From the Guidelines
The life expectancy for stage 4 prostate cancer varies significantly based on individual factors, but generally ranges from 1 to 5 years, with a median survival of less than 2 years for those with metastatic disease, as stated in the study by 1. Without treatment, survival may be limited to 1-2 years, while with appropriate treatments, many patients live 3-5 years or longer. Several factors influence prognosis, including the patient's age, overall health, PSA levels, Gleason score, extent of metastasis, and response to treatment. Treatment options typically include androgen deprivation therapy (ADT) with medications like leuprolide (Lupron) or goserelin (Zoladex), often combined with newer hormonal agents such as abiraterone (Zytiga), enzalutamide (Xtandi), or apalutamide (Erleada). Chemotherapy with docetaxel may be added for rapidly progressing disease. Some patients may benefit from radiation therapy for bone metastases or radiopharmaceuticals like radium-223 (Xofigo) to target bone metastases. It's essential to consider the most recent and highest quality study, which is the 2021 guideline by 1, that provides recommendations for the management of metastatic hormone-sensitive prostate cancer, including the use of ADT, androgen pathway directed therapy, and chemotherapy. The guideline suggests that clinicians should offer ADT with either LHRH agonists or antagonists or surgical castration in patients with metastatic hormone-sensitive prostate cancer, and consider continued ADT in combination with either androgen pathway directed therapy or chemotherapy. Overall, the management of stage 4 prostate cancer requires a comprehensive approach, taking into account individual patient factors, and the latest evidence-based guidelines, as stated in the studies by 1.
From the FDA Drug Label
Median Survival, months (95% CI) 18.4 (17.3, NR) Median Survival, months (95% CI) 32.4 (30.1, NR) Median Survival, months (95% CI) 35.3 (32.2, NR) The median life expectancy for stage 4 prostate cancer patients treated with enzalutamide is around 18.4 to 35.3 months 2.
- The life expectancy can vary depending on the specific patient population and treatment regimen.
- The median survival times reported in the study are based on the overall survival analysis and may not reflect the life expectancy of individual patients.
From the Research
Life Expectancy of Stage 4 Prostate Cancer
- The life expectancy of stage 4 prostate cancer patients can vary depending on several factors, including the extent of metastasis and the effectiveness of treatment 3.
- A study published in 2025 found that the addition of apalutamide to androgen-deprivation therapy may provide less benefit in patients with metastatic castration-sensitive prostate cancer who have fewer bone metastases 3.
- The same study found that counting baseline bone metastases may help identify optimal candidates for apalutamide treatment of metastatic castration-sensitive prostate cancer 3.
- Another study published in 2017 discussed the use of androgen deprivation therapy with Leuprolide acetate for the treatment of advanced prostate cancer, highlighting its importance in daily clinical practice 4.
- A 2015 study reviewed the safety and efficacy of extended release, 6-month formulations of leuprolide acetate for the treatment of advanced prostate cancer, emphasizing the importance of achieving testosterone levels below 20 ng/dl 5.
- A 2014 study investigated the use of intense androgen-deprivation therapy with abiraterone acetate plus leuprolide acetate in patients with localized high-risk prostate cancer, finding that this combination suppresses tissue androgens more effectively than leuprolide acetate alone 6.
- A 2025 review examined the current and future role of theranostics in the diagnosis and management of neuroendocrine prostate cancer, a rare but aggressive form of prostate cancer that can develop in patients treated with androgen deprivation therapy and androgen receptor pathway inhibitors 7.