Stage 4 is the highest stage. Others here have had Stage 3 and they are still here to talk about it.
At this point, testing him to see if there is any other spread is the key to working out the treatment plan. If it has not spread beyond the local area, they will likely remove his bladder and prostate and urethra. Depending on his particular circumstances they may build him a new bladder out of a segment of his intestine. Since the urethra was involved they would hook up his new bladder to a stoma inside his belly button so it doesn't show. Alternatively, he may not be able to get a new bladder (neobladder or Indiana Pouch). In that case, they connect his ureters up to a tube that he will connect to a urostomy bag. Lots of people have these as well. Either way works fine and people are generally able to do pretty much everything they used to.
He will likely have to have a number of rounds of chemo even before they remove the bladder.
Mike
Age 54
10/31/06 dx CIS (TisG3) non-invasive (at 47)
9/19/08 TURB/TUIP dx Invasive T2G3
10/8/08 RC neobladder(at 49)
2/15/13 T4G3N3M1 distant metastases(at 53)
9/2013 finished chemo -cancer free again
1/2014 ct scan results....distant mets
2/2014 ct result...spread to liver, kidneys, and lymph...