It is difficult to give a “fixed” treatment regime for Stage 4 as the cancer is now widespread.
However, for early Stage 4 the likely treatment will be the same as for Stage 3, but followed by some Chemotherapy whose function is to deal with the metastases. As an alternative, there is now some use of Lutetium – Theranostics, and this latter, as it targets the metastases directly, is likely to become a common treatment of choice.
There are times, also, when External Beam Radiotherapy, EBRT, is used on, particularly, bony metastases.
At this stage you should be fully guided by your consultants.
Alex and Dr Scholz discuss patients who have lived for over 20 years in Stage 4.
Update – Feb 2022 – “The Tide is Turning”
The higher levels of Stage 3 Prostate Cancer and all of Stage 4 Prostate Cancer are often referred to as “High Risk” Prostate Cancer.
In my case, I was Stage 3b at diagnosis, but as I had a Gleason Score of 9, I was in the High Risk category. However, almost 4 years downstream now, and with a PSA of <0.1, I believe that I am no longer in the High Risk category.
But if I had proven metastatic disease, I would have remained in the High Risk category.
Advances in recent years, and particularly Theranostics, have made it much easier to gauge if a patient is at Stage 4 and therefore High Risk. If I had been able to have a PET/CT PSMA Ga68 scan during my diagnosis phase, I would have known whether I had already moved to Stage 4. Hitherto, tests for Stage 4 were not possible until a patient was well into that Stage.
Dr Mark Scholz of the PCRI has embraced the new technology and has just put out a video (Feb 2022) in which he describes a modern approach to Stage 4 High Risk Prostate Cancer. This video reflects the course of action that can be taken if Stage 4 is caught early enough.
Someone high in Stage 4 at diagnosis, however, will still be in a potential life threatening situation and This is why it is so important to catch Prostate Cancer early when it is eminently treatable.
The new video is available to watch below.