There are several treatments used for advanced prostate cancer, but hormone therapy is usually the first line of defence. 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 cancer growth. The options offered to you will depend on your health and type of
(hormone sensitive or castration resistant).These treatments may include:
other types of hormone therapy
chemotherapy
radiation therapy (radiotherapy)
Other options may include
active surveillance, immunotherapy, watchful waiting and treatments given through clinical trials. Immunotherapy and watchful waiting will not be intended to slow the cancer growth, but do each have other benefits.
Types of hormone therapy
for advanced prostate cancer
Abiraterone
Abiraterone can be used for both hormone sensitive as well as castration resistant advanced prostate cancer.
How it works:
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, prostate cancer cells won’t be able to grow.
Important: If you are sexually active and your partner can become pregnant, you need to use birth control or contraception while taking abiraterone.
More on abiraterone
How you take it:
Abiraterone is taken on an empty stomach in the form of a tablet, along with a steroid called prednisone. Prednisone is given because it can help reduce some of the side effects of abiraterone. How many tablets you take and how often you take them will depend on your doctor’s prescription.
Side effects:
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
liver problems
high blood pressure
Less common side effects:
high levels of fat in the blood
chest pain
heart problems
severe infections
indigestion
blood in urine
skin rashes
weaker bones which can break more easily
As 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 is 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
Enzalutamide is used for advanced prostate cancer that is either hormone sensitive or castration resistant.
How it works:
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.
More on enzalutamide
How you take it:
It’s usually taken as tablets, 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.
Side effects:
extreme tiredness (fatigue)
headaches
hot flushes
high blood pressure
feeling nervous
problems with memory and concentration
dry or itchy skin
an urge to move a part of your body, usually your legs (restless leg syndrome)
Less common side effects:
pain in your muscles, bones, back, or joints
loose and watery bowel movements (diarrhoea)
difficulty emptying your bowels (constipation)
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. Your doctor and you will decide when the best timing is for you.
Chemotherapy
There are different chemotherapy drugs used to treat advanced prostate cancer. Click on the drug names below to learn more.
Docetaxel
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. It is usually given intravenously every 3 weeks. Docetaxel 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 treatment, and may need medical attention.
Cabazitaxel
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 defence after docetaxel has been tried but cancer has continued to progress. As with docetaxel, cabazitaxel cannot cure prostate cancer but can help prolong life and reduce symptoms. It is also usually given as an injection in your veins, every 3 weeks.
Mitoxantrone
Mitoxantrone is a chemotherapy drug to treat advanced prostate cancer that has stopped responding to hormone therapy — but it’s 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
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 tumours found in the bone, attempting to limit damage to the surrounding healthy tissue. The injection is given once a month for 6 months.
More on Radium-223
What about side effects?
Side effects to radium-223 are usually not severe, but may include:
nausea and vomiting
diarrhoea
low blood counts
Immunotherapy
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. Check with your doctor if you’d like to learn more.
Clinical trials
While these are all current treatments for advanced prostate cancer, doctors and researchers are always testing and looking for more. 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 speak to your care team about any in which you might be able to participate.
Watchful waiting
Although it’s usually not recommended for men with advanced prostate cancer, some men go on
Watchful waiting will not control cancer or help manage symptoms, so doctors only suggest it in certain situations.
