ADVANCED DISEASE

Four Categories of Advanced Prostate Cancer [AIPC]

When prostate cancer has grown beyond its earliest stage, it is called “advanced.” Advanced prostate cancer can fall into several categories, depending on where it has spread and how it responds to treatment. Knowing which category you are in can help you and your care team choose the best treatment options for you.

1. Locally Advanced Prostate Cancer

Locally advanced prostate cancer means the cancer has grown to fill the prostate and may have spread into nearby tissues—such as the lymph nodes or the rectum. Because these cancer cells can spread, treatment is often more aggressive.
Treatment may include:

• Radiation therapy or surgery to remove or destroy the tumor

• Hormone therapy to slow the growth of prostate cancer cells
  This type of cancer can be found when you are first diagnosed, or it can happen after earlier treatment if your PSA (prostate-specific antigen) blood test starts to rise. Your treatment plan will be based on your overall health, life expectancy, and symptoms.

2. Biochemically Recurrent Prostate Cancer (Rising PSA)

This happens when your PSA level starts to rise after you’ve completed treatment—even though there’s no sign the cancer has spread to bones or other organs. This can mean the cancer has returned.
Your doctor may order more tests—such as imaging scans or checking how quickly your PSA is rising—to find out more.
Treatment options depend on:

• Your overall health and life expectancy

• Whether your first treatment was surgery or radiation
  In some cases, your doctor may recommend starting treatment right away. In other cases, they may suggest closely monitoring your PSA before starting new treatment.

3. Metastatic Prostate Cancer (Hormone Sensitive)

Metastatic prostate cancer means the cancer has spread (metastasized) to other parts of the body such as bones, distant lymph nodes, or other organs.
If it has not yet been treated with hormone therapy (also called androgen deprivation therapy or ADT), the cancer is considered “hormone-sensitive.” This means it can still respond to treatments that lower testosterone. Lowering testosterone can help control the cancer’s growth and improve symptoms like bone pain or difficulty urinating.

4. Hormone Refractory Prostate Cancer

Hormone refractory prostate cancer, also called castration-resistant prostate cancer, is cancer that continues to grow even when testosterone levels are very low due to hormone therapy.
Your care team may include:

• Urologists, oncologists, radiation specialists, nurses, and patient navigators

• Your family and support network
  Treatment choices will depend on your previous treatments, where the cancer has spread, how much cancer is present, your symptoms, possible side effects, and your personal preferences.

Common secondary hormonal therapies include:

• Abiraterone (Zytiga) – blocks testosterone production

• Enzalutamide (Xtandi) – blocks testosterone from attaching to cancer cells

• Antiandrogen withdrawal or addition – adjusting hormone-blocking medicines

• Ketoconazole (Nizoral) and corticosteroids – reduce tumor growth or inflammation

Bone Directed Therapies

When prostate cancer spreads beyond the prostate, it often spreads to the bones. This can cause pain, increase the risk of fractures, and weaken the bones. Bone-directed therapies help strengthen bones, relieve pain, and slow down bone damage. They work by affecting certain bone cells (osteoclasts) that break down bone tissue.

Examples include:

• Zometa (Zoledronic Acid)

• Xgeva or Prolia (Denosumab)

• Fosamax (Alendronate)

Some treatments, like corticosteroids or radiopharmaceuticals, can also help reduce bone pain.

Chemotherapy Treatment

Chemotherapy uses strong medicines to target and kill cancer cells. Because cancer cells grow and multiply faster than most normal cells, chemotherapy can be effective in slowing or stopping their growth. Your care team will discuss whether chemotherapy is right for you based on your overall health, type of prostate cancer, and past treatments.