Approximately 8% of men in New Zealand are diagnosed with Stage 4 prostate cancer, called "de novo" metastatic disease.
The 5-year survival rate for metastatic prostate cancer is around 30%, though newer treatments are improving these outcomes.
In New Zealand, approximately 350 men are diagnosed with de novo Stage 4 prostate cancer annually.
About 63% of patients with metastatic prostate cancer in New Zealand receive hormone therapy (ADT) as their primary treatment.
Stage 4 prostate cancer means the cancer has spread beyond the prostate to distant parts of the body. At this stage:
- The cancer has metastasized to other organs, lymph nodes, or bones
- PSA levels are typically very elevated
- The Gleason score is usually 8-10
Stage 4 is further divided into:
- Stage 4A: Cancer has spread to nearby lymph nodes but not to distant organs
- Stage 4B: Cancer has spread to distant lymph nodes, bones, or other organs
In New Zealand, approximately 8% of prostate cancer diagnoses are metastatic (Stage 4) at the time of diagnosis. This equates to about 350 men annually diagnosed with what doctors call "de novo" metastatic disease, meaning they are diagnosed at Stage 4 without having gone through earlier stages.
While Stage 4 prostate cancer is not typically curable, many men live for years with good quality of life with proper treatment and management.
Approaching Metastatic Cancer from a Māori Perspective
Stage 4 prostate cancer presents significant challenges that benefit from both clinical care and cultural support. For Māori men, who are more likely to be diagnosed at this advanced stage, a holistic approach that honors mātauranga Māori (Māori knowledge) alongside Western medicine can provide strength during this journey.
Weaving Together Healthcare Approaches
At Stage 4, treatment focuses on extending life while maintaining quality of life. This approach aligns well with Māori values when:
- Medical teams respect the importance of wairua (spiritual wellbeing) alongside physical treatment
- Care plans acknowledge the central role of whānau in supporting the hauora (health) journey
- Traditional healing practices complement medical interventions where appropriate
- Opportunities exist to return to significant places and connect with whenua (land) during treatment
- Cultural advisors or kaumātua can provide guidance on maintaining tikanga (customs) during treatment
Whānau Support for Advanced Cancer
The whānau plays an essential role in supporting Māori men with Stage 4 prostate cancer:
- Consider appointing a key whānau member as the primary kaitiaki (guardian/caregiver)
- Establish clear communication channels between healthcare teams and the extended whānau
- Organise regular whānau hui to discuss care needs and distribute responsibilities
- Create space for important conversations about preferences for care as the illness progresses
- Acknowledge the impact on all whānau members and ensure they also receive support
Managing Pain and Symptoms
Stage 4 prostate cancer often involves managing pain and other symptoms. A culturally responsive approach may include:
- Comprehensive pain management that addresses both physical and spiritual dimensions
- Integration of rongoā Māori (traditional medicine) alongside conventional pain management, when appropriate
- Access to healers who can provide mirimiri (massage) and romiromi (deep tissue massage) for comfort
- Karakia (prayer) and waiata (songs) that provide comfort and connection
- Discussion with palliative care specialists who understand Māori approaches to comfort care
Palliative Care and End-of-Life Considerations
While treatments aim to extend life, preparing for all possibilities is important. Māori approaches to palliative care often include:
- Early discussions about preferences for care, including desired location (home, hospice, hospital)
- Consideration of tikanga around the dying process and after death
- Involving kaumātua or cultural advisors in palliative care planning
- Creating space for important conversations and farewell rituals
- Access to Māori-responsive hospice services that honor cultural protocols
Specialised Resources for Māori Men with Advanced Cancer
Several organisations provide culturally appropriate support for advanced cancer:
- Hospice New Zealand - Māori Services: Provides culturally responsive end-of-life care
- Māori Health Providers: Offer holistic support services
- Te Aho o Te Kahu: Cancer Control Agency with Māori-specific resources
- Whānau Ora: Can provide comprehensive support for families
Maintaining Dignity and Mana
Throughout the Stage 4 cancer journey, maintaining dignity and mana (prestige/authority) remains paramount:
- Ongoing involvement in decision-making about care and treatment
- Respect for the patient's role within whānau and community
- Opportunities to share knowledge, stories, and wisdom
- Acknowledgment of the person's contribution and legacy
- Support to fulfill important cultural obligations where possible
"Kia hora te marino, kia whakapapa pounamu te moana, kia tere te kārohirohi i mua i tō huarahi."
May the calm be widespread, may the sea glisten like greenstone, and may the shimmer of light guide you on your pathway.
This traditional blessing reflects the wish for peace and clear guidance through challenging times. While Stage 4 prostate cancer presents significant challenges, many men continue to find meaning, connection, and moments of joy with proper support. The integration of cultural strengths alongside quality medical care provides the best foundation for this journey.
Based on New Zealand patient data, the following treatments are commonly used for Stage 4 prostate cancer:
Hormone Therapy (ADT)
The foundation of treatment for metastatic prostate cancer, used in about 63% of metastatic cases in New Zealand. This includes:
- LHRH agonists like Goserelin (Zoladex) - given as a 12-week implant in the abdomen
- Anti-androgens like Bicalutamide - typically taken as tablets
- Combined androgen blockade approaches
Treatment is usually administered by oncology nurses at cancer centers throughout New Zealand, with implants typically given every three months.
