Types Of Metastatic Prostate Cancer & Treatment Options

Androgen deprivation therapy, also known as hormone therapy, is often the first approach to treating advanced prostate cancer because it deprives the cancer of the hormones it needs to progress. When cancer continues to grow despite this hormone therapy, it will be labeled castration-resistant.

Not all metastatic prostate cancers behave the same way.

Knowing which type you have helps your doctor choose the best treatment. Below is a breakdown of what each means, how they are different, and the treatments available.

Metastatic Hormone-Sensitive Prostate Cancer (mHSPC)

This type of prostate cancer has spread beyond the prostate but still responds to lowering testosterone. Testosterone is a male hormone (androgen) that fuels prostate cancer growth. When testosterone is reduced, the cancer slows down or even shrinks.

The most common place prostate cancer spreads is to the bones. It can also affect lymph nodes, and less commonly, organs like the liver or lungs.

Treatment options might include the following:

• Androgen deprivation therapy (ADT): This is the foundation of treatment. ADT reduces testosterone in the body using injections, pills, or sometimes surgery to remove the testicles. Lowering testosterone starves the cancer cells.
• Chemotherapy (docetaxel): Given by IV, chemotherapy is sometimes recommended for men with widespread disease.
• Additional hormone drugs (enzalutamide, abiraterone, apalutamide, or darolutamide): These pills block the cancer from using testosterone more completely than ADT alone. They can extend life and delay progression.
• Radiation therapy: In some men with only a few metastases, radiation to the prostate can improve survival. Radiation may also be used later to ease pain from bone metastases.

Many men live for years with mHSPC when treated with a combination of therapies. Over time, however, the cancer often adapts and becomes resistant to hormone treatment. When that happens, it becomes metastatic castration-resistant prostate cancer (mCRPC).

Metastatic Castration-Resistant Prostate Cancer (mCRPC)

In this stage, the cancer has spread and continues to grow even though testosterone levels are already very low from ADT. The cancer has learned to survive without depending on normal hormone levels.

Treatment might include:

• Additional hormone drugs: Even though testosterone is low, medicines like enzalutamide, abiraterone, apalutamide, or darolutamide can block the cancer from using hormone pathways. These drugs are usually taken daily as pills.
• Chemotherapy: Docetaxel may be used again. If docetaxel stops working, another chemotherapy drug called cabazitaxel may be used. Chemotherapy can shrink tumors, reduce pain, and extend survival.
• Bone-targeted treatments: Because prostate cancer commonly spreads to bones, bone protection is very important. Denosumab (Xgeva) and zoledronic acid (Zometa) strengthen bones and reduce fracture risk. Radium-223 (Xofigo) is a radioactive injection that specifically targets bone metastases, helping with pain and slowing progression.
• Immunotherapy: Sipuleucel-T (Provenge) is a personalized vaccine made from a patient’s own immune cells. It is mainly used in men with few symptoms and slow-growing cancer.
• 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.
• Targeted Therapies: Some men have inherited or acquired mutations in DNA repair genes such as BRCA1, BRCA2, or ATM. For these men, PARP inhibitors like olaparib (Lynparza) or rucaparib (Rubraca) can be effective. Genetic testing is often recommended for men with advanced prostate cancer to see if they qualify.
• Clinical Trials: Many new treatments are in development. Participation in clinical trials can give patients access to cutting-edge therapies.

mCRPC is more difficult to treat than mHSPC, but men today have more options than ever before. With the right combination of therapies, the disease can be controlled for years, and symptoms can often be managed effectively.

How The Two Types Differ

The main difference between the two types of metastatic prostate cancer is how they respond to testosterone lowering.

In mHSPC, the cancer still responds to treatments that reduce testosterone. In mCRPC, the cancer keeps growing even when testosterone is very low.

This difference determines the treatment approach. For mHSPC, the focus is on starting hormone therapy — usually combined with additional medications or chemotherapy. For mCRPC, doctors might use more advanced hormone blockers, chemotherapy, bone-protective drugs, radiopharmaceuticals, and sometimes immunotherapy or genetic-targeted drugs.

Regardless of type, treatment is not just about controlling the cancer — it’s also about maintaining quality of life. Regular monitoring, taking steps to protect bone health, and carefully working with your medical team to manage side effects can all make the treatment process a bit easier.

Questions To Ask Your Doctor

• What type of metastatic prostate cancer do I have?
• Do you recommend any additional testing to determine the best treatment?
• How will I be monitored while undergoing treatment?
• What are the side effects of ADT I should be aware of?

Content independently created by SurvivorNet with support from Novartis Pharmaceuticals Corp.

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