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Prostate Cancer, Advanced or Metastatic - Treatment Overview

Treatment for metastatic prostate cancer

Treatment for prostate cancer that has spread to the bones and/or other organs in the body is aimed at relieving symptoms and slowing the cancer's growth. Treatment may include:

Hormone therapy works by decreasing the amount of testosterone in your body. This can be done with medicine or with surgery to remove the testicles (orchiectomy). Hormone therapy can also relieve pain by shrinking tumors and easing urinary problems.

Sometimes androgen deprivation (orchiectomy or an LH-RH agonist) and an antiandrogen are used together. This is called a combined androgen blockade (CAB). But the slight benefit of CAB may be offset by side effects.

Both orchiectomy and hormone therapy medicine make testosterone levels drop, causing some of the same side effects. These include larger breasts, hot flashes, loss of sexual desire, and the inability to have an erection. Treatment options for these problems include:

  • Taking a temporary break from hormone therapy. This can make some side effects go away. (Side effects after orchiectomy are permanent.)
  • Radiation treatment of the breasts to prevent breast growth. This is done before starting hormone therapy.
  • Radiation treatment or the anti-estrogen breast cancer medicine called tamoxifen to relieve breast pain. Tamoxifen can also help reverse breast growth. It also causes hot flashes.
  • Taking medicines to control hot flashes, such as paroxetine or venlafaxine. If these don't work, sometimes estrogen or megestrol may help reduce hot flashes. But all of these medicines have different side effects, so if you are having a problem with hot flashes, talk with your doctor.

Other serious side effects of hormone therapy may include thin or brittle bones (osteoporosis), reduced muscle mass, increased body mass (BMI), low red blood cell counts (anemia), fatigue, cognitive impairment (trouble thinking clearly), depression, and an increased risk for diabetes and heart disease.

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

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