Doctors can treat, but not cure, advanced prostate cancer. The goal is to slow down the cancer's spread and help you feel better. Most men with it live a high quality of life for many years.
There are different kinds of treatments, including hormone therapy, immunotherapy, radiation, and chemotherapy. Ask your doctor about the risks, benefits, and side effects of each one, and what is best for you.
Hormone Therapy for Advanced Prostate Cancer
The goal is to cut prostate cancer's hormonal fuel supply, slowing down its growth.
The male sex hormones (called androgens), and especially testosterone, can help prostate cancer cells grow inside and outside of the prostate gland. Hormone therapy shuts down this process. It will:
- Dramatically lower your testosterone levels
- Prevent prostate cancer cells from using any low levels of androgens
Most doctors think it makes sense to start this type of treatment as soon as prostate cancer becomes advanced. Your doctor may call it "androgen deprivation therapy."
There are several different hormone therapy drugs. Your doctor may give you one or more of them, including:
GnRH agents. These drugs can work in different ways, but ultimately, they block or stop your body from making luteinizing hormone (LH), which it needs to make testosterone. Drugs of this type include:
- Buserelin (Suprefact)
- Degarelix (Firmagon)
- Goserelin (Zoladex)
- Histrelin (Vantas)
- Leuprolide (Eligard, Lupron Depot)
- Triptorelin (Trelstar)
You'll get these drugs by injection every month, 3 months, or 6 months. Doctors implant others under your skin.
Sometimes, these drugs can cause your body to temporarily make a lot of testosterone before the levels drop. To offset any side effects from the hormonal surge, your doctor may also recommend taking another kind of drug, called "anti-androgens."
Anti-androgens. These drugs completely block prostate cancer cells' ability to use any androgens.
Three common types of anti-androgen drugs are:
- Bicalutamide (Casodex)
- Flutamide (Eulexin)
- Nilutamide (Nilandron)
You may take these before you start GnRH agents to avoid a hormone flare or if other hormone therapy stops working.
How you take them: Some hormone therapy drugs are pills. Others are injections or pellets that doctors implant under your skin. Your doctor will set your drug schedule based on your particular needs and how your cancer responds.
If you become resistant to hormone therapy or have problems with side effects, your doctor may try "intermittent therapy." This means you'll have the drugs for a while, then go off, then go on again. This can improve your quality of life and make the hormone therapy more effective.
Newer types of hormone therapy include:
- Abiraterone acetate (Zytiga), a pill that stops prostate cancer cells (and other cells) from making androgens. It's approved for men with advanced prostate cancer who have tried other hormone therapies.
- Enzalutamide (Xtandi), a pill that blocks cells from receiving androgens. It's approved for men with advanced prostate cancer who have tried other hormone therapies and the chemo drug docetaxel.
Surgery to Remove the Testicles (Orchiectomy)
Your testicles make most of your testosterone. Surgery to remove the testicles (called an orchiectomy) is a type of hormone therapy because it quickly cuts testosterone levels.
This operation used to be common, but most men with prostate cancer don't get it any more. Instead, they take medicines that lower hormone levels while leaving the testicles in place.
If you do get the surgery, it's an "outpatient" procedure, which means you won't have to stay in the hospital. Your doctor may also give you anti-androgen therapy.
If hormone therapy stops working, your doctor may suggest immunotherapy. It uses your immune system to attack the cancer cells.
Sipuleucel-T (Provenge) is used to treat advanced prostate cancer. To make it, the doctor removes white blood cells from your blood. These go to a lab, where experts genetically engineer them to fight your prostate cancer. You then get these cancer-killing cells by IV injection in three separate treatments.
This treatment uses high-energy rays kill cancer cells and shrink tumors. You may get it to shrink your tumors and ease symptoms.
You may get radiation therapy from a machine at a clinic, or through substances doctors put into your body.
If your prostate cancer hasn’t spread beyond your bones, your doctor may consider using the drug radium-223 (Xofigo), along with medicine to lower your testosterone level. You get Xofigo by injection once a month. It binds to minerals in your bones to deliver radiation directly to bone tumors.
If other treatments stop working and your cancer progresses, your doctor may recommend chemotherapy. When to start chemo will depend upon many things, such as:
- Which types of treatment you have already received
- Whether radiation is needed first
- How well you tolerate chemo
- Which other options are available to you
There are many types of chemo drugs. You get them by IV or as a pill. They travel throughout the body to destroy cancer cells.
Doctors often combine the chemo drug docetaxel (Taxotere) with prednisone, a steroid, for men with hormone-resistant prostate cancer that has spread.