Your treatment options for prostate cancer that has spread will depend on:
- What kind of cancer cells you have. This is called the grade or Gleason score of your cancer. Some prostate cancer cells grow more quickly than others.
- Your age.
- Any serious health problems you might have, including urinary, bowel, or sexual function problems.
- Your PSA level.
Treatment for locally advanced or metastatic prostate cancer may include hormone therapy, surgery, radiation therapy, chemotherapy, or immunotherapy. Or if you aren't having symptoms, it may include active surveillance or watchful waiting.
You may want to talk with your doctor about entering a clinical trial of new cancer treatment options. A treatment being studied in clinical trials for advanced prostate cancer is high-intensity-focused ultrasound (HIFU). For metastatic prostate cancer, treatments in clinical trials include new forms of chemotherapy and immunotherapy, including vaccines.
Prostate cancer and its treatment may cause nausea, pain, or other side effects. You can manage some side effects at home. If you experience nausea, wait for 1 hour after vomiting has stopped and then sip a rehydration drink to restore lost fluids and nutrients. Your doctor also may prescribe medicines to control nausea and vomiting. Constipation and diarrhea may be eased if you drink enough fluids.
Pain from cancer that has spread to the bones can be managed. If pain becomes a problem, talk to your doctor about seeing a pain management specialist. For tips on handling pain, see:
Cancer: Controlling Cancer Pain.
For more information, see the topic Cancer Pain.
Treatment for locally advanced prostate cancer
Prostate cancer that has spread to tissue around the prostate may be treated with radiation therapy, surgery, or hormone therapy. Sometimes two of these treatments are combined.
Radiation therapy uses high-energy X-rays or protons to destroy the cancer. This treatment has improved with newer technologies, so there are fewer side effects and complications than in the past. Radiation therapy usually is combined with hormone therapy.
External beam radiotherapy, or EBRT, uses high-energy rays, such as X-rays, to destroy the cancer. It is usually given in multiple doses over several weeks. Radiation destroys tissue, so it may damage the nerves along the side of the prostate that affect your ability to have an erection. If you already have bowel problems, external radiation may cause your symptoms to get worse.
Three common forms of external radiation are:
Conformal radiotherapy (3D-CRT). This uses a three-dimensional planning system to target a strong dose of radiation to the prostate cancer. This helps to protect healthy tissue from radiation.
Intensity modulated radiation therapy (IMRT). This uses newer 3D-CRT technology to target the cancer.
Proton beam therapy. This is radiation therapy that uses a different type of energy (protons) rather than X-rays. This allows a higher amount of specifically directed radiation, which protects nearby healthy tissues (especially the rectum). Sometimes proton beam therapy is combined with X-ray therapy. (It is available only at big medical centers.)