Advanced prostate cancer

Symptoms of prostate cancer may not develop for many years. The symptoms of advanced prostate cancer may be caused by an enlarged prostate. Symptoms of an enlarged prostate can include:

• needing to pee (pass urine) more often than usual, especially at night
• difficulty peeing – for example, a weak flow or having to strain to start peeing
• feeling like you have not completely emptied your bladder afterwards
• an urgent need to pee
• blood in your pee or semen
• rarely, pain when peeing or ejaculating.

Symptoms can also be a sign of secondary cancer, where the cancer has spread to another part of the body. The symptoms will depend on which part of the body is affected.

General symptoms may include:

• being more tired than usual
• generally feeling unwell
• having less of an appetite
• losing weight for no obvious reason.

If you have any of the symptoms we mention here, it is important to have them checked by your doctor.

Secondary cancer in the bones

After the lymph nodes, the most common place for prostate cancer to spread to is the bones. Prostate cancer may spread to bones, such as the:

• spine
• pelvis
• thigh bone (femur)
• ribs.

It may affect different areas of the bones rather than only one area.

Other symptoms

Prostate cancer can sometimes spread to other parts of the body, such as the lymph nodes, lungs or liver. If you notice any new symptoms that last for 2 weeks or more, you should talk to your cancer doctor.

It is important to remember that any of the symptoms mentioned here can be caused by problems other than cancer.

How you are diagnosed with advanced prostate cancer will depend on your situation. It may be:

• after previous treatment for early or locally advanced prostate cancer – possibly many years ago
• after being diagnosed with cancer in the prostate, if further tests show the cancer is advanced
• after tests to check symptoms of bone pain, with no previous diagnosis of prostate cancer.

The most common places for prostate cancer to spread to is the lymph nodes outside the pelvis and the bones. It sometimes spreads to areas such as the lungs or liver.

Your doctor or specialist nurse will explain the tests you will have. You may not need all the tests we mention here.

If you have, or have had, prostate cancer and have symptoms, you will have tests to see if the cancer has spread. These usually include a PSA test and bone scan.

If you have just been diagnosed with prostate cancer, you will have further tests to see if the cancer is advanced. These include a bone scan, a CT scan or an MRI scan.

If you were diagnosed with secondary cancer in the bones, you will need tests to find out if it started in the prostate. You will have a PSA test and depending on your situation, you may be offered a biopsy of the prostate. A biopsy is when samples of tissue are taken.

You may also have x-rays of the bones in a painful area, to find out if there are any abnormal areas.

Waiting for test results can be a difficult time, we have more information that can help.

Although advanced prostate cancer cannot be cured, it can be controlled with treatment, sometimes for several years. Treatments can also help relieve symptoms and improve your quality of life.

A multidisciplinary team (MDT) will meet to discuss the best possible treatment options for you. This will depend on different factors, like your general health. Your cancer doctor will talk to you about the advantages and disadvantages of these treatments.

The main treatments are:

Your doctor or nurse will usually ask you to sign a form giving your permission (consent) for them to give you the treatment. They cannot give treatment without your consent.

Treatments can help to control the cancer and relieve the symptoms. But there may be a time when the treatment has little effect on the cancer. This means you have the side effects without the benefits.

Making decisions about treatment is always difficult. You may want to talk it over carefully with your cancer doctor, specialist nurse, and family.

If you decide not to have further treatment, you will be given supportive (palliative) care, with medicines to control any symptoms. Specialist nurses called palliative care nurses can provide help and support. They are experienced in assessing and treating symptoms of advanced cancer.

We want everyone affected by cancer to feel our information is written for them.

We want our information to be as clear as possible. To do this, we try to:

• use plain English
• explain medical words
• use short sentences
• use illustrations to explain text
• structure the information clearly
• make sure important points are clear.

We use gender-inclusive language and talk to our readers as ‘you’ so that everyone feels included. Where clinically necessary we use the terms ‘men’ and ‘women’ or ‘male’ and ‘female’. For example, we do so when talking about parts of the body or mentioning statistics or research about who is affected.

You can read more about how we produce our information here.