Treatment options for metastatic prostate cancer

Metastatic prostate cancer means that a cancer that began in the prostate has spread to other parts of the body. It is sometimes called advanced prostate cancer.

When prostate cancer is advanced, it usually means it can no longer be cured. Treatment can help to reduce symptoms, make you feel better and help you to live longer. Many men with advanced prostate cancer live a normal life for a number of years.

Deciding which treatment you need

A team of doctors and other professionals recommend the best treatment and care for you. They are called a multidisciplinary team (MDT). The team might include a:

doctor who specialises in cancer - this is an oncologist
specialist nurse or clinical nurse specialist (CNS)
symptom control or palliative care doctor

Your team reviews the scans and tests and recommends the best treatment for you. They will explain its benefits and possible side effects.

Your treatment depends on:

where your cancer is and where it has spread to
your general health and level of fitness
your PSA blood test level
the symptoms you might have
the treatment you have had

Treatment overview

It can be difficult to choose the best treatment for you. Your doctor will explain the different options and help you make a decision. You usually have a combination of these treatments:

hormone therapy
chemotherapy
radiotherapy
targeted cancer drugs
symptom control such as treatments to help with bone pain

You might not have treatment straight away. Instead, your doctor might recommend monitoring your cancer closely. You then start treatment if you develop symptoms.

First treatment for metastatic prostate cancer

At diagnosis, prostate cancer usually depends on the hormone testosterone to grow. Doctors call it hormone sensitive prostate cancer. Hormone therapy is one of the main treatments for metastatic prostate cancer. It blocks or lowers the amount of testosterone in the body. There are several types of hormone therapy which work in different ways.

For metastatic prostate cancer, you usually have hormone therapy as your first treatment. Most people have an injection called goserelin. Another option is a hormone drug called degarelix.

You might have this hormone drug on its own. Or you have it together with another hormone drug such as apalutamide or enzalutamide.

Or you might have the 2 different hormone drugs together with a chemotherapy drug called docetaxel. So you have 3 different drug treatments together. This is sometimes called triplet therapy.

You might also have radiotherapy to your prostate and to other areas of cancer in your body. This depends on how much cancer you have in your body. You are more likely to have radiotherapy if your cancer has only spread to a small number of places.

Treatment for prostate cancer that continues to grow or comes back

Treatment often controls metastatic prostate cancer for many months to years. But sometimes the cancer starts to grow again.

You might hear your doctor saying that you now have:

castration resistant prostate cancer or
hormone refractory prostate cancer

This means that hormone therapy is no longer working. Your treatment depends on several factors. This includes what treatment you have had. Your doctor might suggest one or more of the following:

a different type of hormone therapy
an additional hormone therapy drug
chemotherapy with or without steroids
radiotherapy
radioisotope therapy such as Radium-223
a targeted drug called olaparib

Your doctor might ask if you’d like to take part in a clinical trial. Doctors and researchers do trials to make existing treatments better. And to develop new treatments.

Treatment to prevent or control problems caused by metastatic prostate cancer

Metastatic prostate cancer and its treatment can cause problems. Supportive treatments can help to either prevent or control these problems.

You might have one or more of these supportive treatments:

radiotherapy to an area of cancer that is causing pain
surgery to a broken bone, or to stop a weakened bone from breaking
bisphosphonates to reduce bone pain or lower calcium levels
treatment, drugs or a catheter to help you pass urine

Your choices

Your doctor might offer you a choice of treatments. Discuss each treatment with them and ask how they can control any side effects. This helps you make the right decision for you. You also need to think about the other factors involved in each treatment, such as:

whether you need extra appointments
if you need more tests
the distance you need to travel to and from hospital

You might have to make further choices as your situation changes. It helps to find out as much as possible each time. You can stop a treatment whenever you want to if you find it too much to cope with.

If you decide not to have treatment

You may decide not to have cancer treatments, such as chemotherapy. But you can still have medicines to help control symptoms, such as sickness or pain.

Your doctor or nurse will explain what could help you. You can also ask them to refer you to a local symptom control team to give you support at home.

How you might feel

When prostate cancer is advanced, it can no longer be cured. Finding out that cancer can’t be cured can be a big shock. It might help to talk to a close friend or relative about how you feel. Your specialist nurse can also offer support and talk to you about what is available for you.