If you just learned that you or a loved one has advanced prostate cancer, you may have many questions and concerns. By taking the time to research your condition, you've taken a good first step. Here are answers to the most common questions. After looking over these answers, click on other articles in this guide to find in-depth information about treatments, side effects, and other issues that affect you and your family.
What Is Advanced Prostate Cancer?
Prostate cancer is defined as ''advanced'' when it spreads outside the prostate gland. It may spread to nearby tissues, lymph nodes, bones, or other parts of the body. When it goes beyond the tissues next to the prostate gland, it is called metastatic prostate cancer. The bones are a common place for it to spread, and it may show up in your spine, pelvis, or ribs, or the upper part of your thighbone, called the femur.
When the cancer moves to your bones, you can have problems like:
- Pain. It can be a dull ache or sharp and stabbing, and it may feel worse at night.
- Anemia. Cancer can affect your bone marrow, which makes red blood cells. Anemia, or a low red blood cell count, can make you feel tired, weak, dizzy, and short of breath.
- Bone loss and fractures. The cancer can weaken your bones. Plus, medicines that lower your levels of testosterone and other male sex hormones (which are called androgens) can lead to bone loss and broken bones.
- Pressure on your spinal cord. This happens when the cancer spreads to your spine. It can cause bladder and bowel problems, trouble walking, and weakness or numbness in your legs. It's an emergency and needs treatment right away.
Prostate cancer can also cause trouble peeing if it has enlarged the prostate. This can be a symptom of early or advanced disease.
Can Advanced Prostate Cancer Be Cured?
There’s no cure for advanced, or metastatic, prostate cancer, but treatments may greatly extend life and ease symptoms. A look at treatments:
- Most prostate cancer grows in response to androgens in the body such as testosterone. That’s why one of the first treatments for advanced prostate cancer is to lower these hormone levels with androgen deprivation therapy. Several medications can do this, including degarelix (Firmagon), goserelin (Zoladex), histrelin (Vantas), leuprolide (Eligard, Lupron), relugolix (Orgovyx), and triptorelin (Trelstar). These drugs reduce testosterone levels to those seen in castrated patients. Other hormonal treatments include antiandrogens, estrogen- and progesterone-type drugs, and cortisone derivatives.
If these stop working, the drugs abiraterone (Zytiga), apaleutamide (Erleada), darolutamide (Nubeqa), or enzalutamide (Xtandi) may be effective. The most frequent side effects from hormone therapy include reduced sex drive, impotence, erectile dysfunction, infertility, and bone loss. Your doctor may be able to help prevent some side effects, such as bone loss.
- In the past, it was common for doctors to recommend surgical removal of the testicles (called orchiectomy) to decrease hormone levels. This is usually not necessary, because medications typically work, though such medications are more expensive than the surgical procedure. The use of medical rather than surgical treatment offers the option of stopping -- sometimes temporarily, sometimes permanently -- the medicines if the side effects are severe or if the patient or doctor prefers. The surgery is not reversible.
- If hormone therapy doesn’t slow the growth of the cancer, the next step may be a prostate cancer "vaccine" called sipuleucel-T (Provenge). Most men who take Provenge live at least 2 more years after starting the treatment. Provenge is created by taking immune cells from a patient, genetically engineering them to fight prostate cancer, and putting them back into the patient. It's used for men with few or no symptoms and when advanced prostate cancer no longer responds to hormone therapy. The most common side effect is chills. Other common side effects include fatigue, fever, back pain, and nausea.
- Chemotherapy is another option when hormone therapy stops working. Only a few chemotherapy medications have been shown to work for advanced prostate cancer. Docetaxel (Taxotere), when taken with the steroid prednisone, can help extend survival in some men. When Taxotere stops working, other chemo drugs, such as cabazitaxel (Jevtana), can help extend survival in some men. Possible side effects of Taxotere include nausea, hair loss, and lower production of blood cells. Men may also have fluid retention and pain, tingling, or numbness in the fingers or toes. Jevtana has side effects similar to Taxotere.
- External beam radiation therapy may reduce pain from bone metastases in advanced prostate cancer. This treatment shrinks your bone tumors. Your doctor may focus a beam of radiation on a certain spot, or they may inject a radioactive substance into your vein, which kills the prostate cancer cells that absorb it.
- Radium-223 (Xofigo) is approved for use in men who have advanced prostate cancer that has spread only to the bones. Candidates should have also received androgen deprivation therapy. Xofigo, given by injection once a month, works by binding to minerals within bones to send radiation directly to bone tumors. A study of 809 men showed that those taking Xofigo lived an average of 3 months longer than those taking a placebo. Samarium-153 (Quadramet) and strontium-89 (Metastron) can also be used to treat prostate cancer that has spread to bone.
- Drugs called bisphosphonates (Actonel, Xgeva, Zometa) can make bones stronger and prevent fractures. Zoledronic acid (Zometa) can ease pain and delay or prevent breaks in some men with prostate cancer and can help protect their bones when they are taking hormone therapy. Denosumab (Prolia, Xgeva) can slow the loss of bone. It may also protect your bones when you take hormone therapy.
- A surgeon can remove a tumor in your bones and then repair the bone with bone cement, pins, screws, plates, rods, or other devices. You may also need surgery to strengthen a broken bone.
- A noninvasive procedure uses MRI scanning to focus the energy from ultrasound in order to destroy nerve endings in the bone around a tumor. This can provide relief from bone pain with a low risk of complications. Other treatments include the use of extreme cold or electrical currents to reduce or destroy the tumor.
Your doctor may also prescribe medications to manage pain, including:
- Prednisone. This steroid can curb swelling around the cancer in bones.
- Nonsteroidal anti-inflammatory drugs (NSAIDs) or acetaminophen, which can ease mild pain.
- Opioids, such as long-acting morphine or fentanyl patches, which you may need if you have severe pain.
Can People With Advanced Prostate Cancer Enroll in Clinical Trials?
Major organizations such as the National Comprehensive Cancer Network recommend this course of action for all cancer patients. Researchers are exploring several new ways of diagnosing, monitoring, and treating prostate cancer. Clinical trials test the safety and effectiveness of these new methods and treatments. There are risks and limitations in every clinical trial. For example, you may be assigned to the "control" group, and not get the new medicine. In that case, the control medicine is the best therapy already available. Placebo -- or ineffective treatment -- is rarely if ever used anymore, and if it will be used in the trial, you would be informed. Keep in mind that the new medicine under investigation in the clinical trial may not work. But clinical trials also offer early access to new treatments.
You can find out more about clinical trials by asking a medical oncologist, inquiring at an academic medical center, or browsing a clinical trials listing service. The National Institutes of Health lists clinical trials at www.clinicaltrials.gov.