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Advanced prostate cancer treatment
If the cancer has only spread to the nearby lymph nodes in the pelvis, you may have a combination of EBRT and ADT to try to remove the cancer.
If prostate cancer has spread (metastasised) to other parts of the body, treatment usually aims to relieve symptoms or keep the cancer under control for years. ADT is the main treatment. Other treatments are outlined below.
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). For prostate cancer, chemotherapy is usually given once every three weeks for 4–6 months 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; watery eyes and runny nose; and rare side effects, such as allergic reactions or blocked tear ducts.
Newer drug therapies may be used to treat advanced prostate cancer that has stopped responding to ADT. These drugs (e.g. abiraterone, enzalutamide, apalutamide, darolutamide) 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 target specific features of cancer cells. These are known as targeted therapy. Clinical trials are testing whether targeted therapy drugs will benefit people with gene changes linked to prostate cancer.
You may be offered radiation therapy to slow the growth of the cancer. Radiation therapy may be given to the sites where the cancer has spread, such as the lymph nodes or bones. You may also have radiation therapy to the prostate if you have not previously had any treatment.
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 (bone metastases), 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 people’s quality of life by managing the symptoms of cancer without trying to cure the disease. You might think that palliative treatment is only for people at the end of their life, but it may 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 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 (e.g. samarium, radium, strontium) which spreads through the body and targets cancer cells. It delivers high doses of radiation to kill cancer cells with minimal damage to normal tissues.
Palliative treatment is one aspect of palliative care, in which a team of health professionals aims to meet your physical, emotional, practical, cultural, social and spiritual needs. The team also provides support to families and carers.
Clinical trials are testing new treatments for people with prostate cancer that has come back or not responded to treatment. These include a type of radiation therapy called focal brachytherapy and a type of radionuclide therapy known as lutetium PSMA, as well as new drugs. Ask your doctor about recent developments and whether a clinical trial may be an option for you.
This information is reviewed by
This information was last reviewed in March 2022 by the following expert content reviewers: A/Prof Ian Vela, Urologic Oncologist, Princess Alexandra Hospital, Queensland University of Technology, and Urocology, QLD; A/Prof Arun Azad, Medical Oncologist, Urological Cancers, Peter MacCallum Cancer Centre, VIC; A/Prof Nicholas Brook, Consultant Urological Surgeon, Royal Adelaide Hospital and A/Prof Surgery, The University of Adelaide, SA; Peter Greaves, Consumer; Graham Henry, Consumer; Clin Prof Nat Lenzo, Nuclear Physician and Specialist in Internal Medicine, Group Clinical Director, GenesisCare Theranostics, and Notre Dame University Australia, WA; Henry McGregor, Men’s Health Physiotherapist, Adelaide Men’s Health Physio, SA; Jessica Medd, Senior Clinical Psychologist, Department of Urology, Concord Repatriation General Hospital, NSW; Dr Tom Shakespeare, Director, Radiation Oncology, Coffs Harbour, Port Macquarie and Lismore Public Hospitals, NSW; A/Prof David Smith, Senior Research Fellow, Daffodil Centre, Cancer Council NSW; Allison Turner, Prostate Cancer Specialist Nurse (PCFA), Canberra Region Cancer Centre, Canberra Hospital, ACT; Maria Veale, 13 11 20 Consultant, Cancer Council QLD; Michael Walkden, Consumer; Prof Scott Williams, Radiation Oncology Lead, Urology Tumour Stream, Peter MacCallum Cancer Centre, and Professor of Oncology, Sir Peter MacCallum Department of Oncology, The University of Melbourne, VIC.