A diagnosis of locally advanced or metastatic prostate cancer can be tough to hear.

Advanced prostate cancer is harder to treat than early prostate cancer (cancer that has not spread beyond the prostate). Metastatic prostate cancer (cancer that has spread to lymph nodes and distant organs) and most cases of locally advanced prostate cancer (cancer that has spread to tissues just outside the prostate) cannot be cured. Instead, treatment aims to prolong survival, delay the cancer's progression, relieve symptoms, and improve quality of life.

The good news is that there are treatment options still available, including medication, radiation, and surgery. The treatment chosen depends on many factors:

  • previous treatments you have received
  • where the cancer has recurred
  • whether you have other conditions such as heart disease or diabetes
  • individual considerations

Available treatment options include hormone therapy, radiation therapy, chemotherapy, and surgery.

Hormone therapy

Hormone therapy is used to treat metastatic prostate cancer and some cases of locally advanced prostate cancer. It is used to prolong life, relieve symptoms, delay cancer progression, and improve quality of life. With hormone therapy, medications or surgery are used to reduce the levels of androgens (male hormones such as testosterone), so they cannot cause the tumour to grow. This may be done through surgery to remove the testicles (which produce androgens) or by using medications.

Hormone therapy medications may be given through subcutaneous injection (injection under the skin), subcutaneous depot (a tiny long-acting implant inserted under the skin), intramuscular injection (injection into a muscle), intramuscular depot (long-acting injection into a muscle), orally (by mouth; e.g., tablets), or nasally (into the nose).

Hormone therapy medications include:

  • luteinizing hormone-releasing hormone (LHRH) analogues (which work by blocking androgen production):
    • buserelin nasal (Suprefact®) and subcutaneous (Suprefact®, Suprefact Depot®)
      • usual dose (nasal): two pumps in each nostril three times a day
      • usual dose (subcutaneous): one injection once daily
      • usual dose (subcutaneous depot): one implant every 2 or 3 months
    • goserelin subcutaneous (Zoladex®, Zoladex-LA®)
      • usual dose: one implant (given by subcutaneous injection) every 1 or 3 month
    • leuprolide intramuscular (Lupron®, Lupron Depot®)
      • usual dose (intramuscular): one injection once daily
      • usual dose (intramuscular depot): one injection every 1, 3, or 4 months
    • leuprolide gel subcutaneous (Eligard®)
      • usual dose: one injection every 1, 3, 4, or 6 months
    • triptorelin intramuscular (Trelstar®)
      • usual dose: one injection every 1 or 3 months
  • nonsteroidal anti-androgens (which work by blocking the effects of androgens on the prostate; they are used in combination with LHRH analogues or surgery):
    • bicalutamide tablets (Casodex®, generics)
      • usual dose: 50 mg once daily
    • cyproterone tablets (Androcur®, generics) and intramuscular (Androcur Depot®)
      • usual dose (tablets): 100 mg to 300 mg divided into two or three doses per day
      • usual dose (intramuscular): 300 mg once every one or two weeks
    • flutamide tablets (Euflex®, generics)
      • usual dose: 250 mg three times a day
    • nilutamide tablets (Anandron®)
      • usual dose: 150 mg once daily

Radiation therapy

Radiation therapy uses radiation (a type of energy) to kill cancer cells. It can be given by:

  • external beam
  • brachytherapy (radioactive seed implants inserted through surgery)

For locally advanced prostate cancer, radiation is often used in combination with hormone therapy to slow the spread of the cancer, prolong life, and relieve symptoms. For metastatic prostate cancer, it is used to relieve symptoms and control the spread of the cancer.

Chemotherapy

Chemotherapy uses medications (usually in combinations called regimens) to kill cancer cells. Chemotherapy is used when advanced prostate cancer stops responding to hormone therapy or when prostate cancer returns. Chemotherapy may be used to prolong life, improve quality of life, and relieve side effects caused by the cancer's spread.

Chemotherapy medications often used to treat advanced prostate cancer include:

  • docetaxel (Taxotere®) - used in combination with prednisone or prednisolone
    • usual dose: one infusion (a slow injection into a vein) every 3 weeks
  • mitoxantrone (generics) - used in combination with prednisone
    • usual dose: one infusion (a slow injection into a vein) every 3 weeks

Chemotherapy medications are usually continued until the cancer progresses or until a maximum dose (determined by the doctor based on your body size) has been reached.

Surgery

For locally advanced prostate cancer, a transurethral resection of the prostate (also called TURP, a surgery where excess prostate tissue is removed) can help relieve symptoms. In some cases, a radical prostatectomy (a surgery that removes the entire prostate) can even provide a cure.

For metastatic prostate cancer, surgery is used to relieve symptoms of the cancer's spread (e.g., a tumour that is blocking urination) and make a person more comfortable.

Working with your doctor

There are a variety of options for treating advanced prostate cancer. To find the option that's right for you, discuss your treatment options with your doctor. Though all treatments have side effects, it's important to realize that side effects may be preventable, manageable, or reversible. Speak with your doctor about the risks and benefits of each treatment and how you will feel as you receive treatment.