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Prostate Cancer, Advanced or Metastatic - Treatment Overview

Surgery

The two most common surgeries are:

Hormone therapy

Hormone therapy is 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.

Combination treatments

In some cases, men will have radiation therapy after a prostatectomy, especially if the tumor could not be completely removed by surgery.

Some men choose to start hormone therapy only after they have symptoms. But many doctors recommend starting hormone therapy right away if cancer is found in the lymph nodes camera.gif during surgery to remove the prostate. Early treatment may allow men to live a little longer. Other doctors say to wait, because waiting delays the bothersome and serious side effects of hormone therapy.

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