22-07-2025
The new stage four cancer treatments and what they mean for patients
A stage-four cancer diagnosis once sounded like the end of the road – after all, there is no stage five. When Joe Biden's prostate cancer was recently labelled 'aggressive' and described as having spread to his bones, many assumed the worst. Yet today, thanks to astonishing advances in cancer science, a stage-four label need not mean imminent death.
'Stage four means the cancer has spread to another part of the body further away from where it started,' explains Dr Ben O'Leary, a clinical oncologist at the Royal Marsden and a researcher at The Institute of Cancer Research (ICR). 'Most stage-four cancers still can't be cured, but our deeper understanding of how cancers evolve and grow means many people are living longer. In some cases, we now see responses, and yes, even cures, that weren't thought possible 10 years ago.'
What's driving this optimism? Five types of cancer offer a snapshot of progress.
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Prostate cancer
Blood cancers
Breast cancer
Bladder cancer
Lung cancer
Prostate cancer
By the age of 80, half of men harbour cancer in their prostate, though it proves fatal in only a small minority. Even so, around 12,000 men die of metastatic prostate cancer each year in the UK.
Dr Anna Wilkins of the ICR and Royal Marsden says metastatic prostate cancer most often spreads to the bones. 'On scans, you can see up to 50 spots all over the skeleton. But there has been big progress in new drugs.'
Total testosterone blockade
Standard treatment reduces testosterone, the hormone that fuels tumour growth. Abiraterone, developed at the ICR, goes further by blocking its precursor hormones, extending survival significantly.
Liquid radiotherapy
This exciting development involves injecting patients with a radioactive liquid. Cancer cells 'drink' more of the liquid than healthy cells and the resulting burst of radiation destroys bone metastases. Liquid radiotherapy drug Radium-223 is already available on the NHS, while the even more potent Lutetium-177 PSMA is available privately and awaiting National Institute of Health and Care Excellence (Nice) appraisal.
Multimodal first strikes
'We now combine hormone drugs – and sometimes chemotherapy – immediately after diagnosis,' says Dr Wilkins. Even resistant cancers respond to this approach. Treating the original tumour with radiotherapy, even in metastatic cases, also boosts survival: 'It's as if you're silencing a mothership that coordinates the metastases,' she says.
While there is no cure yet, Dr Wilkins says, these approaches are turning stage-four prostate cancer into a condition many men will live with, not die from.
