Your treatment options for prostate cancer that has spread will depend on:
- What kind of cancer cells you have. This is called the
grade or Gleason score of your cancer. Some prostate
cancer cells grow more quickly than others.
- Your age.
- Any serious health problems you might have, including urinary,
bowel, or sexual function problems.
locally advanced or
metastatic prostate cancer may include hormone
therapy, surgery, radiation therapy, chemotherapy, or immunotherapy. Or if you aren't having symptoms, it may include active surveillance or watchful waiting.
want to talk with your doctor about entering a
clinical trial of new cancer treatment options. A treatment being studied in clinical trials for advanced prostate cancer is high-intensity-focused ultrasound (HIFU). For metastatic prostate cancer, treatments in clinical trials include new forms of chemotherapy and immunotherapy, including vaccines.
Prostate cancer and its treatment may cause nausea, pain, or other side
effects. You can manage some side effects
at home. If you experience
nausea, wait for 1 hour after vomiting has stopped and
then sip a
rehydration drink to restore lost fluids and
nutrients. Your doctor also may prescribe
medicines to control nausea and vomiting.
diarrhea may be eased if you drink enough fluids.
Pain from cancer that has spread to the bones can be managed. If pain becomes a problem, talk to your doctor about seeing a pain management specialist. For tips on handling pain, see:
- Cancer: Controlling Cancer Pain.
For more information, see the topic
Treatment for locally advanced prostate cancer
Prostate cancer that has spread to
tissue around the prostate may be treated with radiation therapy, surgery, or hormone therapy. Sometimes two of these treatments are combined.
Radiation therapy uses high-energy
X-rays or protons to destroy the cancer. This treatment has improved with newer technologies, so there
are fewer side effects and complications than in the past. Radiation therapy
usually is combined with hormone therapy.
External beam radiotherapy, or EBRT, uses high-energy rays,
such as X-rays, to destroy the cancer. It is usually given in multiple doses
over several weeks. Radiation destroys tissue, so it may damage the
nerves along the side of the prostate that affect your ability to have an
erection. If you already have bowel problems, external radiation may cause your
symptoms to get worse.
Three common forms of external radiation are:
- Conformal radiotherapy (3D-CRT).
This uses a three-dimensional planning system to target a strong dose of radiation
to the prostate cancer. This helps to protect healthy tissue from
- Intensity modulated radiation therapy (IMRT). This uses newer 3D-CRT technology to target the cancer.
- Proton beam therapy. This is radiation therapy that uses a different type of energy (protons) rather than X-rays. This allows a higher amount of specifically directed radiation, which protects nearby healthy tissues (especially the rectum). Sometimes proton beam therapy is combined with X-ray therapy. (It is available only at big medical centers.)
The two most common surgeries are:
- Radical prostatectomy. This operation
takes out your prostate gland and the cancer in and around it.
- Transurethral resection of the prostate (TURP). This surgery can help relieve bladder problems, because it
removes part of the tumor that may be blocking the
urethra, the tube that carries urine from your bladder
through your penis. The procedure is done under
general anesthesia. This can keep the tumor from
growing for a while. But TURP does not take out the whole tumor.
Hormone therapy is also called androgen deprivation therapy (ADT). Prostate cancer needs male
hormones (testosterone) in order to survive. Hormone therapy
decreases the amount of testosterone and other male hormones in your body. This
often causes tumors to shrink. Shrinking the tumors can ease severe bone pain
caused by the spread of cancer to the bones. Hormone therapy usually is
combined with radiation therapy.
The most common methods are:
- LH-RH agonists and GnRH agonists. These drugs, such as
goserelin (Zoladex), leuprolide (Lupron), and triptorelin (Trelstar),
stop the body from making testosterone.
- GnRH antagonists. These drugs stop the body from making testosterone. They work right away and avoid the flare caused by GnRH agonists that can make symptoms worse for several weeks. One GnRH antagonist is degarelix (Firmagon).
- Antiandrogens. These drugs, such as bicalutamide
(Casodex), often are used along with LH-RH agonists. Antiandrogens help block
the body's supply of testosterone.
- Orchiectomy. This is surgery to remove
the testicles, which produce more than 90% of the body's male hormones (androgens), including testosterone.
In some cases, men will have radiation therapy after a
prostatectomy, especially if the tumor could not be completely removed by
Some men choose to start hormone therapy only after they
have symptoms. But many doctors recommend starting hormone therapy right away
if cancer is found in the
lymph nodes during surgery to remove the prostate. Early treatment may allow
men to live a little longer. Other doctors say to wait, because waiting delays
the bothersome and serious side effects of hormone therapy.
