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Advanced prostate cancer treatment

If prostate cancer is in nearby tissues or organs (locally advanced) or has spread (metastasised) to other parts of the body, treatment will aim to relieve symptoms or keep the cancer under control for years. Androgen deprivation therapy (ADT) is the main treatment. Other treatments include:

Chemotherapy uses drugs to kill cancer cells or slow their growth. If the prostate cancer continues to spread despite using ADT, 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). It is usually given once every three weeks and you do not need to stay overnight 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; and rare side effects, such as allergic reactions or blocked tear ducts.

Download our booklet ‘Understanding Chemotherapy’ 

Newer drug therapies may be used to treat advanced prostate cancer that has stopped responding to ADT. These drugs (e.g. abiraterone, enzalutamide, apalutamide) are hormone therapy tablets that can be combined with ADT to help prolong life and reduce symptoms. They are usually taken daily. Other drug therapies include drugs that affect specific molecules within cells to block cell growth. These are known as targeted therapy. Clinical trials are testing whether targeted therapy drugs will benefit people with genetic mutations.

Download our fact sheet ‘Understanding Targeted Therapy’

Radiation to the prostate may be recommended to slow the growth of the cancer. In some cases, radiation therapy is given to the sites where the cancer has spread, such as the bones or lymph nodes.

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This surgical procedure is used to relieve blockages in the urinary tract. 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 thin 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.

If the prostate cancer has spread to the bones, your doctor may suggest treatments to manage the effect of the cancer 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 cancer in the spine that is causing pressure on spinal nerves (spinal cord compression).

Palliative treatment helps to improve quality of life by managing cancer symptoms without trying to cure the disease, and is best thought of as supportive care.

You may think that palliative treatment is only for people at the end of their life; however, it can help at any stage of advanced cancer. 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 for bone pain if the cancer has spread to the bones (bone metastases). Pain-relieving medicines (analgesics) are also often used. Radionuclide therapies (e.g. samarium, radium, strontium) are also being used to control pain and improve quality of life. A type of radiopeptide therapy known as lutetium is being tested in clinical trials.

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

Download our booklet ‘Understanding Palliative Care’

Download our booklet ‘Living with Advanced Cancer’

This information is reviewed by

This information was last reviewed in March 2020 by the following expert content reviewers: Dr Amy Hayden, Radiation Oncologist, Westmead and Blacktown Hospitals, and Chair, Faculty of Radiation Genito-Urinary Group (FROGG), The Royal Australian and New Zealand College of Radiologists, NSW; Prof Shomik Sengupta, Professor of Surgery and Deputy Head, Eastern Health Clinical School, Monash University, and Visiting Urologist and Uro-Oncology Lead, Urology Department, Eastern Health, VIC; A/Prof Arun Azad, Medical Oncologist, Urological and Prostate Cancers, Peter MacCallum Cancer Centre, VIC; Ken Bezant, Consumer; Dr Marcus Dreosti, Radiation Oncologist, GenesisCare, and Clinical Strategy Lead, Oncology Australia, SA; A/Prof Nat Lenzo, Nuclear Physician, Specialist in Internal Medicine, Group Clinical Director, GenesisCare Theranostics and The University of Western Australia, WA; Jessica Medd, Senior Clinical Psychologist, Department of Urology, Concord Repatriation General Hospital, and HeadwayHealth Clinical and Consulting Psychology Services, NSW; Caitriona Nienaber, 13 11 20 Consultant, Cancer Council Western Australia; Graham Rees, Consumer; Kerry Santoro, Prostate Cancer Specialist Nurse, Southern Adelaide Local Health Network, SA; A/Prof David Smith, Senior Research Fellow, Cancer Research Division, Cancer Council NSW; Matthew Starr, Consumer.