How Quickly Does Prostate Cancer Spread?

The exact cause of prostate cancer is not known. The tumor arises from cells with abnormal deoxyribonucleic acid (DNA) changes in the prostate. These abnormal cells rapidly grow and divide, invading surrounding structures and can spread to other parts of the body (metastasize).

Risk factors

There are certain factors that can increase the risk of prostate cancer. These include 

• Age: The risk of prostate cancer increases with age and is most commonly seen after the age of 50.
• Race: African American men have a higher risk of prostate cancer than men of other ethnicities. Cancer in African Americans is also more likely to be aggressive.
• Family history: If a blood relative has prostate cancer, it increases the risk as well. Having a family history of genes that increase the risk of breast cancer (BRCA1 or BRCA2) or a very strong family history of breast cancer also increases the risk of developing prostate cancer.
• Obesity: Obese people have a higher risk of developing prostate cancer, which is also more likely to be aggressive and recurrent despite treatment. 
• Smoking

Prostate cancer may not cause any signs and symptoms in the early stages. Hence, it is advisable for men over 50 years of age with or without other risk factors to consult with a doctor to be screened for prostate cancer.

Prostate cancer can cause the following signs and symptoms in the later stages

• Difficulty urinating
• Weak urine stream or dribbling of urine 
• Blood in the urine
• Blood in the semen
• Bone pain
• Weight loss 
• Erectile dysfunction

Testing healthy men with no symptoms for prostate cancer is controversial. However, many doctors do recommend asymptomatic men over the age of 50 years old, especially those with other risk factors, to get screened for prostate cancer routinely because there are often no symptoms in the early stages. The advantage of routine screening is early detection of cancer and treatment with the possibility of complete cure. 

Prostate screening tests might include the following

• Digital rectal exam (DRE): This is a part of a physical examination performed by a doctor on an outpatient basis. The doctor, with gloves on, inserts a finger into the rectum to examine the prostate to feel the texture and assess the shape and size. The prostate is situated adjacent to the rectum. The doctor uses a numbing lubricant while performing the exam to reduce discomfort.
• Prostate-specific antigen (PSA) test: This is a blood test to detect the level of PSA, a substance that is naturally produced by the prostate gland. If the PSA level is higher than normal, it indicates prostate abnormalities. PSA levels are usually also increased in cases of prostate infection or benign enlargement of the prostate. The PSA test is also done to monitor disease progress and response to treatment. 

Diagnostic tests for prostate cancer

If there are abnormal findings in the screening tests, the doctor may advise the following diagnostic tests. 

• Ultrasound: Trans-rectal (through the rectum) ultrasound is done using a small probe inserted into the rectum to study the prostate gland.
• Magnetic resonance imaging (MRI) scan 
• Prostate biopsy: A small sample of prostate tissue is collected using a thin needle inserted into the prostate.
• Detecting the presence of metastasis 

Detection of metastasis

The doctor may recommend one or more of the following tests if metastasis is suspected.

• Bone scan
• Ultrasound
• Computerized tomography (CT) scan
• Magnetic resonance imaging (MRI)
• Positron emission tomography (PET) scan for the whole body 

The treatment options of prostate cancer depend on the aggressiveness of the tumor, whether it is metastasized and the overall health of the patient. Treatment may involve one or a combination of multiple treatment modalities. 

Treatment options include

• Observation and follow-up: Low-grade prostate cancer may not require treatment immediately. Hence, the doctor may recommend observation and regular follow-up. This may be an option for those who have a very small, slow-growing tumor confined to a small area in the prostate, which is not causing any symptoms. It may also be an appropriate strategy for those with other serious medical conditions or who are at a very advanced age, making them medically unfit for other treatment options. 
• Surgery: Surgery to remove the prostate is called prostatectomy, where the entire prostate gland is removed. Radical prostatectomy may be performed, which involves removal of the prostate along with surrounding tissues and lymph nodes. Surgery may be curative in most cases (if there is no metastasis) and may be combined with other treatments.
• Radiation therapy: Radiation therapy uses high-powered energy to kill cancer cells. Radiation therapy is a good option for treating cancer confined to the prostate.
• Cryotherapy: This involves freezing prostate tissue using cold gas, which can kill the cancer cells.
• Heating the prostate tissue: High-intensity focused ultrasound (HIFU) uses concentrated heat generated by ultrasound energy, causing cell death.
• Hormone therapy: This involves taking medication to stop the production of the male hormone, testosterone, or blocking the action of testosterone. Prostate cancer cells require testosterone to grow. Therefore, cutting off the supply of testosterone can cause cancer cells to die and/or decrease their growth rate.
• Chemotherapy: Chemotherapy involves using medications to kill cancer cells. It can also help kill cancer cells that have metastasized.
• Immunotherapy: Immunotherapy modulated the body’s immune system to help fight cancer.
• Targeted drug therapy: Targeted drug treatments target specific abnormalities present within cancer cells and block the abnormalities causing cancer cells to die.
• Pain management: Large prostate cancers and metastasis can cause significant pain for which the doctor would prescribe appropriate painkillers.
• Emotional support: It is necessary to help with the emotional stress and depression that may be associated with a chronic disease.