# Symptoms and Phases of Metastatic Prostate Cancer
Metastatic prostate cancer (metastatic prostate cancer) progresses in several phases. The course depends heavily on how sensitive the cancer cells are to hormonal treatment. Below, we describe the most important phases and what usually comes with them.
Metastatic hormone-dependent prostate cancer (mHSPC)
This is the phase where the cancer has spread outside the prostate (usually to bone and/or lymph nodes) but is still responding well to hormonal therapy (androgen deprivation therapy, ADT).
**Symptoms in this phase: **
- Often few complaints in the beginning; many men feel relatively well
- When symptoms occur: bone pain (usually in the spine, pelvis, or ribs), where the metastatic cancer often settles
- Fatigue and difficulty concentrating
- Sometimes swelling of the legs due to congestion in the lymphatic vessels
- Pressure or pain in the lower abdominal or pelvic area
- In case of extension to vertebrae: radiating pain in the arms or legs
In daily life, these complaints can lead to decreased mobility, sleep disruption due to nocturnal pain, and emotional impact due to the realization that the cancer has spread. Fatigue can be especially understanding for loved ones, because it is not always visible but affects daily activities.
**Figures about this phase: **
In the MHSPC phase, men receiving treatment usually have a median overall survival of around 3 to 5 years (depending on treatment used and patient factors), according to recent studies from 2025—2026. Using newer combination therapies (e.g. hormonal blocking combined with chemotherapy or newer hormonal agents) may increase this duration. *These are population averages; individual turnover varies widely and depends on many factors, including disease severity at diagnosis, body condition and how well the cancer is responding to treatment. *
Castration-resistant prostate cancer (CRPC) — hormone-dependent phase
When the cancer starts to grow after months to years despite hormonal therapy, people speak of castration resistance. Initially, the cancer still responds to certain advanced hormonal therapies (therefore “hormone-dependent”), but aggressiveness is increasing.
**Symptoms in this phase: **
- Growing bone pain, sometimes with movement restrictions
- Increasing tiredness
- Weight loss
- Reduced appetite
- Sometimes loss of blood in urine or stool (rare), if tumors grow close to these pathways
- Increase in local pressure symptoms (bladder problems, bowel problems)
- Expansion to new areas involves local symptoms (e.g. rib pain with lung metastases)
This has a lot of influence on daily functioning: men often experience growing need for help, possible admission to nursing home care, and psychological pressure due to the progression of the disease.
**Figures about this phase: **
The median survival in the castration-resistant phase is estimated at 1 to 2.5 years, depending on which treatments are available and how fast the cancer progresses (source: US and European guidelines, 2025—2026). Men who have previously been treated with aggressive combination therapy (e.g. in the MHSPC phase) sometimes have a little longer survival in the CRPC phase. *Again, these are group averages and say nothing about the individual forecast. *
Castration-resistant prostate cancer (CRPC) — hormone-resistant phase
This is the phase where the cancer no longer responds to available hormonal therapies. The cancer continues to grow despite all previous treatments.
**Symptoms in this phase: **
- Increasing, more difficult to control bone pain
- Severe tiredness (cachexia: muscle and weight loss)
- Decreased functional capacity (difficulty walking, self-care)
- Possible extension to the abdomen, lungs or brain, with appropriate new symptoms (abdominal swelling, shortness of breath, headache, confusion)
- Sometimes night sweats
- Decreased appetite and thirst due to metabolic changes
- Sometimes a consequent decrease in kidney function
In daily life: many men in this phase need considerable help, can no longer work independently, and require regular contact with hospital or home care. Pain and fatigue determine much of what is and isn't possible. Psychologically, this is typically a difficult period, as recovery is no longer realistic and the focus shifts to palliative care (comfort, quality of life).
**Figures about this phase: **
The median survival in the hormone-resistant CRPC phase is typically between 6 and 18 months, depending on available treatment options (chemotherapy, PSMA therapy, radioisotope therapy with radium-223, and experimental agents) and overall health status (source: international guidelines, 2025–2026). Recent data indicate that combination treatments — for example chemotherapy (docetaxel, cabazitaxel) combined with newer medicines or PSMA-targeted radioisotope therapy — in some groups extend survival to around 2 years on average. *These are again population data; the actual course per individual can be much shorter or longer.*
When to contact your healthcare provider?
It is important that you contact your doctor or treatment team in case of:
- **Sudden or severe pain increase** that your GP cannot help with
- **Appearance of new symptoms**: nerve pain radiating into arms or legs, erectile dysfunction that suddenly changes, loss of sensation in legs, sudden bowel problems
- **Severe fatigue or weakness** that drastically changes your daily life
- **Persistent fever, bleeding or other alarming symptoms**
- **Psychological complaints** such as deep sadness or lack of hope — help is available
Regular contact with your treatment team helps ensure that symptom control remains optimal and that you know what to expect and what supportive care is available.
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_This information never replaces a doctor's judgment. Always discuss your situation with your own healthcare provider._