Treatment options for metastatic prostate cancer

Metastatic prostate cancer means that a cancer that began in the prostate has spread to other parts of the body. It is sometimes called advanced prostate cancer.

When prostate cancer is advanced, it usually means it can no longer be cured. Treatment can help to reduce symptoms, make you feel better and help you to live longer. Many men with advanced prostate cancer live a normal life for a number of years.

Deciding which treatment you need

A team of doctors and other professionals recommend the best treatment and care for you. They are called a multidisciplinary team (MDT). The team might include a:

• medical cancer specialist or oncologist
• specialist nurse or clinical nurse specialist (CNS)
• symptom control or palliative care doctor

Your team reviews the scans and tests and recommends the best treatment for you. They will explain its benefits and possible side effects.

Your treatment depends on:

• where your cancer is and where it has spread to
• your general health and level of fitness
• your PSA blood test level
• the symptoms you might have
• the treatment you have had

Treatment overview

It can be difficult to choose the best treatment for you. Your doctor will explain the different options and help you make a decision. You usually have a combination of these treatments:

• hormone therapy 
• chemotherapy
• radiotherapy 
• targeted cancer drugs
• symptom control such as treatments to help with bone pain

You might not have treatment straight away. Instead, your doctor might recommend monitoring your cancer closely. You then start treatment if you develop side effects.

First treatment for metastatic prostate cancer

The first treatment you have is usually hormone therapy in combination with:

• more hormone therapy such as apalutamide and enzalutamide or
• chemotherapy

Prostate cancer usually depends on the hormone testosterone to grow. Hormone therapy blocks or lowers the amount of testosterone in the body. Common hormone therapy injections include goserelin and degarelix.

Chemotherapy is a type of anti cancer drug treatment. The drugs work by killing prostate cancer cells. The drugs circulate throughout the body in the bloodstream. The most common chemotherapy drug used for prostate cancer is docetaxel.

Treatment for metastatic castration resistant prostate cancer

A  combination of different hormone therapy drugs or hormone therapy with chemotherapy often controls metastatic prostate cancer for many months to years. But sometimes the cancer can start to grow again after the initial treatment.

You might hear your doctor saying that you now have:

• castration resistant prostate cancer or

• hormone refractory prostate cancer

This means that hormone therapy is no longer working. If this happens, your doctor might suggest:

• a different type of hormone therapy with chemotherapy

• an additional hormone therapy drug

• chemotherapy with steroids

• bisphosphonates

• radiotherapy

• radioisotope therapy such as Radium-223 and Lutetium-177-PSMA

Your doctor may also recommend a targeted drug called Olaparib. You can have this if you have a change (mutation) in the BRCA1 or BRCA2 genes .

Treatment for metastatic hormone sensitive prostate cancer

Hormone sensitive metastatic prostate cancer means the cancer has spread to other parts of the body but can still be treated with hormone therapy. Your doctor might recommend treatment with:

• hormone therapy with chemotherapy

• hormone therapy alone

• a combination of different hormone therapy drugs

Your choices

Your doctor might offer you a choice of treatments. Discuss each treatment with them and ask how they can control any side effects. This helps you make the right decision for you. You also need to think about the other factors involved in each treatment, such as:

• whether you need extra appointments
• if you need more tests
• the distance you need to travel to and from hospital

You might have to make further choices as your situation changes. It helps to find out as much as possible each time. You can stop a treatment whenever you want to if you find it too much to cope with.

If you decide not to have treatment

You may decide not to have cancer treatments, such as chemotherapy. But you can still have medicines to help control symptoms, such as sickness or pain.

Your doctor or nurse will explain what could help you. You can also ask them to refer you to a local symptom control team to give you support at home.

How you might feel

When prostate cancer is advanced, it can no longer be cured. Finding out that cancer can’t be cured can be a big shock. It might help to talk to a close friend or relative about how you feel. Your specialist nurse can also offer support and talk to you about what is available for you.