Prostate cancer originates in the prostate, a gland in the male reproductive system below the bladder. This gland produces fluid that contributes to semen, helping to nourish and transport sperm. Prostate cancer is a common diagnosis, with approximately 1 in 8 men receiving this diagnosis during their lifetime. While many prostate cancers grow slowly and remain confined to the prostate, some types can be more aggressive.
How Prostate Cancer Spreads
Metastasis occurs when cancer cells break away from the primary tumor and spread from their original location. These detached cancer cells can then travel through the body using either the lymphatic system or the bloodstream. The lymphatic system consists of vessels and lymph nodes that filter bodily fluids and help fight infection. Cancer cells can enter these vessels and be carried to nearby or distant lymph nodes. Alternatively, cancer cells can enter the bloodstream directly. Once in the blood vessels, these cells can circulate to various parts of the body, potentially forming new tumors in distant organs. For prostate cancer, the most common sites for metastasis are the bones and lymph nodes. Less commonly, it can spread to other organs, including the lungs and liver.
Spread to the Liver
Prostate cancer can spread to the liver, although this is a less common site for initial metastasis compared to the bones or lymph nodes. When prostate cancer metastasizes to the liver, it is considered an advanced stage of the disease. The liver is a potential site for metastasis due to its rich blood supply and its role in filtering blood. This environment can make it a receptive location for circulating cancer cells. Liver metastasis from prostate cancer is associated with a less favorable prognosis compared to metastasis in other sites like bones or lymph nodes. Studies indicate that patients with prostate cancer liver metastasis may have a shorter median overall survival compared to those with non-liver metastases. The incidence of liver metastases may be increasing, potentially due to longer survival times with contemporary therapies.
Recognizing Liver Metastasis
Liver metastasis is recognized through symptoms and diagnostic tools. Symptoms that might suggest prostate cancer has spread to the liver include discomfort or pain in the upper right side of the abdomen. Other signs can include fatigue, unexplained weight loss, and a poor appetite. In more advanced cases, a swollen abdomen due to fluid buildup (ascites) and jaundice, characterized by yellowing of the skin and whites of the eyes, may occur. Diagnostic procedures help confirm the presence of liver metastasis. Blood tests can reveal elevated liver enzymes, which may indicate liver involvement. Imaging techniques like computed tomography (CT), magnetic resonance imaging (MRI), and PSMA PET scans are used. A liver biopsy may be performed to confirm prostate cancer cells.
Treatment and Management
Treatment for prostate cancer that has spread to the liver primarily focuses on managing the disease and its symptoms, as a cure is often not achievable at this advanced stage. Systemic therapies are commonly used because they can affect cancer cells throughout the body. Hormone therapy is a frequent initial approach, as prostate cancer cells often rely on testosterone for growth. This therapy aims to block or lower testosterone levels, which can slow cancer growth or cause cancer cells to die. If hormone therapy becomes less effective, or in combination with it, chemotherapy may be employed. Chemotherapy drugs circulate in the bloodstream to destroy cancer cells. Docetaxel and cabazitaxel are common chemotherapy agents used for metastatic prostate cancer. Targeted therapies and immunotherapy are options for advanced prostate cancer, particularly when other treatments are less effective. Treatment plans are highly individualized, considering the patient’s overall health and the specific characteristics of the cancer.