Advanced prostate cancer

Advanced prostate cancer is when the cancer has spread outside the prostate.

If the cancer has only spread to the nearby lymph nodes in the pelvis, you may have a combination of external beam radiation therapy (EBRT) and androgen deprivation therapy (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.

Learn more about:

• Chemotherapy
• Other drug therapies
• Radiation therapy
• Transurethral resection of the prostate (TURP)
• Bone therapies
• Palliative treatment

Chemotherapy

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.

For more on this, see Chemotherapy.

Other drug therapies

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.

For more on this, see Targeted therapy and listen to our podcast on 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 sites 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 treatment.

Transurethral resection of the prostate (TURP)

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.

Bone therapies

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).

→ READ MORE: Palliative treatment for prostate cancer

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