preferences, and values.

The American Urologic Association

The American Urologic Association recommends the following regarding prostate screening:

• Clinicians should engage in shared decision-making (SDM) with people for whom prostate cancer screening would be appropriate and proceed based on a person's values and preferences.
• When screening for prostate cancer, clinicians should use PSA as the first screening test.

The US Preventive Services Task Force (USPSTF)

The US Preventive Services Task Force (USPSTF) makes the following recommendations about prostate cancer screening:

• Men who are 55 to 69 years old should make individual decisions about being screened for prostate cancer with a prostate specific antigen (PSA) test.
• Before deciding, men should talk to their doctor about the benefits and harms of screening for prostate cancer, including the benefits and harms of other tests and treatment.
• Men who are 70 and older should not be screened for prostate cancer routinely.

This recommendation applies to men who:

• Are at average risk for prostate cancer.
• Are at increased risk for prostate cancer.
• Do not have symptoms of prostate cancer.
• Have never been diagnosed with prostate cancer.

Prostate screening tests include the following:

• Prostate-specific antigen (PSA) blood test
  • PSA is a protein produced by prostate tissue. Elevated levels may indicate cancer, but other conditions that are non-cancerous conditions can also raise PSA levels.
    • These include:
      • Prostate enlargement (benign prostatic hypertrophy)
      • Infections (prostatitis)
      • Recent ejaculation
      • Aggressive bicycling
  • PSA test is the recommended test for prostate cancer screening.
• Digital rectal exam (DRE)
  • A healthcare provider inserts a gloved finger into the rectum This is a part of a physical examination examine the prostate which is located next to the rectum and can be felt through the rectal wall.
  • The purpose is to feel its texture and assess its shape and size, looking for abnormalities like a lump or mass.
  • The DRE often misses early cancers.

Diagnostic tests for prostate cancer

If there are abnormal findings in the screening tests, a diagnostic test will be recommended, such as:

• Imaging the prostate with ultrasound or MRI
• Biopsy using a small sample of prostate tissue is collected using a thin needle inserted into the prostate

MRI-guided biopsies may be more accurate and with a trans peroneal approach and may decrease the risk of infection.

Detection of metastasis

If the diagnosis of prostate cancer is made, the healthcare provider may recommend looking for metastases using one or more of the following tests:

• Bone scan
• Ultrasound
• Computerized tomography (CT) scan
• Magnetic resonance imaging (MRI)
• Positron emission tomography (PET) scan

The treatment options for prostate cancer depend on the individual patient situation.

Low grade cancers may be observed with regular follow up. More aggressive cancers will require a treatment plan individualized for the specific patient's situation and their specific needs. Treatment may or may not be directed at curing the cancer, but rather controlling its spread and minimizing any complications that might occur.

Treatment options for prostate cancer include:

• Surgery
• Radiation therapy
• Chemotherapy
• Immune therapy
• Hormone therapy

Where is the first place prostate cancer spreads?

Prostate cancer typically first spreads to the pelvic lymph nodes, which are the primary drainage sites for the prostate. These nodes are a common initial pathway for metastasis.

Which lymph nodes does prostate cancer spread to first?

Prostate cancer first spreads to the lymph nodes located in the pelvis.

How long can you live if prostate cancer has spread?

The five-year survival rate for patients with prostate cancer located just in the prostate is almost 100%. For patients who have metastatic prostate cancer (stage IV), the five year survival rate is about 32%.

Can a man live 10 years with metastatic prostate cancer?

The average survival after a diagnosis of metastatic prostate cancer is between three and five years. Longer life expectancy may occur in healthier patients or those who respond well to treatment.

How long does it take for aggressive prostate cancer to spread?

Aggressive prostate cancer may spread rapidly, within a few months to a year. However, the rate of progression depends on the tumor's biology and the patient's underlying health condition.

How long does it take for prostate cancer to spread to bones?

How fast metastatic prostate cancer spreads depends upon how aggressive the cancer cells are. The time frame may be months or years.