There isn’t one way to control advanced prostate cancer. It depends on a mix of things. That includes your age, symptoms, and how fast your cancer grows. Michael Kahn, MD, a medical oncologist who specializes in prostate cancer at Northwestern Medicine, says your quality-of-life goals also matter.
“Is it to get your disease under the best control for as long as you possibly can, come hell or high water?” Kahn asks. “Or is it: I just want to have a life that’s as normal as possible.”
No matter what, your doctor will partner with you to find the right cancer care plan.
Here are some common treatments for advanced prostate cancer.
Hormone Therapy
Michael Leapman, MD, a urologic oncologist with Smilow Cancer Hospital and Yale Cancer Center, says the mainstay of treatment is androgen deprivation therapy (ADT). Like the name suggests, these drugs suppress androgens, which are sex hormones such as testosterone.
The goal is to take away the “fuel” that prostate cancer cells need to grow.
You might also get a secondary hormonal therapy.
“There are newer anti-androgen therapies -- things that work in the same way that androgen deprivation works but are more potent -- which are also life-extending,” Leapman says.
Hormone suppression can cause some bothersome symptoms, such as hot flashes. Because of that, some people decide to take breaks from therapy.
“What we can do is give them a vacation from it and let their testosterone recover,” Leapman says. “This will generally help with side effects.”
Doctors call this on-and-off approach intermittent ADT. Some people deal with it better than sustained treatment. And studies show that intermittent ADT “appears to be almost on par with continuous therapy,” Leapman says. But we need more research to know for sure.
Chemotherapy
You might have this along with ADT or another treatment. But you won’t have it every day.
“It’s an initial course of chemotherapy, so not a continuous thing,” Leapman says.
This treatment isn’t for everyone with prostate cancer. It uses strong drugs that kill cancer but can hurt healthy tissue, too. It can give you more serious side effects when compared to hormone therapy.
Before starting chemo, Leapman says your doctor should consider:
- Your age and overall health
- Whether you have other medical conditions
- How well you might handle chemo
- Where your cancer has spread
- How well you get around in daily life
Targeted Therapy
This treatment uses drugs that attack cancer cells without hurting your healthy cells. Right now, targeted therapy for prostate cancer involves the BRCA1 and BRCA2 genes. You can get a test to see if you have changes, or mutations, to these genes.
Targeted therapy isn’t the right choice for everyone. But it’s something you should ask your doctor about. If you have certain gene alterations, “that can change the treatment plan,” Leapman says.
Immunotherapy
Some newer treatments use your body’s immune system -- your defense against germs -- to slow or stop cancer cells from growing. Some call one, sipuleucel-T (Provenge), "the cancer vaccine." Leapman says it usually goes to people whose advanced prostate cancer causes few to no symptoms.
There'll probably be more kinds of immunotherapy in the future. Researchers are studying a group of drugs called checkpoint inhibitors. These help your immune system find and kill cancer cells. But they haven't gotten approval for prostate cancer yet.
Clinical Trials
These are studies that test new cancer drugs. Your doctor might suggest one if you’ve already tried standard therapies or you have certain health problems.
“For example, one of the [chemotherapy] drugs used can cause peripheral neuropathy,” Kahn says. “If somebody already has an underlying peripheral neuropathy, we want to avoid making that worse for them. For those people, we’ll look for a trial.”
Kahn says it’s important to know you’re not a “guinea pig” if you enroll in a clinical trial. Instead, you’re helping researchers find better ways to treat cancer.
Pain Management
The first approach is usually to make sure your cancer treatment is working, Leapman says. And if you’re taking a break from ADT, and you start to have serious pain, “it’s almost always a good idea to restart hormonal therapy,” he says.
Commonly, advanced prostate cancer can spread to your bones. If that’s the case, your doctor will likely send you to a radiation oncologist “for directed therapies,” Kahn says. “Radiation agents go directly to sites of bone metastasis.”
Other things that might help you feel better include:
Pain medication. This includes over-the-counter meds like nonsteroidal anti-inflammatory drugs (NSAIDs) or stronger prescriptions like opioids.
Surgery. Your doctor will check to see if you have any broken bones that need to be set.
Complementary therapies. “Things like reiki [also called ‘hands-on healing’] or acupuncture, I absolutely encourage,” Leapman says. “I think there can be a pain and psychological benefit.”
Some aches can signal a more serious issue. Call your doctor right away if you have:
- New or worsening back pain
- Tingling or numbness in your groin
- Loss of control over your bowel or bladder.
These could be signs that your cancer has spread to your spine, a condition called metastatic spinal cord compression (MSCC).
Questions for Your Doctor
It’s OK to bring up anything that’s on your mind. Maybe you’re curious about drug side effects, sexual health treatments, or how to deal with death. Whatever you want to know, make a checklist of things you want to go over.
“Preparation is everything,” Leapman says.
Here are some of his tips about what to ask your doctor:
- What is the name for my cancer?
- What part of my body is it in?
- How serious, or what stage, is it?
- What is the Gleason score?
- Is there a high, low, or medium amount of disease?
- What is your therapeutic plan?
- If the first therapy doesn’t work, what will happen next?
- What resources are available at the hospital if I need help?
- Can I enroll in a clinical trial?
- Should I get genetic testing?
Leapman urges people to bring in an “impartial notetaker.” That’s a family member or friend who’ll jot down details for you. Or you can make an audio or video recording of your visit. Just give your doctor a heads-up.
“The first time someone pulled out the recorder, maybe I was a bit jarred by it,” Leapman says. “[But now,] I would encourage it because there’s so much information overload.”
