What Happens in the Final Stages of Prostate Cancer?

  • Medical Reviewer: Dany Paul Baby, MD
Medically Reviewed on 7/1/2022

What are the prostate cancer stages?

Prostate cancer is an abnormal growth of cells in the prostate gland. In the final stages of prostate cancer you may feel grief, get closer with family and friends, and have faith in a power greater than yourself.
Prostate cancer is an abnormal growth of cells in the prostate gland. In the final stages of prostate cancer you may feel grief, get closer with family and friends, and have faith in a power greater than yourself.

The prostate is a gland about the size of a walnut that is a part of the male reproductive system. In the USA, roughly 13 out of every 100 men will develop prostate cancer sometime in their lives, making it one of the most common cancers in men. Most cases are diagnosed in the early stages when cancer affects only the prostate. As the disease progresses, prostate cancer can spread to lymph nodes, bones, liver, and other body parts. In the final stages, prostate cancer is often incurable, but some treatments can help lengthen and improve your quality of life. 

Doctors often use the Gleason score and Grade Groups to evaluate prostate cancer as it develops. Cancer cells don’t look the same as healthy cells. If cancer is suspected, your doctor will take a sample (biopsy) to study under a microscope. Cancer cells are then graded based on how similar or different they look compared to healthy cells. The grades typically range between 3 and 5. Low-scoring cancer cells that look more normal are often slow-growing, but higher scored cancer cells are much more likely to be aggressive and spread quickly (metastasize).

The grades from the two most common cell patterns in your biopsy sample are added together. This number is usually between 6 and 10 and is called a Gleason Score. The cancer is then further broken down into Grade Groups 1 through 5 based on your Gleason score. A Gleason score of 6 would be put in Grade Group 1, and a Gleason score of 10 would be in Grade Group 5.

Men with higher Gleason scores and Grade Groups are more likely to develop higher stages of prostate cancer and need immediate treatment. Prostate cancer is then broken down into four stages based on how much cancer has spread.

Stage 1 prostate cancer 

In the first stage, prostate cancer can be difficult to diagnose. The tumor affects a small part of the prostate and can’t be felt during a digital rectal exam (DRE) or seen with imaging tests. In this early stage, the cancer is often only found accidentally during treatment for other health issues.

Stage 2 prostate cancer 

During stage 2, prostate cancer tumors can be felt during a DRE and seen with imaging scans. Cancer may be on one or both sides of your prostate. In stage 2 prostate cancer, the tumor still affects only the prostate and has not yet spread to other body parts.

Stage 3 prostate cancer 

By stage 3, cancer is no longer confined to just the prostate. The cancer begins to spread to nearby body parts, often into the seminal vesicles.

Stage 4 prostate cancer 

Stage 4 is the most severe and final stage of the disease. In this stage, cancer spreads to other body parts like the lymph nodes, bladder, rectum, pelvic walls, or bones. 

Who is at risk of stage 4 prostate cancer?

Each year almost 200,000 American men are diagnosed with prostate cancer. Obesity and smoking are linked to a higher risk of prostate cancer, but most prostate cancers happen to men over 55. The risk increases as you get older— about 60% of prostate cancers are diagnosed in men over 65 years old. 

Stage 4 prostate cancer happens when cancer becomes aggressive and spreads to other parts of your body. Some genetic mutations have been connected to an increased likelihood of developing aggressive prostate cancer, so men with family histories of the disease are at greater risk. Men with family members who have had pancreatic, breast, or ovarian cancers might also have a higher risk of prostate cancer. 

Black or African-American men are also more likely to have aggressive forms of prostate cancer than men from other races.

What are stage 4 prostate cancer symptoms?

Symptoms of late-stage prostate cancer often depend on how much cancer has spread and what parts of your body are affected. You might have difficulty urinating and may not be able to urinate as forcefully as before. It can be painful to urinate, and you might see blood in your semen. You may also have swelling in your legs, bone pain, and feel very tired (fatigue).

Treatments for your prostate cancer can cause additional side effects, including:

What are stage 4 prostate cancer treatments? 

After prostate cancer has spread to other parts of your body and reached the final stage it is often incurable. Some treatments may be able to shrink tumors or slow the cancer’s spread.

Hormone blocking therapy 

Prostate cancer needs the male hormone testosterone to grow. Blocking or preventing your body from making testosterone can potentially slow the cancer’s spread or even shrink tumors. Testosterone can be blocked with many different types of medications or surgery to remove your testicles.

In late-stage prostate cancer, hormone therapy is usually used alone but can also be combined with other treatments.

Radiation and chemotherapy

Radiation therapy may be recommended in stage 4 prostate cancer for men with very large tumors or cancer that has spread to the lymph nodes and other areas. It is often combined with hormone therapy or used after surgery to kill off any remaining cancer cells. 

Chemotherapy might be recommended for people with stage 4 prostate cancer in combination with hormone therapy or other treatments. It can help relieve some of your prostate cancer symptoms and potentially prolong your life expectancy.

Surgical treatment

Stage 4 prostate cancer isn’t often treated surgically, but the approach may be beneficial in certain circumstances. Your doctor might recommend it if you have difficulty passing urine or other symptoms that can be relieved by surgery. Surgical treatments will either remove your prostate (radical prostatectomy) or nearby lymph nodes (pelvic lymph node dissection) and any other cancer in the area.

Pain relief and supportive care

Roughly 1 in 3 men will live more than five years after cancer has spread outside the prostate gland. Supportive, or palliative care focuses on relieving pain, easing your symptoms, and helping you live a better quality of life. Along with direct cancer treatments, your doctor or care team will work with you to find other treatment options that might help you live longer and feel better overall.


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Coping with the final stages of prostate cancer

Being diagnosed with advanced or late-stage prostate cancer is devastating news that causes a lot of uncertainty and anxiety. Learning about your cancer and the treatment options can help you navigate the process with more confidence and understanding.

Every person is unique and will cope with late-stage prostate cancer differently. Many people find comfort in strengthening their relationships with family members and close friends. Some people cope better after talking with someone about their fears, hopes, and plans. Others find peace in their faith or belief in something greater than themselves. 

Talk to your doctor about books, websites, and other resources that can help you understand your diagnosis or can connect you with support groups where you live.

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Medically Reviewed on 7/1/2022

CDC: "Prostate Cancer."

Cleveland Clinic: "Prostate Cancer."

Johns Hopkins Medicine: "Prostate Cancer Stages."

Mayo Clinic: "Stage 4 Prostate Cancer."

National Cancer Institute: "Advanced Cancer," "Gleason score," "Prostate Cancer—Patient Version."