By Matthew Schmitz, M.D.
Prostate cancer progression can never, unfortunately, be definitively determined for an individual. Each case of prostate cancer is different from the next, and a multitude of factors play into how prostate cancer progresses in a given man.
With that being said, there are some general statements that can be made about how prostate cancer typically progresses. If you’ve been diagnosed, you should discuss your particular case with your oncologist.
Most Prostate Cancers Grow Slowly
Prostate cancer, in general, is a slow growing cancer. In comparison to many types of cancer, prostate cancer takes longer to invade the adjacent tissues and spread to distant sites in the body.
The rate of growth and spread of prostate cancer has a lot to do with the prostate cancer grade. Grade is a measure of how abnormal the prostate cancer cells are. Prostate cancers that are composed of very abnormal cells (high grade) are much more likely to spread quickly from the region of the prostate and go elsewhere in the body.
Today, because of better screening and diagnostic examinations, most prostate cancers are found early on before they have spread to other parts of the body.
Other factors, such as the presence of other health conditions, can also play a role in the rate at which prostate cancer grows. For example, men with weakened immune systems can have faster rates of prostate cancer growth.
From one man to the next, however, it is not possible to tell for sure if or when a given prostate cancer will grow and spread.
Prostate Cancer Often Spreads to the Same Sites in the Body
Prostate cancer typically first spreads to the tissues immediately adjacent to the prostate, which include the seminal vesicles and nearby lymph nodes.
Prostate cancer also has a very strong tendency to spread to the bones. This is most common in the lower spine, the pelvis, and the upper legs, though prostate cancer can spread to bones anywhere in the body.
There Are Often Clues That Prostate Cancer Is Spreading
The most common clue that prostate cancer may be spreading comes from the PSA test. When prostate cancer grows and spreads, the PSA level typically rises as well. The absolute level of PSA, as well as its rate of rise (the PSA “velocity”), can tip off your doctor that your prostate cancer may be growing and spreading. Frequent PSA tests after prostate cancer diagnosis are important for this reason.
If prostate cancer has spread to the bones, the level of an enzyme known as alkaline phosphatase will usually also rise. This also can alert your physician to possible spread to the bones. Imaging exams such as the bone scan can also detect the spread of prostate cancer to the bones.
The spread of prostate cancer can sometimes cause symptoms. Pain in the spine, hips, or pelvis is not uncommon if prostate cancer has spread to these bones.