ABOUT PROSTATE CANCER

Understanding advanced prostate cancer

Published June 2021

Understanding advanced prostate cancer
Understanding advanced prostate cancer

Cells are the building blocks that make up our bodies, including the prostate gland. Cells divide and grow every day as part of the upkeep and repair of our bodies.1 Prostate cancer occurs when one or more of your normal prostate cells mutate. These mutations cause cells to lose control over how often they divide. Cells keep on multiplying to form a cancerous tumour.1,2

No one is sure why the mutations that cause prostate cancer happen; they may be due to being exposed to certain things during our lives, the lifestyle we lead or the genes we’ve inherited from our parents.2

The prostate

The prostate is a walnut-size gland found in men. It sits under the bladder, surrounding the urethra – the tube that urine and semen pass along as they exit through the penis. The prostate is partly responsible for producing the fluid that makes up semen. It tends to get bigger in men as they get older.3

Non-metastatic prostate cancer

Initially, the cancer will only be found inside the prostate gland. Often the cancer grows slowly or doesn’t grow at all. But, some patients will have cancer that grows quickly. This cancer needs treatment as there is a high risk of it spreading outside the prostate.4 Non-metastatic prostate cancer can also be defined as localised, early or organ-confined prostate cancer.4

Metastatic prostate cancer

At a certain point the cancer can spread away from the prostate to other parts of the body. The spread of these new tumours is called metastatic prostate cancer. Some patients get symptoms, such as pain, with these tumours. Another term for metastatic prostate cancer is ‘advanced prostate cancer’.5

Castration-resistance

For some patients with prostate cancer, testosterone-lowering treatments are an option and these can be in the form of a surgical procedure (orchidectomy) or medical hormonal treatments. Testosterone is a hormone present in healthy people, but can also help prostate cancer to develop and grow. Treatments that lower testosterone levels help keep prostate cancer in check.6 However, prostate cancer cells can adapt, making them resistant to treatment so that the cancer can grow even at low testosterone levels. At this point the testosterone lowering treatment is no longer effective and this is called ‘castration- (or castrate-) resistant’ or ‘hormone-relapsed’ prostate cancer.7,8

How you feel

Extreme tiredness is one of the most common symptoms experienced by patients with advanced prostate cancer. This tiredness can be a direct result of the cancer itself or a side-effect of treatment. People with advanced prostate cancer can also experience bone pain and problems urinating. There are treatments available to help manage these symptoms. You may want to talk to your doctor or nurse if you experience any of these symptoms.

Your tests and scans9,10

Your healthcare team will perform regular tests and scans to determine the activity of your cancer and to see how your selected therapy is working. The most common screening tool/marker for prostate cancer is called prostate specific antigen or ‘PSA’.

Prostate-specific antigen (PSA)

This is a protein produced by the prostate (and prostate cancer cells) that is often higher in men with prostate cancer.10 PSA is found in the blood and levels are measured by a blood test. Sometimes PSA levels are used to monitor prostate cancer or to see how well treatments are working. PSA is one of several measures used to monitor disease in advanced prostate cancer, among other blood tests or scans.10

Your treatment options11

It is not yet possible to cure advanced prostate cancer, but there are treatments available to slow progression, relieve symptoms, and prolong life. Your healthcare team will discuss your individual options with you – some of the more common treatments for advanced prostate cancer are listed below. Common treatments for localised prostate cancer include surgery (radical prostatectomy), external beam radiotherapy and brachytherapy.

You may not receive all of these treatments – it depends on the type of cancer you have and what side effects from treatment you and your specialist team feel that you are able to tolerate.

Your specialist team are the best source of information and advice on treatment options and possible side effects.

Hormone therapy

This is the therapy many men are prescribed when they are diagnosed with prostate cancer – you may already have been taking this treatment for some time. Testosterone helps prostate cancer cells to grow and divide – hormone treatment lowers testosterone levels in the body, helping to keep prostate cancer under control. After a certain amount of time the cancer may change so that it can grow even with this low level of testosterone – this is called castration-resistant prostate cancer. The hormone therapy is still having a positive effect, but other treatments are needed to help slow the course of the disease. These include other forms of hormone therapy that target markers on the prostate cell that control cell division, or target enzymes involved in testosterone production.

There are also several hormone treatments available for castration-resistant prostate cancer, which generally either lower testosterone even further or block the activity of testosterone in prostate cancer cells.

Chemotherapy

A treatment usually given in hospital by infusion, via a drip, usually through a vein in the arm. Chemotherapy uses drugs that are ‘cytotoxic’ – they kill fast-dividing cells in the body, especially the cancer cells.

Other therapies

Some therapies target cancer that has spread to the bones. One example is a medicine that targets tumours in the bones and can help to slow the course of the disease. Another is radiotherapy, in which a beam of radiation is focussed onto a tumour. This helps kill off some of the cancer cells in the tumour, reducing the symptoms associated with it.

Before starting any treatment, make sure you have got all the information you need. Speak to your doctor or nurse if you have any questions – they are there to help and will also be able to give you practical advice on how to cope with any treatment-related side effects.

SOURCES:
  1. Macmillan UK. What is cancer? Available at: https://www.macmillan.org.uk/cancer-information-and-support/worried-about-cancer/what-is-cancer. Accessed October 2025.
  2. Cancer Research UK. How cancer starts. Available at: http://www.cancerresearchuk.org/about-cancer/what-is-cancer/how-cancer-starts. Accessed October 2025.
  3. Prostate Cancer UK. About prostate cancer. Available at: https://prostatecanceruk.org/prostate-information/about-prostate-cancer. Accessed October 2025.
  4. Prostate Cancer UK. What is localised prostate cancer? Available at: 
https://prostatecanceruk.org/prostate-information/just-diagnosed/localised-prostate-cancer. Accessed October 2025.
  5. Prostate Cancer UK. Advanced prostate cancer. Available at: https://prostatecanceruk.org/prostate-information/advanced-prostate-cancer. Accessed October 2025.
  6. Prostate Cancer UK. Hormone therapy. Available at: https://prostatecanceruk.org/prostate-information/treatments/hormone-therapy. Accessed October 2025.
  7. Prostate Cancer UK. Treatment options after your first hormone therapy. Available at: 
https://prostatecanceruk.org/prostate-information/treatments/treatment-options-after-your-first-hormone-therapy. Accessed October 2025.
  8. National Cancer Institute (NCI). NCI Dictionary of Cancer Terms. Available at: 
https://www.cancer.gov/publications/dictionaries/cancer-terms/def/castrate-resistant-prostate-cancer. Accessed October 2025.
  9. National Cancer Institute (NCI). Prostate-specific antigen (PSA) test. Available at: 
https://www.cancer.gov/types/prostate/psa-fact-sheet. Accessed October 2025.
  10. Prostate cancer: Tests. Cancer Research UK. Available at: https://about-cancer.cancerresearchuk.org/about-cancer/prostate-cancer/getting-diagnosed/tests#needle. Accessed October 2025.
  11. Treatment: Prostate cancer. NHS. Available at: https://www.nhs.uk/conditions/prostate-cancer/treatment/. Accessed October 2025.

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