When Prostate Cancer Becomes Life‑Threatening: Metastasis and Treatment Resistance

High‑Risk Features

• Gleason ≥8 (Grade Group 4–5).
• PSA >20 ng/mL or rapid doubling time (<6 months).
• Seminal vesicle invasion, lymph node involvement, distant mets (bone, viscera).
• Castration‑resistant progression (CRPC).

Monitoring

• PSA every 3–6 months post‑treatment.
• Imaging (PSMA PET/CT, bone scan) for biochemical recurrence.
• Genomic classifiers (Decipher, Oncotype DX) refine risk.

Advanced‑Disease Therapies

• Androgen deprivation therapy (ADT) + novel hormonal (abiraterone, enzalutamide, apalutamide, darolutamide).
• Chemotherapy (docetaxel, cabazitaxel).
• Radiopharmaceuticals (Ra‑223, Lu‑177‑PSMA).
• Immunotherapy (sipuleucel‑T), PARP inhibitors (BRCA2).

Early detection and multidisciplinary care extend survival significantly.