Hearing that you have advanced (or metastatic) prostate cancer can completely knock the wind out of you. And you’ll likely have a number of questions about what the future holds.
But right now, it's important to know that you’re not alone and that there are people (including your doctors, nurses, counselors, family, and friends) who will support you the whole way.
What is advanced (or metastatic) prostate cancer?
When the cancer spreads to other parts of the body, beyond the prostate gland and the immediate surrounding area—it is considered ‘advanced.’
Most commonly, the cancer spreads to the bones, especially in the hips and back. But it can also spread to the lymph nodes in your pelvis and your pelvic tissue, and the abdomen (stomach area). This growth and spreading beyond the prostate is what makes the cancer advanced versus a localized disease that stays contained to the prostate.
Advanced prostate cancer can be:
Hormone-sensitive. The cancer has spread to other parts of the body but responds well to hormone therapy.
Castration-resistant prostate cancer. The cancer has spread to other parts of the body and, it can no longer be slowed down by hormone therapy which gets rid of testosterone from your testicles. You can tell the cancer is castrate-resistant because of a rising PSA level, worsening x-rays, or worsening symptoms.
Although it’s not possible to cure advanced prostate cancer, treatments can keep it under control, often for several years. This is because prostate cancer often grows slowly, so your care team will help you manage it over time. The treatment options offered to you will depend on your health and type of advanced prostate cancer (hormone sensitive or castration resistant).
What treatments are available for advanced prostate cancer?
There are several treatments used for advanced prostate cancer, but hormone therapy is usually the first line of defense. For some men, however, the disease may eventually stop responding to some forms of hormone therapy. If this happens, you may need further treatment to help control the cancer growth.
These treatments may include:
Other types of hormone therapy.
Other options may include immunotherapy, advanced prostate cancer treatments given through clinical trials, surveillance (or watchful waiting) and best supportive care. The availability of some of these can vary depending on where you live, and your doctor will discuss the best option for your situation.
Hormone therapy for advanced prostate cancer
Abiraterone can be used for both hormone-sensitive as well as castration-resistant advanced prostate cancer.
Similar to other forms of hormone therapy, abiraterone prevents the production of testosterone, but does it differently. Abiraterone blocks prostate cancer cells and the adrenal glands from producing testosterone themselves. Without testosterone, the prostate cancer cells won’t be able to grow.
If you’re sexually active and your partner can become pregnant, you need to use birth control or contraception while taking abiraterone.
Abiraterone is an oral pill that is taken along with a steroid pill called prednisone. Prednisone is given because it can help reduce some of the side effects of abiraterone. How many pills you take and how often you take them will depend on your doctor’s prescription.
A build-up of fluid in your body, which can cause swollen legs or feet.
A drop in the level of potassium in your blood, which can cause weakness or twitches in your muscles, or a fast, pounding heartbeat. Speak to your doctor right away if you notice these symptoms.
High blood pressure.
Common side effects of abiraterone include:
High levels of fat in the blood.
Blood in urine.
Weaker bones which can break more easily.
Less commonly, you may also experience:
Taking abiraterone can make your bones thinner and weaker over time—you may be advised to take calcium and vitamin D plus other medications to help with this. It’s also important to discuss with your health care team what other things you can do to help lower your risk of thin bones.
Abiraterone and chemotherapy
Your doctor may offer you abiraterone before or after chemotherapy with a drug called docetaxel. Your doctor and you will decide when the best timing is for you.
Enzalutamide is used for advanced prostate cancer that is either hormone sensitive or castration resistant.
It blocks the effect of testosterone on prostate cancer cells. Without testosterone, the prostate cancer cells can’t grow, even if they have spread to other parts of the body.
Enzalutamide is usually taken as oral pills once a day. Also, you’ll most likely continue your original form of hormone therapy (that you had before enzalutamide) as it can still help keep your testosterone levels low.
Extreme tiredness (fatigue).
High blood pressure.
Problems with memory and concentration.
Dry or itchy skin.
An urge to move a part of your body, usually your legs (restless leg syndrome).
Side effects of enzalutamide include:
Pain in your muscles, bones, back or joints.
Loose and watery bowel movements (diarrhea).
Difficulty emptying your bowels (constipation).
Less commonly, you may also experience:
There’s also a small risk of having a seizure, but this is rare.
Enzalutamide and chemotherapy
Your doctor may offer you enzalutamide before or after chemotherapy with a drug called docetaxel. You and your doctor will decide what the best timing is for you.
Chemotherapy for advanced prostate cancer
There are different chemotherapy drugs used to treat advanced prostate cancer.
Docetaxel is a very commonly used chemotherapy drug for advanced prostate cancer. It can be combined with hormone therapy for men who have just been diagnosed with advanced prostate cancer that is hormone-sensitive. It can also be used for men who have castration-resistant prostate cancer.
Docetaxel is usually given as an injection in your veins (intravenously) every 3 weeks. It is typically well-tolerated and some men see an improvement in their PSA level and symptoms while on treatment. It has also been shown to make some men live longer.
