From the Guidelines
Yes, prostate cancer can spread to other areas of the body through a process called metastasis, with the most recent and highest quality study 1 supporting this notion. When prostate cancer spreads, it most commonly travels to nearby lymph nodes and bones, particularly the spine, pelvis, and ribs. It can also metastasize to other organs such as the lungs, liver, and brain, though this is less common. The spread typically occurs when cancer cells break away from the original tumor and travel through the bloodstream or lymphatic system to establish new tumors elsewhere. This metastatic process is more likely in advanced stages of prostate cancer, which is why early detection through regular screening is important, especially for men over 50 or those with risk factors like family history.
Some key factors that influence the likelihood of spread include:
- The cancer's aggressiveness (Gleason score)
- PSA levels
- How advanced the cancer was at diagnosis
According to the study 1, the primary rationale for utilizing conventional imaging approaches, such as CT or MRI along with 99mTc-methylene diphosphonate bone scintigraphy, relates to the fact that current standard of care systemic treatments in metastatic hormone-sensitive prostate cancer are based on such conventional imaging approaches. However, novel PET tracers, such as fluciclovine or choline, appear to show greater sensitivity in detecting prostate cancer recurrence and metastases at low PSA values.
When prostate cancer has metastasized, treatment approaches shift to systemic therapies like hormone therapy, chemotherapy, immunotherapy, or targeted radiation rather than focusing solely on the prostate itself, as supported by studies 1 and 1. The goal of these therapies is to palliate symptoms and improve quality of life, rather than to achieve a cure.
In terms of morbidity and mortality, prostate cancer is the second leading cause of cancer mortality among American men, with most deaths occurring in men who had originally presented with disease that was thought to be clinically localized, underwent definitive primary management with curative intent, experienced treatment failure with biochemical recurrence, and then had their recurrent disease progress while on nontargeted systemic therapy to become fatal, as noted in study 1. Therefore, early detection and treatment are crucial in reducing the risk of metastasis and improving outcomes for men with prostate cancer.
From the Research
Prostate Cancer Spread
- Prostate cancer can spread to other areas of the body, with the most common sites being bone, distant lymph nodes, liver, and thorax 2.
- A study found that 84% of patients with metastatic prostate cancer had bone metastases, while 10.6% had distant lymph node metastases, 10.2% had liver metastases, and 9.1% had thorax metastases 2.
- The study also found that 18.4% of patients had multiple metastatic sites involved, with the proportion of men with multiple sites involved varying depending on the site of metastases 2.
Detection and Screening
- Digital rectal examination (DRE) and prostate-specific antigen (PSA) testing are commonly used for prostate cancer screening 3, 4, 5, 6.
- A meta-analysis found that the pooled sensitivity, specificity, and positive predictive value for PSA were 72.1%, 93.2%, and 25.1%, respectively, while for DRE were 53.2%, 83.6%, and 17.8%, respectively 4.
- Another study found that the cancer detection rate was 3.2% for DRE, 4.6% for PSA, and 5.8% for the two methods combined 6.
- The use of PSA in conjunction with DRE has been shown to enhance early prostate cancer detection, with a significant increase in the detection of organ-confined disease 6.
Metastatic Sites
- The distribution of metastatic sites in patients with prostate cancer has been studied, with the most common sites being bone, distant lymph nodes, liver, and thorax 2.
- The study found that the proportion of men with multiple metastatic sites involved varied depending on the site of metastases, with 19.4% of men with bone metastases having multiple sites involved, compared to 43.4% of men with lymph node metastases, 76.0% of men with liver metastases, and 76.7% of men with thorax metastases 2.