Stage 4 prostate cancer treatment

Treatment for stage 4 prostate cancer often involves hormone therapy. Find out how this and other treatments are used in men with advanced prostate cancer.

By Mayo Clinic Staff

Stage 4 prostate cancer treatment often involves hormone therapy. Other treatments may include radiation therapy and surgery, depending on your particular situation.

Treatments may slow or shrink an advanced prostate cancer, but for most men, stage 4 prostate cancer isn't curable. Still, treatments can extend your life and reduce the signs and symptoms of cancer.

Here's a look at the treatment options for men with stage 4 prostate cancer.

Hormone therapy

Hormone therapy is treatment to stop your body from producing the male hormone testosterone or to block the effects of testosterone on the cancer. Prostate cancer cells rely on testosterone to help them grow. Cutting off the supply of hormones may cause the cancer to shrink or to slow its growth.

In men with stage 4 prostate cancer, hormone therapy is most often used alone, but it may be used after radiation therapy or, rarely, surgery. Hormone therapy may be continued for as long as the treatment continues to work.

Hormone therapy options include:

  • Medications that stop your body from producing testosterone. Medications known as luteinizing hormone-releasing hormone (LH-RH) agonists and antagonists prevent the testicles from receiving messages to make testosterone. Drugs typically used in this type of hormone therapy include leuprolide (Lupron, Eligard), goserelin (Zoladex), triptorelin (Trelstar), histrelin (Vantas) and degarelix (Firmagon).
  • Surgery to remove the testicles (orchiectomy). Removing your testicles reduces testosterone levels in your body. The effectiveness of orchiectomy in lowering testosterone levels is similar to that of hormone therapy medications, but orchiectomy may lower testosterone levels more quickly.
  • Medications that block testosterone from reaching cancer cells. Medications known as anti-androgens prevent testosterone from reaching your cancer cells. Examples include bicalutamide (Casodex), enzalutamide (Xtandi), flutamide and nilutamide (Nilandron). These drugs may be given along with an LH-RH agonist or given before taking an LH-RH agonist.

    Enzalutamide (Xtandi) works differently from other anti-androgen drugs and may be an option if other hormone therapy treatments are no longer effective.

  • Other medications. Other medications that work differently from other hormone therapies to control testosterone in the body may be options when other treatments are no longer effective. Examples include abiraterone (Zytiga) and the antifungal medication ketoconazole.

    The female hormone estrogen also can help control prostate cancer. This older treatment is used less often due to side effects.

Side effects of hormone therapy may include erectile dysfunction, hot flashes, loss of bone mass, reduced sex drive, breast enlargement and weight gain.

Most advanced prostate cancers will eventually adapt to hormone therapy and begin growing despite treatment (castration-resistant prostate cancer). When that occurs, your doctor may recommend switching to a different combination of hormone therapy drugs to see if your cancer responds.


In certain situations, your doctor may recommend surgery. In men with stage 4 prostate cancer, surgery is generally limited to men who are experiencing signs and symptoms that would be relieved by surgery, such as difficulty passing urine.

Surgery may include:

  • Radical prostatectomy. Your doctor may recommend surgery to remove your prostate and any cancer that has grown locally beyond the prostate. Surgery may be an option if your prostate cancer is locally advanced and hasn't spread to other areas of the body.
  • Lymph node removal. Your doctor may recommend removal of several lymph nodes near your prostate (pelvic lymph node dissection) to test for cancer cells.

Surgery can cause infection, bleeding, incontinence, erectile dysfunction and damage to the rectum. Surgery to remove the prostate in men who have locally advanced prostate cancer may be more likely to cause complications.

May. 20, 2014 See more In-depth