While on docetaxel, it’s very important to closely monitor for symptoms of infection as your white blood cell count may go low. Some men experience a lowered count during advanced prostate cancer treatment and may need medical attention.
You might be offered cabazitaxel if you have advanced prostate cancer that has stopped responding to hormone therapy and you've already had docetaxel.
Cabazitaxel is typically used as a second defense after docetaxel has been tried but the cancer has continued to progress. As with docetaxel, cabazitaxel cannot cure prostate cancer but can help prolong life and reduce symptoms.
Carbazitaxel is usually given as an injection in your veins (intravenously), every 3 weeks.
Mitoxantrone is a chemotherapy drug used to treat advanced prostate cancer that has stopped responding to hormone therapy. It is rarely used anymore; however, it may be offered if your doctor thinks you may not tolerate the side effects of docetaxel well. Your doctor will make that judgement based on your level of fitness and any other health issues you may have.
Radium-223 treatment for advanced prostate cancer
Radium-223 is a form of radiation therapy for metastatic castration-resistant prostate cancer. It is used to treat prostate cancer that has spread to the bones.
With this treatment, a very small amount of radioactive liquid is injected into a vein in your arm. It delivers radiation directly to tumors found in the bone, attempting to limit damage to the surrounding healthy tissue. The injection is given once a month for 6 months.
Side effects to radium-223 are usually not severe, but may include:
Nausea and vomiting.
Low blood counts.
Immunotherapy treatment for advanced prostate cancer
Sipuleucel-T, also called Provenge, is a type of immunotherapy for advanced prostate cancer. This treatment activates your immune system and encourages it to seek out and attack cancer cells. Immunotherapy isn’t available in every country, so check with your doctor if you’d like to learn more.
Clinical trial treatments for advanced prostate cancer
Doctors and researchers are always testing and looking for more treatments for advanced prostate cancer. Your quality of life and how you feel day-to-day are a priority, so finding the best treatment is the goal. Clinical trials are one way to try to find the right treatment for you, so talk to your doctor or care team about any in which you might be able to participate.
Although it’s usually not recommended for men with advanced prostate cancer, some men go on watchful waiting. Watchful waiting will not control cancer or help manage symptoms, so doctors only suggest it in certain situations.
Getting support with advanced prostate cancer
Finding out you have advanced prostate cancer can be profoundly disorienting. Even if you feel alone at times, you don’t have to face this diagnosis on your own. There is support and guidance available—you just need to know what steps to take.
Build your prostate cancer support team
Living with a cancer diagnosis is not something you have to face alone. Lean on the community around you to take some of the stress of advanced prostate cancer off your mind. You’ll not only feel better, but the people that care about you will get the chance to be there when you need them most.
Share your diagnosis with your partner, family, and friends
Being open with people you trust can lighten the load on your shoulders. Don’t be ashamed or afraid to talk through what’s bothering you. Are you worried about life expectancy with prostate cancer? Quality of life? How treatment might affect you? Or just generally what comes next? Your support system wants to help you get through it.
Consider joining a prostate cancer registry
In addition to clinical trials, many men choose to join a prostate cancer registry. A registry collects information on your cancer type, any treatments you’ve had, side effects, family history, overall quality of life, and more. Doctors and researchers use this knowledge to work towards better care and treatments and to improve quality of life for all men with prostate cancer.
The True North IRONMAN registry is for men with advanced prostate cancer—visit to learn more and explore a location near you.
Who can help you get through advanced prostate cancer?
Your doctor or care team
Talk openly to your doctor, nurse, or someone else you trust in your care team. They can help you understand your diagnosis, your prognosis (the likely outcome of your treatment), treatments for advanced prostate cancer and potential side effects. They can also listen to your concerns and put you in touch with other people who can help.
Counselors are trained to listen and can help you to find your own ways to deal with things. Many hospitals have counselors or psychologists who specialize in helping people with cancer - ask your doctor or care team at the hospital if this is available or if they know of services in the community you can access at low or no cost to you. Your GP or family doctor may also be able to refer you to a counselor, or you can seek out a private counselor yourself.
Advanced prostate cancer support groups
Talking to other men with advanced prostate cancer can be a helpful way to connect with people who understand what you’re going through. Talk to your doctor for recommendations on any good local groups or check online for ones that interest you.
Some men find that talking with a spiritual leader or counsellor can be useful during this time. It may also help to visit places that make you feel calm, at peace, and grounded like at a lake or somewhere out in nature.
Between diagnosis, treatment, finances, and changes in relationships, there’s a lot that might keep you up at night. And if worries pile up, it’s normal to feel stressed or anxious.
Remember, there is support available to help you make decisions and process all the feelings and questions you have. Never hesitate to reach out for help, and don’t be ashamed to let people know how you’re doing. Others have been right where you are, and many men are able to extend and maintain a quality of life for prolonged periods. Although everyone’s exact path is different, the key is to take it one day at a time and make looking after yourself a priority.