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 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.
Radiation therapy uses high-powered beams of energy, such as X-rays, to kill cancer cells. Radiation therapy for stage 4 prostate cancer uses a large machine that moves around your body, directing energy beams to the area around the cancer (external beam radiation therapy).
In men with very large prostate tumors or cancer that has spread to nearby lymph nodes (locally advanced prostate cancer), radiation therapy may be combined with hormone therapy. Or it may be used after surgery to kill any cancer cells that might remain.
In men with cancer that has spread to other areas of the body, radiation therapy is used to relieve pain or other symptoms.
If your cancer has spread beyond your prostate to other areas of your body, your doctor may recommend:
- Chemotherapy. Chemotherapy can slow the growth of cancer cells, relieve signs and symptoms of cancer, and prolong the lives of men with advanced prostate cancer.
- Training your immune system to recognize cancer cells. Immunotherapy uses your immune system to kill cancer cells. Sipuleucel-T (Provenge), a form of immunotherapy, has been developed to genetically engineer your immune cells to fight prostate cancer.
- Bone-building medications. Medications used to treat thinning bones (osteoporosis) may be helpful in preventing broken bones in men with prostate cancer that has spread to the bones.
- Infusions of a radioactive drug. Men with prostate cancer that has spread to the bones may consider treatment that infuses a radioactive substance into a vein. Strontium-89 (Metastron), samarium-153 (Quadramet) and radium-223 (Xofigo) are medications that target fast-growing cancer cells in the bones and may help relieve bone pain.
- Radiation therapy. External beam radiation therapy may help control bone pain in men with prostate cancer that has spread to the bones.
- Pain medications and treatments. Medications and treatments are available if you experience cancer pain. Which pain treatments are right for you will depend on your particular situation and your preferences.
May 20, 2014
- Niederhuber JE, et al., eds. Abeloff's Clinical Oncology. 5th ed. Philadelphia, Pa.: Churchill Livingstone Elsevier; 2014. http://www.clinicalkey.com. Accessed March 17, 2014.
- Prostate cancer. Fort Washington, Pa.: National Comprehensive Cancer Network. http://www.nccn.org/professionals/physician_gls/f_guidelines.asp. Accessed March 17, 2014.
- Wein AJ, et al. Campbell-Walsh Urology. 10th ed. Philadelphia, Pa.: Saunders Elsevier; 2012. http://wwwclinicalkey.com. Accessed March 17, 2014.
- Dawson NA. Overview of the treatment of disseminated prostate cancer. http://www.uptodate.com/home. Accessed March 17, 2014.
- Zytiga (prescribing information). Horsham, Pa.: Janssen Biotech Inc.; 2013. http://www.zytiga.com. Accessed March 17, 2014.
- Xtandi (prescribing information). Northbrook, Ill.: Astellas Pharma US Inc.; 2013. http://www.xtandi.com. Accessed March 17, 2014.
- Xofigo (prescribing information). Wayne, N.J.: Bayer HealthCare Pharmaceuticals Inc.; 2013. http://www.xofigo.com. Accessed March 17, 2014.
- Castle EP (expert opinion). Mayo Clinic, Phoenix/Scottsdale, Ariz. April 6, 2014.
- Moynihan TJ (expert opinion). Mayo Clinic, Rochester, Minn. April 17, 2014.