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If your prostate cancer has spread outside of the prostate then you will need to look at your metastatic prostate cancer treatment options. While most prostate cancer is diagnosed and treated while the disease is localized to the prostate, some men are diagnosed with metastatic prostate cancer treatment initially and need treatment for that. Other men may require metastatic prostate cancer treatment after being treated initially for disease localized to the prostate.
Standard metastatic prostate cancer treatment involves androgen deprivation therapy (hormone therapy) initially. The primary androgen is testosterone produced by the testes. Therapy may include:
- Orchiectomy. This is surgical removal of the testicles, which leads to lowering of the testosterone levels.
- Medical orchiectomy. Rather than surgical removal, medications can also be used to achieve a lowering of testosterone levels for metastatic prostate cancer treatment. Medications suppress the production of testosterone. Unfortunately, this treatment option can sometimes result in the ‘flare phenomenon,’ which may result in an initial worsening of the prostate cancer.
Many patients will have anti-androgen therapy followed by the addition of chemotherapy.
Metastatic prostate cancer treatment—advanced disease
Over time, patients with androgen deprivation therapy may develop disease progression as evidenced by a rising PSA, new spread to distant sites, or worsening disease in areas where the cancer has already spread.
A number of treatment options exist for patients with metastatic prostate cancer—either newly diagnosed or those with progressive disease. Unfortunately, it can be hard to know which treatment is optimal at this point as science has not clearly delineated best practices.
Here are a few options that you can discuss with your doctor:
- Sipuleucel-T, or Provenge. This is an immunotherapy that is tailored to your specific cancer. This treatment is most effective in men with distant metastasis, a rising PSA despite other treatment, and whose disease was not so severe as to require narcotics. With this treatment PSA levels may not decrease, and it may take some time to work, so it is not appropriate for patients needing a rapid response.
- Abiraterone and enzalutamide. These drugs are anti-androgens that stop the formation of testosterone. Both of these drugs are orally administered and generally well tolerated.
- Docetaxel chemotherapy. This metastatic prostate cancer treatment is generally indicated in patients with rapidly progressive disease and symptomatic patients where the previous less-toxic metastatic prostate cancer treatments are not as good an option. Patients undergoing this treatment are subject to many of the potential side effects of chemotherapy such as low blood counts, nausea, and hair loss.
- Radium-223. This metastatic prostate cancer treatment is indicated for patients with bone metastasis that has not spread to any other internal organs. Radium-223 is bone seeking and allows deposition of high amounts of energy to be directed over a short distance. This allows your doctor to aggressively treat your cancer while minimizing side effects to normal bone.
Metastatic prostate cancer treatments are varied. You should talk with your doctor about which ones are most appropriate for you.
Read more in our Prostate Cancer Health Center.
Brady D et al. Bone-targeting radiopharmaceuticals including radium-223. Cancer J 2013 Jan-Feb; 19(1):71-8.
Higano CS et al. Integrated data from 2 randomized, double-blind, placebo-controlled, phase 3 trials of active cellular immunotherapy with sipuleucel-T in advanced prostate cancer. Cancer 2009; 115(16):3670.
Loblaw DA et al. American Society of Clinical Oncology recommendations for the initial hormonal management of androgen-sensitive metastatic, recurrent, or progressive prostate cancer. J Clin Oncol 2004;22(14):2927.
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