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It is usually in the shape of a walnut. However, if it increases in size, it may press the urethra that would obstruct the flow of urine out of the bladder. Cancer refers to the uncontrolled cell division that leads to tumorous growth. Such growths cause the prostate to enlarge that may lead to problems in urination, sexual intercourse, and erectile dysfunction. There are various stages of prostate cancer, which is a measure of the spread and growth of the cancer. The fourth stage of prostate cancer refers to the stage when the cancer has moved out of the seminal vesicles and invaded the surrounding tissues, like the rectum, bladder, and even the bones and lymph nodes.

The Different Stages

Cancer in the prostate gland may spread out from its original location. This is known as metastasis. Identifying the stage (staging) is important so that the doctor knows the extent of spread of cancer and can decide upon the relevant treatment according to the stage. Enlisted below are the various stages of prostate cancer:

Stage I

Cancer at this stage can't be detected either by a sonogram or digital rectal exam. It is detected in the body during a surgery carried out for another reason or by a needle biopsy, which is carried out when the PSA (an abnormal protein formed due to cancerous prostate cells) level is found to be increased.

Stage II

Out here, the cancer can be detected by a digital rectal exam or sonogram but hasn't spread out of the prostate gland.

Stage III

The cancerous cells have moved out of the prostate gland and spread into the seminal vesicles. However, they have not yet reached the lymph nodes.

Stage IV

The tumor has spread out of the seminal vesicles into the nearby structures, like the bladder and rectum. In the stage four cancer, the lymph nodes, bones, and other parts of the body may also be affected by the cancerous cells.

Classification

Stage 4 prostate cancer may be further divided into the following two groups depending upon the extent to which it has spread:

Localized Stage IV (D1)

Cancer has spread to the pelvic lymph nodes or is obstructing the ureters or both.

Metastatic Stage IV (D2)

Cancer has spread to the lymph nodes outside the pelvic region. It may have spread to the bones and other parts further away from the prostate gland.

Symptoms

• Trouble urinating
• Blood in the urine even if there is no problem in urination
• Severe pain in the lower abdomen and back
• Nausea
• Weakness

Treatment

For Localized Stage IV (D1)

Cancer that is still in the pelvic region or in the close by organs like the bladder and rectum is treated by the external beam radiation therapy (EBRT) and hormone therapy. In most cases, these are administered together. Radiation therapy followed by hormonal therapy has been found to improve one's chances of survival and also restrict the localized stage IV from developing into a metastatic stage IV cancer. Hormone therapy involves the removal of the male hormones that facilitate the growth of prostate cancer. In ERBT, the patient is subjected to a beam of high energy X-ray that destroys the cancerous cells.

For Metastatic Stage IV (D1)

Hormonal treatment has been used for long as a standard mode of treatment for metastatic stage IV cancer. It may control the metastatic stage for several years. However, cancerous growth can spread despite the administration of this therapy. Recent trials have shown that chemotherapy can kill cancerous cells in patients suffering from the problem of recurrent cancer.

For Bone Complications

If the cancer has reached the bones, it can increase the risk of bone fractures and a life-threatening condition called hypercalcemia in which the levels of calcium in the blood become very high. Bone complications can be treated by giving the patients bisphosphonate drugs and radiation therapy.

Surgery (radical prostatectomy)

In some cases, removal of the prostate gland by surgical means may become necessary. In case the tumor can't be removed completely and some amount of cancerous cells are left behind, surgery may be followed by radiation therapy. Side effects of surgery involve impotence and incontinence (inability to control urination).

Although the modes of treatment listed above are the ones that have been followed for long, recent research has led to the availability of several other modes. These involve the nerve-sparing radical prostatectomy in which the prostate gland is surgically removed without severing the nearby nerves that carry the signals between the brain and penis. This helps in ensuring normal sexual functioning. Other more recent methods of treatment are conformal external beam radiation therapy, image-guided radiation therapy, proton beam therapy, and brachytherapy.

What treatment should be taken for stage four prostate cancer is decided by the physician after he/she has carried out a number of tests. It is advisable to go for a second opinion. Do your own research about the disease and its possible methods of treatment. Have a clear idea about all the pros and cons. Discuss any doubts you have with your physician, and agree to the treatment that both you and your physician feel would work the best for you.

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