Last stage of prostate cancer–what to expect

Whether you are a patient or a family member, receiving a terminal cancer diagnosis can be depressing, especially if you don't know what to expect. 

In this article, we will explain what advanced prostate cancer is, how this disease spreads, the life expectancy, what to expect, the complications you might face, and how to support a loved one with prostate cancer.

Key takeaways

• For most people with stage 4 cancer, the prostate no longer responds to cancer treatment. 
• During the last stage of prostate cancer, a person may experience severe pain, changes in breathing patterns, and loss of bladder control.
• The five-year survival rate for advanced prostate cancer is 31%. 
• When prostate cancer spreads, the bone is usually the first to be affected.

When a person is diagnosed with prostate cancer, doctors will want to know how far the cancer has spread. This is referred to as "staging."

The stage at which the cancer is discovered will help inform the doctor about the best treatment plan for that patient as well as the patient's chances of survival.

There are 4 main stages of prostate cancer. Healthcare professionals determine the stage of prostate cancer using tests like prostate biopsy results or blood PSA testing. 

What is advanced prostate cancer?

Cancer that has spread beyond the prostate to other parts of the body, such as the bones, liver, or lymph nodes, is referred to as advanced or stage 4 prostate cancer.

Stage 4 prostate cancer is further classified into two substages:

• Stage 4A: At stage 4A prostate cancer, the cancer cells have spread to nearby lymph nodes or organs like the rectum, bladder, or pelvic wall.
• Stage 4B: During stage 4B, the prostate cancer has spread farther away from the prostate to other parts of the body, such as the bones or distant lymph nodes.

For most people with stage 4 prostate cancer, the prostate is no longer responding to cancer treatment. Thus, treatment at this stage is typically focused on managing their symptoms and improving their quality of life rather than providing a cure.

Symptoms of advanced prostate cancer

Symptoms of stage 4 cancer may include:

• Painful urination
• Difficulty urinating
• Blood in the semen
• Bone pain
• Swelling in the legs or feet
• Fatigue

How does prostate cancer spread?

Prostate cancer develops when cells in the prostate begin to grow uncontrollably and multiply. If the abnormal growth is not stopped at this point, the abnormal cells will start to spread.

When cancer cells spread, doctors refer to it as having metastasized. This means that the cancer cells have spread from the site where they were formed to other parts of the body.

Prostate cancer metastasis occurs when the abnormal prostate cells break away from the prostate and then travel through the blood or lymphatic system to other areas of the body. However, because prostate cancer grows slowly, it can take a long time before it spreads to other body parts.

In most cases, prostate cancer first spreads to nearby tissues like the seminal vesicles and lymph nodes. It may later spread to other parts of the body, including the bones, bladder, liver, or even the lungs (although this is less common).

What to expect as prostate cancer progresses

Most people are symptom-free in the early stages of prostate cancer. However, as cancer spreads to other parts of the body, some people experience symptoms that may reduce their quality of life.

For example, when cancer spreads to the bones, some people may experience bone pain. When it spreads to the urethra or urinary tract, some may have trouble passing urine or see blood in their urine.

These symptoms can be bothersome and interfere with your daily activities. Consult your doctor if you notice any symptoms that make you uneasy, as there are treatments available to help you manage these issues.

Complications of advanced prostate cancer

Possible complications of advanced prostate cancer include: 

1. Pain

Most people who have advanced prostate cancer usually experience pain. However, some might not experience any pain at all.

The location of the pain is determined by where the cancer has spread. For example, if cancer spreads to the bones, you might experience a sharp, dull ache in your bones. This pain might be constant, or it may come and go.

You may also experience shooting, burning, or stabbing pain if cancer presses on a nerve. The type of pain you feel differs from person to person.

In rare cases, the pain you feel in the advanced stage of prostate cancer might be a symptom of a serious condition called metastatic spinal cord compression (MSCC).

MSCC happens when prostate cancer cells grow in or near the spine and put pressure on the spinal cord. In severe cases, this condition can result in nerve damage and even paralysis.

There are several medications available to help relieve your pain. Talk to your doctor about the best option for you.

2. Fractured or broken bones

In the late stage of prostate cancer, cancer cells typically spread to the bones, putting the patient at risk of certain complications like fractures or excess calcium levels in the blood. Studies show that cancer often spreads to the bones in 65 to 75 percent of all advanced cancer patients.

In addition, people undergoing hormonal therapy to treat cancer may experience bone loss and fractures.

3. Urinary incontinence

As prostate cancer spreads to the urinary tract, it may damage the muscle that controls urine function.

Hence, it is common for people with stage 4 prostate cancer to lose control of their bladder and experience urine leaks. People who have had surgical treatment for prostate cancer might also experience urinary incontinence.

Those who experience bladder leaks may need to use absorbent pads to prevent leakage. There are also medications like alpha-blockers that may help relax the bladder muscles, making it easier to urinate.

4. Anemia

People with advanced prostate cancer who have surgery to remove their testes may experience anemia. This is because the male hormone testosterone, which is needed to form red blood cells, decreases after the testes are removed.

Another reason people with advanced prostate cancer may develop anemia is the spread of cancer to the bones. When cancer spreads to the bones or bone marrow, it may affect the production of healthy red blood cells, leading to anemia.