Radiation Therapy with Hormone Therapy
About 31% of metastatic patients in New Zealand receive radiation combined with hormone therapy, which can help:
- Control symptoms from the primary tumor
- Relieve pain from bone metastases
- Slow disease progression
The Canterbury Regional Cancer and Haematology Service and other cancer centers in New Zealand provide radiation therapy services.
Chemotherapy
Often given alongside hormone therapy for metastatic disease:
- Docetaxel (Taxotere) - usually the first chemotherapy option
- Given as intravenous infusions at cancer centers
- Typically administered in a six-cycle program over 18 weeks
Before starting chemotherapy, patients often have dental checks and other preparations to reduce potential side effects.
Bone-Targeted Therapies
To strengthen bones and prevent complications:
- Bisphosphonates like zoledronic acid - given as intravenous infusions
- Typically administered every 12 weeks
- Requires drinking plenty of water before treatment
Advanced Hormone Therapies
Second-generation hormone therapies:
- Abiraterone acetate (Zytiga) - now available in New Zealand but may not be fully funded for all patients
- Often reserved for when standard hormone therapy is no longer effective
Based on data from New Zealand patients, people with Stage 4 prostate cancer reported these experiences one year after diagnosis:
Hormone Therapy Side Effects
- Lack of energy (36% of patients)
- Sexual function issues (34% reported as a problem)
- Very few patients (6%) reported having fair-to-good erections
- Emotional changes (14% reported feeling depressed)
- Urinary issues (13% reported urinary function as a problem)
- Hot flashes and night sweats (not quantified but commonly reported)
Chemotherapy Specific Side Effects
Docetaxel chemotherapy can cause additional side effects:
- Lowered immune system - increasing risk of infection
- Taste changes - affecting many foods for up to 6 months
- Peripheral neuropathy - numbness or tingling in fingers and toes
- Nail changes - including possible loss of toenails
- Hair loss - affecting head and body hair
Managing Side Effects
New Zealand cancer centers provide comprehensive support including:
- Anti-nausea medications for chemotherapy side effects
- Medications for managing hot flashes
- Regular monitoring of blood tests
- Emergency access to oncology services if side effects become severe
- Green cards for emergency access through hospital oncology departments
- 24-hour phone access to nursing support
Before starting treatment, take note of the side effect monitoring protocol provided by your medical team. Always check your temperature if you feel unwell and contact your oncology team immediately if your temperature is 38°C or above.
Support is crucial for Stage 4 patients and their families in New Zealand:
Medical Support Services
- Cancer Society New Zealand: Located on many hospital campuses with information and support services
- Prostate Cancer Foundation NZ: Provides support groups throughout New Zealand. You can find them here
- District Health Board Services: Including:
- Dietitians - for nutrition advice during treatment
- Social Workers - for psychosocial support and financial assistance
- Occupational Therapists - to help maintain independence
- Physiotherapists - to assist with mobility and exercise programs
- Cancer Psychological and Social Support Service - specialist support
- Leukaemia & Blood Cancer NZ: Also provides resources and support for some prostate cancer patients
Practical Support
- Financial Assistance: Work and Income New Zealand (0800 559 009) may provide financial assistance for those unable to work
- Travel & Accommodation: The National Travel Assistance programme helps with travel and accommodation costs for treatment
- Cancer Society Accommodation: May be able to assist with accommodation for those traveling to Christchurch for treatment
- Home Support Services: Available through DHB referrals
For immediate concerns during treatment, you can contact the oncology department at (03) 364 0020 to speak with a nurse 24 hours a day.
Day-to-Day Life
While Stage 4 prostate cancer requires ongoing management, many men maintain good quality of life:
- Continue normal activities as much as you feel able
- Any amount of activity, no matter how small, can help maintain strength
- Maintain good nutrition and hydration
- Take medications as prescribed
- Report any unusual symptoms promptly
- Accept help from others when needed
Family Involvement
Communication with family is important:
- Consider bringing a family member to appointments to help remember information
- Discuss your care preferences with those close to you
- If you have children, age-appropriate information can help them understand
- Family members can also access support services
Medical Care
Ongoing medical management includes:
- Regular PSA testing to monitor treatment response
- Scheduled appointments with your oncology team
- Additional blood tests to monitor treatment effects
- Regular assessments for any new symptoms
- Possible adjustments to treatment as needed
Contact the Oncology Service immediately (24 hours) if:
- You begin to feel unwell or are unexpectedly unwell
- You start to feel muddled or confused
- Your temperature is 38°C or more
- Your temperature is less than 35.5°C
- You have uncontrolled shaking or shivering
- You have large and/or frequent diarrhoea/loose bowel motions
- You have chest heaviness/tightness or chest pain
- You notice any bleeding or unusual bruising
- You have sensory changes (numbness, tingling) that are worsening
If you experience chest discomfort of any sort and/or difficulty breathing, call an ambulance immediately as this is a medical emergency.
You can reach the Canterbury Regional Cancer and Haematology Service at (03) 364 0020 to talk to a nurse 24 hours a day. Similar services are available at other regional cancer centers throughout New Zealand.
Reliable New Zealand-specific resources for Stage 4 prostate cancer:
- Ministry of Health
- Canterbury Regional Cancer and Haematology Service
- Cancer Society of New Zealand
- Prostate Cancer Foundation NZ
- HealthInfo - For Canterbury-specific health information
- Leukaemia & Blood Cancer NZ
- Work and Income New Zealand
For concerns about treatment side effects, contact your oncology team at any time by telephoning (03) 364 0020 (Canterbury) or your local cancer center.