Metastatic prostate cancer is the advanced form of prostate cancer. It means the cancer has already spread from the prostate gland to other body parts, typically bones, lymph nodes, liver, and lungs. These cancerous cells break away from the original site of the prostate gland and spread to other parts of the body via the bloodstream and lymphatic vessels. The likelihood of developing metastatic prostate cancer from prostate cancer is about 50%. However, early detection can reduce the rate of developing metastatic prostate cancer.

Signs and Symptoms

1. Frequent urination, especially at night
2. Painful ejaculation
3. Blood in urine and semen
4. Bone pain in hips, spine, and pelvis
5. Weight loss 
6. Fatigue

Diagnosis of Metastatic Prostate Cancer

1. CT Scan- It is used to identify the spread of cancer cells to nearby lymph nodes
2. MRI Scan- It is used to identify the spread of cancer cells into nearby soft tissues
3. Bone scans- It is used to identify the spread and intensity of cancer cells in bones.
4. Prostate-Specific Membrane Antigen- Positron Emission Tomography ( PSMA-PET)- It is used to detect the levels of prostate-specific antigens in the body.
5. Biopsy- In rare cases, a biopsy outside the prostate may become essential for finding out the spread.

Hormone Therapy or Antiandrogen Therapy

Androgens are essential for the production of testosterone, which acts as a fuel for the growth of cancerous prostate cells. This kind of hormonal therapy aims to block the action of this androgen. It shuts down the action of testosterone, thereby eradicating tumor cells. It is the gold standard and often the first-line treatment for advanced prostate cancer. The major advantage hormonal therapy offers is reversibility; if the medications used in this therapy are discontinued, your testosterone levels will return to normal. Some classes of this hormonal therapy include,

• Luteinizing hormone: releasing hormone agonists- cause an initial rise followed by rapid degeneration of the testosterone hormone.
• LHRH antagonists: They cause a rapid reduction in testosterone levels without the initial rise. 
• Androgen receptor blockers: These medications block the hormone androgen from binding to the adrenergic receptors on the prostate cancerous cells. The male hormone testosterone is changed in the prostate into a molecule called DHT, which has a similar structure. The "active" chemical in the prostate, known as DHT, stimulates new growth in prostate cancer cells and healthy prostate tissue. The specifics of this mode of action are intricate and have yet to be fully known at this time. These antiandrogens obstruct the way DHT encourages prostate cell proliferation. The result is a significant slowdown in the proliferation of prostate cancer and new prostate cells.

Enzalutamide, Apalutamide, Darolutamide, and Nilutamide are a few of the medications. These medications are frequently used in addition to other forms of treatment,  such as LHRH agonists and antagonists, and also with surgical castration to achieve maximum androgenic blockage.

Other treatment options for metastatic cancer include,

• Chemotherapy: It is employed once hormonal therapy becomes resistant.
• Radiation therapy: A high powered radiation shrinks the tumor cells by also damaging soft, healthy tissues
• Surgery: It is often not employed since cancer has already spread. However, the removal of testicles surgically can reduce testosterone and aid in further therapies.
• Immunotherapy: These medications target the immune system to attack the body's cells to reduce the rapid multiplication of tumor cells. 

Precision Medicine and Metastatic Cancer

Precision medicine or personalized medicine has become a novel approach in medical science that involves personalizing the patient's therapy based on their genetic mutations and molecular and clinical profile. In the case of metastatic cancer, the metastatic spread among various sites and androgenic mutations are critical in identifying the correct therapeutic regimen based on individual characteristics. 

Conclusion

By employing precision medicine techniques using antiandrogenic hormonal medications, we can significantly change the course of treatment guidelines in prostate cancer. Further research and newer discoveries are constantly evolving and precision medicine holds a promising futuristic approach to treating various cancers.