Metastatic prostate cancer is prostate cancer that has spread outside of the prostate to other parts of the body. This is also known as stage IV disease.

At MD Anderson, I treat patients with advanced prostate cancer, most of whom have metastatic disease. A lot of our research is focused on how we can better treat metastatic prostate cancer to improve patients’ results.

Here, I’ll answer common questions I get about metastatic prostate cancer, including what MD Anderson is doing to advance treatment.

Where is prostate cancer most likely to spread?

Prostate cancer often spreads to the bones and lymph nodes. It most commonly spreads to bones in the pelvis or spine. Sometimes it spreads to the ribs.

Over time, prostate cancer can spread to other bones, such as the base of the skull. This is usually a sign of very advanced cancer.

How is metastatic prostate cancer treated?

We’ve known since the 1940s that prostate cancer is a hormone-driven disease. Early studies showed that surgically removing the testes in men, which decreases the body’s testosterone, led to improvement in prostate cancer – temporarily, at least.

While we don’t commonly perform those surgeries anymore, we continue to direct treatment at testosterone, the male sex hormone. Surgery is usually not an option for metastatic prostate cancer. At MD Anderson, we work together as a team of specialists to treat stage IV prostate cancer. Patients may receive:

Hormone therapy

Antiandrogens are medications that block the production of testosterone or stop their interaction with cancer cells.

Chemotherapy

Chemotherapy is often used to treat metastatic prostate cancer by destroying cancer cells.

Radiation therapy

Patients who have painful metastases in their bones may receive targeted radiation therapy to those areas.

Supportive care

We work closely with our Supportive Care team to help patients manage pain during treatment.

What is the survival rate for metastatic prostate cancer?

The average length of survival after a new, metastatic prostate cancer diagnosis is about 5 to 6 years. But it’s important to remember that prostate cancer is not a one-size-fits-all disease. Survival rates are averages. Some patients will live longer than the average, and some will live less than the average. Speak with your doctor about your specific prognosis.

Metastatic prostate cancer goes through two phases, and this impacts the length of survival.

Hormone-sensitive prostate cancer

During this phase, treatments directed toward the testosterone hormones are working well to keep the cancer from growing.

Hormone-refractory prostate cancer

Prostate cancer is smart, and eventually, it learns how to grow without testosterone. This is what we call hormone-refractory, or castration-resistant, prostate cancer. On average, metastatic prostate cancer takes 2 to 3 years to become castration-resistant, but it could be longer or shorter depending on the features of the cancer. Once the disease reaches this phase, average survival is another 2 to 3 years.

What are the latest advances in metastatic prostate cancer treatment?

There is a lot of exciting research happening right now. We’re focusing on identifying specific biomarkers to help us select the right treatment for each patient.

In 2022, the Food and Drug Administration (FDA) approved a targeted nuclear medicine therapy called lutetium Lu 177 vipivotide tetraxetan to treat prostate-specific membrane antigen (PSMA) metastatic castration-resistant prostate cancer. It targets the PSMA protein and delivers radiation to those cancer cells.

We have PSMA PET scans that look for PSMA in cancer cells. If the prostate cancer makes this protein, the patient is a good fit for PSMA-targeted treatment. A Phase III clinical trial showed that patients who received lutetium Lu 177 vipivotide tetraxetan lived longer than those in the control arm who received a different treatment. So, we have a new treatment option to offer patients. Eligible patients receive the treatment as an infusion every six weeks.

At MD Anderson, we’re also conducting clinical trials to study how immunotherapy can help treat prostate cancer. Prostate cancer historically hasn’t seen the same success with immunotherapy as other cancers, like melanoma or lung cancer. We’re hoping to change that.

What’s your best advice for men who’ve been diagnosed with advanced prostate cancer and their loved ones?

I always tell people that one of the key reasons for coming to MD Anderson is the wealth of clinical trial opportunities we offer. Of course, there are pros and cons, but that is a conversation we have with each patient.

If you have been diagnosed with prostate cancer, specifically metastatic prostate cancer, I strongly encourage you to ask your oncologist about clinical trials. Ask them, ‘What’s new in the pipeline? What other options beyond the standard treatment do we potentially have?’

We haven’t cured metastatic prostate cancer yet. But we’re moving in the right direction.

Bilal Siddiqui, M.D., is a genitourinary medical oncologist at MD Anderson who specializes in treating advanced prostate cancer.

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