Metastatic Prostate Cancer: Causes, Symptoms, Risk Factors, and Treatment Options

Prostate cancer begins with abnormal cell growth in the prostate gland. It is a small organ located below the bladder that produces fluid for semen as part of the male reproductive system.

When we hear about prostate cancer, we often imagine it as something contained within the gland. But in more advanced cases, prostate cancer can spread or metastasize to other body parts.

We spoke to Dr Ankit Goel - Head of Department Urology, Andrology and Urology - Oncology, MASSH Hospital, Delhi, who explained prostate cancer and how it spreads.

What Is Metastatic Prostate Cancer?

Metastatic prostate cancer occurs when prostate cancer cells spread beyond the prostate to other body parts, classified as stage 4 or advanced disease. “While most prostate cancers are diagnosed at an early stage, metastatic disease usually develops in those with a history of prostate cancer treatment. Although metastatic prostate cancer can't be cured, various treatments can help slow its progression and manage symptoms,” explained Dr Goel.

Causes of Metastatic Prostate Cancer

“The exact cause of metastatic prostate cancer remains uncertain. It occurs when cancer cells detach from the original tumor in the prostate and spread to other parts of the body. These cells typically travel through the bloodstream or lymphatic system to establish new tumours elsewhere,” added Dr Goel.

Also Read: Do You Push While Peeing? Causes And Why You Shouldn't Do It

Common Sites of Prostate Cancer Metastasis

Metastasis sites associated with prostate cancer are:

• Bones: This is the most frequent site, especially the spine, hips, and ribs. A 2014 study found that around 84% of men with metastatic prostate cancer had bone involvement.
• Lymph Nodes: These small glands, part of the immune system, are involved in approximately 10.6% of metastatic cases.
• Liver: Roughly 10.2% of cases involve the liver.
• Lungs: About 9.1% of men with advanced prostate cancer show metastases in the lungs.

Rare sites where prostate cancer can spread include:

• Adrenal glands
• Brain
• Pancreas

“The bones are by far the most common site,” added Dr Goel. “In fact, new back or hip pain in someone with a history of prostate cancer should never be ignored.”

Signs and Symptoms of Metastatic Prostate Cancer

In its early stages, metastatic prostate cancer may not show any noticeable symptoms. But as the disease progresses, certain signs can start to appear. These may include:

• Persistent fatigue or feeling unusually tired
• Frequent urination or discomfort during urination
• Unexplained weight loss
• Nausea or episodes of vomiting
• Pain that develops in the back, hips, pelvis, or bones, and tends to become more intense over time

These symptoms often depend on where the cancer has spread in the body.

Also Read: Men's Health: Signs To Get Prostate Cancer Screening

Risk Factors for Prostate Cancer Spread

The factors that increase the risk of prostate cancer spreading (metastasising) are generally the same as those that increase the risk of developing prostate cancer in the first place. Key risk factors include:

• Age: Prostate cancer becomes more common with age, especially after 50.
• Race and Ethnicity: In the U.S., Black men face a higher risk of prostate cancer and are more likely to be diagnosed with aggressive or advanced forms. The reasons for this aren't fully understood.
• Family History: Having a close blood relative like a father, brother, or even a grandparent, who’s had prostate cancer can raise your risk.
• Inherited Genetic Mutations: Certain inherited DNA changes, like those in the BRCA1 and BRCA2 genes (better known for their link to breast and ovarian cancers), may increase prostate cancer risk as well.
• Obesity: According to the Cancer Research UK, excess body weight is associated with a higher risk of aggressive prostate cancer. It is linked to a higher risk of prostate cancer growing rapidly and recurring after treatment.
• Smoking tobacco: Some studies suggest that smokers are more likely to develop prostate cancer that spreads beyond the gland and may face a higher chance of recurrence, though research findings on this are mixed.

Potential Complications from Metastatic Prostate Cancer

Treatments for metastatic prostate cancer can weaken the bones, making them more fragile and prone to fractures. To help protect bone health, doctors may advise:

• Exercise: Aim for 30 minutes of weight-bearing activity most days (walking, light strength training).
• Nutrition: Eat calcium-rich foods (dairy, leafy greens) and discuss vitamin D or calcium supplements with your doctor.
• Lifestyle: Quit smoking and limit alcohol to support overall bone and cardiovascular health.

Also Read: Life After Prostate Cancer Treatment: How To Minimise Chances Of Recurrence

Why Stage 4 Prostate Cancer Is Less Common at First Diagnosis

Early Screening Success: Most men are diagnosed via PSA (prostate‐specific antigen) testing or digital rectal exams before the cancer spreads.
Prior Treatment: Metastatic disease more often appears in men who’ve had surgery, radiation, or hormonal therapy for earlier‐stage prostate cancer.

When To See A Doctor

Dr Goel concluded, "If you’ve had prostate cancer in the past, or you’re experiencing any of the symptoms mentioned earlier, especially bone pain, fatigue, or urinary issues, it’s important to consult your doctor. Early evaluation can make a world of difference. Even if you’ve been treated before, new symptoms deserve attention. Timely treatment can slow down disease progression and preserve quality of life."