Prostate Cancer, Advanced or Metastatic - Treatment Overview
Choosing treatment for
prostate cancer can be confusing. Any treatment
probably will cause serious side effects. It's important to learn all you can
about your choices and talk to your doctor about them.
Your treatment options 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.
locally advanced or
metastatic prostate cancer may include hormone
therapy, surgery, radiation therapy, and chemotherapy. You may
want to talk with your doctor about entering a
clinical trial of new cancer treatment options.
Some treatments being studied in clinical trials for advanced prostate cancer include ultrasound-guided cryosurgery, proton beam radiation, mixed beam radiation, and 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.
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
Localized prostate cancer is
cancer that has not spread outside the prostate. For more
information on treatment of localized prostate cancer, see the topic
Treatment for locally advanced prostate cancer
Prostate cancer that has spread to
tissue around the prostate may be treated with:
. This treatment uses high-energy
X-rays or protons to destroy the cancer. Radiation treatments, both external
and internal radiation, have been 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 radiation. Also called
external beam radiotherapy, or EBRT, radiation therapy uses high-energy rays,
such as X-rays, to destroy the cancer. It is usually given in multiple doses
over several weeks. For men with locally advanced cancers, ERBT may be given
along with brachytherapy. 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. The two most common forms of external radiation are
- Conformal radiotherapy (3D-CRT)
uses a three-dimensional planning system to target a strong dose of radiation
to the prostate cancer. This helps to protect healthy tissue from
- Intensity modulated radiation therapy (IMRT) uses newer 3D-CRT technology to target the cancer.
Radical prostatectomy. This operation
takes out your prostate gland and the cancer in and around it. After surgery, men usually are started on hormone therapy.
Transurethral resection of the prostate (TURP). This surgery can help relieve bladder problems, because it
removes part of the tumor that may be blocking the
urethra, the tube that carries urine from your bladder
through your penis. The procedure is done under
general anesthesia. This can keep the tumor from
growing for a while. But TURP does not take out the whole tumor.
Hormone therapy, also called androgen deprivation therapy (ADT). Prostate cancer needs male
hormones (testosterone) in order to survive. Hormone therapy
decreases the amount of testosterone and other male hormones in your body. This
often causes tumors to shrink. Shrinking the tumors can ease severe bone pain
caused by the spread of cancer to the bones. Hormone therapy usually is
combined with radiation therapy. The most common methods are:
- LH-RH agonists and GnRH agonists. These drugs, such as
goserelin (Zoladex), leuprolide (Lupron), and triptorelin (Trelstar),
stop the body from making testosterone.
- GnRH antagonists. These drugs stop the body from making testosterone. They work right away and avoid the flare caused by GnRH agonists that can make symptoms worse for several weeks. One GnRH antagonist is degarelix (Firmagon).
- Antiandrogens. These drugs, such as bicalutamide
(Casodex), often are used along with LH-RH agonists. Antiandrogens help block
the body's supply of testosterone.
- Orchiectomy. This is surgery to remove
the testicles, which produce more than 90% of the body's male hormones (androgens), including testosterone.