Treatment for metastatic prostate cancer
prostate cancer that has spread to the bones and/or
other organs in the body is aimed at relieving symptoms and slowing the
cancer's growth. Treatment may include:
Hormone therapy works by decreasing the amount of testosterone in your body. This can be done with medicine or with surgery to remove the testicles (orchiectomy). Hormone therapy can also relieve pain by shrinking tumors and easing urinary
androgen deprivation (orchiectomy or an LH-RH agonist) and an antiandrogen are
used together. This is called a combined androgen blockade (CAB). But the slight benefit of CAB may be offset by side effects.
Both orchiectomy and hormone therapy medicine make
testosterone levels drop, causing some of the same side effects. These include
hot flashes, loss of sexual desire, and the inability
to have an erection. Treatment options for these problems include:
- Taking a temporary break from hormone therapy. This can make
some side effects go away. (Side effects after orchiectomy are
- Radiation treatment of the breasts to prevent breast growth.
This is done before starting hormone therapy.
- Radiation treatment or the anti-estrogen breast cancer medicine
called tamoxifen to relieve breast pain. Tamoxifen can also help reverse breast
growth. It also causes hot flashes.
- Taking medicines to control hot flashes, such as paroxetine or
venlafaxine. If these don't work, sometimes estrogen or
megestrol may help reduce hot flashes. But all of these medicines have
different side effects, so if you are having a problem with hot flashes, talk
with your doctor.
Other serious side effects of hormone therapy may include thin or brittle bones (osteoporosis), reduced muscle mass, increased body mass (BMI), low red blood cell counts (anemia), fatigue, cognitive impairment (trouble thinking clearly), depression, and an increased risk for diabetes and heart disease.
Hormone therapy usually works well at first to stop
cancer growth. But in most cases the cancer returns in a few years. At this
point, the cancer is described as hormone-resistant,
meaning it is not responding to standard hormone therapy. When this happens,
other kinds of hormone treatment may be tried. If the cancer continues to grow,
chemotherapy or immunotherapy may be recommended.
Some men choose
to start hormone therapy only after they have symptoms. But some doctors
recommend starting hormone therapy right away if cancer is found in the
lymph nodes during surgery to remove the prostate. Other doctors say to wait, because waiting delays
the bothersome and serious side effects of hormone therapy.
With intermittent androgen deprivation, known as IAD,
men take cycles of hormone therapy medicines. Taking breaks between
hormone therapy cycles gives men the chance to recover their ability to
function sexually. It also gives relief from the other side effects of hormone
therapy, including hot
flashes, the loss of energy, and the loss of bone and muscle mass.
Treatment for pain
Pain is one of the main concerns of people who have metastatic cancer. But cancer pain can almost always be controlled. You and your doctor have several options to help your pain, including pain-relieving medicines and radiation, such as external beam radiation therapy and bone-targeted radioisotopes.
Additional information about prostate cancer is provided by the National Cancer Institute at www.cancer.gov/cancertopics/types/prostate.
Palliative care is a kind of medical care for people who have serious and chronic illnesses. It
is different from trying to cure your illness. Palliative care focuses on
improving your quality of life—not just in your body but also in your mind and
spirit. Some people combine palliative care with curative care.
With prostate cancer, palliative care may involve treatments to reduce
tumors or bone pain, such as
radiation therapy, radionuclides (medicine used in
external radiation) for bone metastasis, and
bisphosphonates, which slow the breakdown of bone and
help relieve bone pain. Surgery to relieve bladder problems (transurethral resection of the prostate, or TURP) is
also an option.
Palliative care may help you manage symptoms or side effects from
treatment. It could also help you cope with your feelings about living with a
long-term illness, make future plans around your medical care, or help your
family better understand your illness and how to support you.
you are interested in palliative care, talk to your doctor. He or she may be
able to manage your care or refer you to a doctor who specializes in this type
For more information, see the topic
You may wish to
discuss health care and other legal issues that arise near the end of life with
your family and your doctor. You may find it helpful and comforting to state
your health care choices in writing—with an
advance directive or living will—while you are still
able to make and communicate these decisions.
You may want to
health care agent to make and carry out decisions
about your care if you should become unable to speak for yourself. Be sure to share your wishes with your family or close friends.
You can get forms from Caring Connections (www.caringinfo.org or 1-800-658-8898) or Aging With Dignity (www.agingwithdignity.org or 1-888-594-7437).
information, see the topic
Care at the End of Life.
Hospice care provides medical services,
emotional support, and spiritual resources for people who are at the end of
life. Hospice care also helps family members manage the practical details and
emotional challenges of caring for a dying loved one. For more information, see