The Basics Of Treating Advanced Prostate Cancer
- Metastatic prostate cancer means the disease has spread beyond the prostate, most often to bones or distant lymph nodes.
- It can be detected through blood tests, imaging, and sometimes biopsy.
- Even when prostate cancer progresses to an advanced stage, there are still many treatment approaches available.
- Androgen deprivation therapy (ADT), commonly referred to as “hormone therapy,” is often the cornerstone of treatment. Additional hormonal agents, chemotherapy, radiation, and innovative new therapies can also be part of the treatment plan.
- Ongoing communication with your healthcare team is essential to adjust treatment as your needs may change.
At this stage, prostate cancer is generally not considered curable, but that doesn’t mean there’s no hope. In recent years, medical research has brought forward a range of new treatments that can slow down cancer growth, relieve symptoms, and extend survival — in some cases, for many years. For most men, hormonal therapy (androgen deprivation therapy) is the starting point.
Read MoreHow Is Metastatic Cancer Diagnosed?
Cancer cells can break away from the original tumor in the prostate and travel to other areas of the body.This spread typically happens in three main ways: through the lymphatic system, through the bloodstream, or direct extension (where the cancer grows directly into nearby tissue such as the bladder or seminal vesicles).
The reason prostate cancer so often spreads to bone is that bone tissue contains factors that encourage prostate cancer cells to settle and grow. These metastases can appear in the spine, hips, ribs, or other areas.
Your doctor will use a combination of your medical history, physical exams, lab tests, and imaging studies to look for signs of metastasis.
Common steps include:
- PSA (prostate-specific antigen) blood test
- Bone scan
- CT scan
- MRI scan
- PSMA (prostate-specific membrane antigen) PET scan
- Biopsy of metastatic site
Your healthcare team will use these results to assign a stage to your cancer, which helps guide treatment decisions.
Symptoms When Cancer Has Spread
Not everyone with metastatic prostate cancer has symptoms right away — some men feel completely well, and the spread is only detected through routine tests. However, symptoms may develop over time.
Common symptoms include:
- Bone pain (often felt in the back, hips, or ribs)
- Fractures
- Leg swelling
- Fatigue
- Urinary changes
- Unexplained weight loss
- Decreased appetite
Any new or worsening symptom should be discussed with your healthcare provider promptly. Early intervention can prevent complications and improve comfort.
Understanding Treatment Options
While metastatic prostate cancer is not usually curable, it can often be controlled for years.
Treatment aims to:
- Slow or stop the growth of cancer
- Relieve symptoms
- Maintain your quality of life
- Improve the length of survival
Your treatment plan will be personalized and may include one or more of the following approaches.
Hormone Therapy (Androgen Deprivation Therapy or ADT)
Prostate cancer cells grow in response to male hormones called androgens (mainly testosterone). ADT lowers androgen levels or blocks their effect, effectively starving the cancer.
Hormone levels may be lowered through:
- Injections or implants that stop testosterone production
- Pills that block testosterone from attaching to cancer cells
- Surgical removal of the testicles (this is less common today)
ADT often works well for years, but cancer can eventually adapt, leading to castration-resistant prostate cancer (CRPC). When that happens, additional treatments are used.
Androgen Receptor Pathway Inhibitor (ARPI) Hormonal Agents
Drugs like abiraterone, enzalutamide, apalutamide, and darolutamide can further block androgen production or signaling, even after standard hormone therapy stops working.
“There are new, advanced hormonal therapies which are often combined with the traditional hormonal therapies,” Dr. Hamstra explains. “These are called androgen receptor blockers or ARPIs, and these can provide a more effective treatment, either in the castrate resistant setting or, frankly, in the castrate sensitive setting as well.”
Indeed, in current practice, androgen receptor pathway inhibitors are commonly used in combination with traditional testosterone-lowering ADT for the majority of patients upon initial diagnosis of a metastatic prostate cancer.
Chemotherapy
Medications like docetaxel or cabazitaxel target fast-growing cancer cells throughout the body. For some patients with advanced prostate cancer, chemotherapy can shrink tumors, ease symptoms, and improve survival.
Targeted Therapy
If genetic testing of your cancer reveals certain mutations (for example, BRCA1/2), drugs like PARP inhibitors (olaparib, talazoparib, niraparib, rucaparib) may be effective.
Immunotherapy
Some men with specific tumor markers (such as mismatch repair deficiency) may benefit from immune checkpoint inhibitors, which help the body’s immune system attack cancer, though Dr. Hamstra notes that the role of immunotherapy in prostate cancer treatment is not yet well-established.
“Immune therapy has not played a huge role in prostate cancer at this point in time, but is potentially something that may become more relevant,” he explains.
Radiopharmaceuticals
These are radioactive medicines injected into the bloodstream that travel to metastatic sites and deliver targeted radiation, such as radium-223 or lutetium-177 PSMA therapy.
Radiation Therapy for Symptom Control
External beam radiation can be directed at bone metastases or other symptomatic sites to relieve pain or prevent fractures.
Clinical Trials
Participating in a research study can give access to cutting-edge treatments not yet widely available.
Questions To Ask Your Doctor
- What role will hormone therapy play in my treatment path?
- How will I be monitored during treatment?
- What can we do to help offset and control side effects?
- What are the next steps if my cancer becomes resistant to initial treatments?
Content independently created by SurvivorNet with support from Novartis Pharmaceuticals Corp.
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