Prostate Cancer: Treatments by Stage
Stage IV continued...
Treatment options may include:
- Hormone therapy
- External beam radiation plus hormone therapy (in selected cases)
- Surgery (TURP) to relieve symptoms such as bleeding or urinary obstruction
- Watchful waiting for older men whose cancer is causing no symptoms or for those who have another serious illness
One drug, Xofigo, is approved for use in men who have advanced prostate cancer that has spread only to the bones. Candidates should have also received therapy designed to lower testosterone. Xofigo, given by injection once a month, works by binding to minerals within bones to deliver radiation directly to bone tumors. A study of 809 men showed that those taking Xofigo lived an average of 3 months longer than those taking a placebo.
If symptoms are not relieved by standard treatments and the cancer continues to grow and spread, chemotherapy may be an option. Treatment of stage IV prostate cancer may also include treatments for relief (palliation) of symptoms such as bone pain. Finally, you can consider taking part in a clinical trial.
Recurrent Prostate Cancer
If the PSA level indicates the prostate cancer has not been cured or has come back (recurred) after initial treatment, follow-up therapy will depend on where your medical team thinks the cancer is and which treatment(s) you have already had.
Usually, the same type of treatment is not an option. For example, men who have already had radiation therapy cannot have radiation therapy again to the same area.
If the cancer is still localized to the area of the prostate, a second attempt at curative therapy may be possible. If you've had a radical prostatectomy, radiation therapy may be helpful. If your initial treatment was radiation, radical prostatectomy may be an option in selected cases, although it carries a high risk for potential side effects. Cryosurgery may also be an option if the cancer is still localized.
If the cancer has spread to other parts of the body, hormone therapy is probably the most effective treatment. Your doctor may suggest radiation therapy (using external beams or radiopharmaceuticals) or other treatments (medicines such as bisphosphonates) to relieve symptoms of bone pain. Or he or she may consider chemotherapy or other treatments under study in clinical trials.
Hormone-Refractory Prostate Cancer (HRPC)
Cancer that is no longer responding to hormone therapy such as LHRH analogs or anti-androgens is considered hormone-refractory. This can be difficult to treat. Other drugs that affect hormone levels, such as abiraterone, and older agents including ketoconazole, megestrol, or diethylstilbestrol (DES), are sometimes effective.
At one time, doctors thought chemotherapy was not effective against prostate cancer. But in recent years, this notion has been challenged. Several chemotherapy drugs seem to reduce PSA levels and improve quality and sometimes duration of life.