If you get anemia, your doctor might suggest a blood transfusion.

Life expectancy - How to know how long you have left

There is no way to say exactly how long you have left after receiving your cancer diagnosis. However, according to the American Cancer Society, the five-year survival rate of advanced prostate cancer is 31%.

This means that 31% of people with advanced prostate cancer live at least five years after diagnosis.

For some people, this statistic might not mean much, as they might just want to know how long they have left to live so they can put their lives in order.

If this is you, you can ask your doctor how long you have left. Although they won't be able to give you an accurate answer, they may be able to provide you with an estimate based on how far your cancer has spread or how quickly it is spreading.

Also, if you are at the end stage of your life (days or weeks), it will be easier for your doctor to say how much time you have left based on some physical changes that corroborate with those of a dying man. However, no matter what your doctor says, you may have a shorter or longer time left to live. So it may be best to use your time left to be with your family and set things in place.

What happens in the last few days of life

Many changes occur as we near the end of our lives. Some are physical, while others are emotional.

However, if you are nearing the end of your life, you may be unaware of what is going on. This is why the information in this section is especially important for caregivers, relatives, and friends who may be unsure what to expect as you approach the end of your life.

Some of the changes that occur when a person is near the end of their life include:

1. Pain

Many people with prostate cancer at the end of their lives will experience pain. However, some may not experience any pain at all. The experiences vary from person to person.

The pain might be due to cancer cells spreading to the bones or nerves.

If your loved one appears to be in severe pain, doctors can administer medications to help alleviate the pain and make them more comfortable.

If at this stage, they appear to have difficulty swallowing tablets or liquid medicines, you can tell their doctors so they can administer the medication using skin patches or syringes.

2. Changes in breathing patterns

Another important change you will notice as people with prostate cancer near the end of their lives is a change in breathing patterns.

As they take each breath, a dying person's breath may sound like a gurgle or rattle. This happens when mucus and saliva build up in the windpipe, and the person cannot cough it up because their cough reflex is too weak.

Although hearing these rattling or gurgling sounds can appear unsettling, they don't usually cause much distress to the dying person.

In some cases, the nurses or doctor can suction fluid out of the windpipe using a tube. However, this is only sometimes necessary.

3. Loss of bladder and bowel control

As a person with prostate cancer nears the end of their lives, they may lose control of their bladder and bowels, a condition known as incontinence.

If this happens, your nurses may recommend disposable adult diapers and give caregivers instructions on keeping incontinent people as clean and dry as possible.

When taking care of an incontinent person at the end of their life, it is better to change the bedding and diapers frequently rather than use a catheter. This is because catheters increase the risk of urinary tract infections.

In addition, some people at this stage may feel very constipated, which might make them very uncomfortable. If you notice that your loved one has fewer or no bowel movements, inform your doctor and see if they may be able to give you medicines to help empty your bowel.

4. Difficulty eating or drinking

As dying people near the end of their lives, they might lose the will to eat or drink. If this happens, try to be patient and accept that this is normal for people at the end of their lives.

The truth is that at the end of one's life, nutrition offers little to no value. Doctors believe that offering nutritional support or forcing a dying person to eat only makes them more uncomfortable.

Instead, when the patient's lips become dry, use wet swabs, ice chips, or a lip moisturizer to help relieve the dryness.

5. Restlessness

Some people may feel restless or agitated as they near the end of their lives. This usually happens for a lot of reasons.

One common reason people feel restless at the end of their lives is pain. If the pain is not well controlled, it can make the patient very uncomfortable. 

Another cause of restlessness may be constipation or a problem with urination. Talk to the patient's doctor or nurse so they can find ways to help.

6. Changes in body temperature

As a person nears the end of their lives, activities in the body slow down, and so does body temperature. A dying person's skin often becomes very cold to touch.

The skin of some people may also look pale and blotchy. This happens due to changes in their blood flow.

If the patient appears very cold, you can use a blanket to keep them warm and ensure the room is comfortable so they do not become restless.

7. Confusion

A dying person gets easily confused. It is common for them to say things that make no sense. In some cases, they might not remember who you are or might even say hurtful things. This is completely normal. You have to understand that they are not aware of what they are saying or doing.

8. Slipping in and out of consciousness

Right toward the end of a person's life, it is common for them to slip in and out of consciousness. You may want to say your goodbyes at this point because sometimes patients might slip into an unconscious state and never wake up.

Providing support for a loved one with prostate cancer

Taking care of a loved one with prostate cancer is not easy and can take a toll on you both physically and emotionally. 

It helps to know what to expect as your loved one nears the end of their life, especially when the diagnosis is terminal. You can talk to your doctor or nurse about what to expect and do in certain situations.

Another way to support a loved one who is nearing the end of their life is to communicate that you are there for them every step of the way. Share happy memories, provide physical comfort through touch, and offer reassurance that it is okay to let go.

If they are in the last days of their life, you can give them permission to go because most dying patients feel very guilty leaving their loved one behind. Assure them that they are loved and valued, and that it is okay for them to let go and find peace.

Finally, remember that you are only human, and might need some form of support for yourself. It may help to lean on your friends, talk to a therapist, or even see a healthcare professional. You can also find support groups available that can provide a sense of community and understanding. Remember, it is okay to grieve, and you should take time to care for yourself.