Advanced prostate cancer treatment

If prostate cancer has spread (metastasised) to other parts of the body, you may have a combination of drug therapies, EBRT, ADT or chemotherapy. Treatment may also include surgery and bone therapies.

Androgen deprivation therapy (ADT)

Androgen deprivation therapy (ADT) is usually one of the main treatment options for advanced (metastatic) prostate cancer. It is used to slow the growth of prostate cancer. It can be done with injections, tablets or surgery. Additional hormone therapy, newer drug therapy or targeted therapy is often combined with ADT. 

Drug therapies

Newer drug therapies may be used to treat advanced prostate cancer that has come back while having ADT. These drugs are often hormone therapy tablets that can be combined with ADT to help control the cancer and reduce symptoms. They are usually taken daily.

These new drugs are usually available for advanced prostate cancer through the PBS. Treatment usually aims to relieve symptoms or keep the cancer under control for years.

Hormone-sensitive prostate cancer may be treated with ADT alongside the treatments discussed below. Drug therapies, chemotherapy and hormone therapies used together is called triple therapy.

Other drug therapies include drugs that target specific features of cancer cells, called targeted therapy. These drugs (e.g. olaparib) are used for cancer with gene changes (such as BRCA) linked to prostate cancer.

Learn more at Targeted therapy and listen to Cancer Council's podcast episode New Cancer Treatments.

Radiation therapy

You may be offered radiation therapy to slow the growth of the cancer. Radiation therapy may be given to the areas where the cancer has spread, such as the lymph nodes or bones (see Bone therapies). You may also have radiation therapy to the prostate if you have not previously had any radiation treatment.

Chemotherapy

Chemotherapy uses drugs to kill cancer cells or slow their growth. If the prostate cancer continues to spread despite using ADT and other drug therapies, chemotherapy may be suitable. Chemotherapy may also be offered as part of initial treatment in combination with ADT.

Generally, chemotherapy is given through a drip (infusion) into a vein (intravenously). For prostate cancer, chemotherapy is usually given once every 3 weeks for 4–6 months and you do not stay in hospital.

Side effects of chemotherapy may include fatigue, hair loss, changes in blood counts increasing the risk of bleeding or infections, numbness or tingling in the hands or feet (peripheral neuropathy), changes in nails, watery eyes and runny nose, and rare side effects, such as allergic reactions or blocked tear ducts.

Transurethral resection of the prostate (TURP)

This surgical procedure is used to treat problems passing urine. It helps with symptoms of more advanced prostate cancer, such as the need to pass urine more often and a slow flow of urine.

If you have localised cancer, TURP may be used before radiation therapy to relieve symptoms of urinary blockage. TURP is also used to treat benign prostate hyperplasia.

You will be given a general or spinal anaesthetic. A narrow tube-like instrument is passed through the opening of the penis and up the urethra to remove the blockage. The surgery takes about an hour, and you will usually stay in hospital for a couple of days. Side effects may include blood in urine or problems urinating for a few days.

Bone therapies

If the prostate cancer has spread to the bones (bone metastases), your doctor may suggest treatments to manage the effect on the bones. Drugs can be used to prevent or minimise bone pain and reduce the risk of fractures and pressure on the spinal cord.

Radiation therapy can also be used to control bone pain, to prevent fractures or help them heal, and to treat pressure on spinal nerves (spinal cord compression) from cancer that has spread to the spine.

Palliative treatment

Palliative treatment helps to improve quality of life by managing the symptoms of prostate cancer. Treatment may include radiation or radionuclide therapy, which involves swallowing or being injected with radioactive material.

Palliative treatment helps to improve quality of life by managing the symptoms of cancer without trying to cure the disease. It is about living for as long as possible in the most satisfying way you can.

As well as slowing the spread of cancer, palliative treatment can relieve pain and help manage other symptoms.

Treatment may include:

• radiation therapy to control pain if the cancer has spread to the bones
• pain medicines (analgesics)
• radionuclide therapy to control pain and improve quality of life. This involves swallowing or being injected with radioactive material which spreads through the body and targets cancer cells. The high doses of radiation kill cancer cells with little damage to normal tissues.

Palliative treatment is part of palliative care, in which a team of health professionals aims to meet your physical, emotional, practical, cultural, social and spiritual needs. They also support families and carers.

To learn more, see Living with advanced cancer, Palliative care or Pain and cancer. For more information or support, call Cancer Connect on 13 11 20.