Prostate Cancer, Advanced or Metastatic

Medicines may be used to slow the growth of prostate cancer and to relieve your symptoms.

Prostate cancer needs the male hormone Reference testosterone Opens New Window to grow. Hormone therapy uses special drugs to block the production or action of testosterone and may cause the cancer to shrink. This can improve your symptoms. Hormone therapy may be given before or after Reference radiation or Reference surgery to remove the prostate.

Reference Hormone therapy usually works well at first to stop cancer growth. But in most cases the cancer returns in a few years. At this point, the cancer is called hormone-resistant. This means it will no longer get better with hormone therapy. When this happens, other kinds of hormone treatment may work. If the cancer continues to grow, chemotherapy or immunotherapy may be the next choice.

Reference Chemotherapy Opens New Window is the use of drugs to control cancer's growth or relieve pain. Often the drugs are given through a needle in your vein, and your blood vessels carry the drugs through your body. Sometimes the drugs are available as pills you can swallow. Sometimes they are given through a shot, or injection.

Chemotherapy usually involves two or more drugs given together. Combinations may work better than a single medicine. That's because each drug can attack the cancer cells in a different way. This is most often used when prostate cancer is hormone-resistant.

Reference Immunotherapy Opens New Window is treatment that uses the body's Reference immune system Opens New Window to destroy the cancer cells. This is used for prostate cancer that is hormone-resistant.

Medicine Choices

Hormone therapy

• Reference LH-RH agonists/GnRH agonists, such as goserelin (Zoladex) and leuprolide (Lupron).
• GnRH antagonists, such as degarelix (Firmagon).
• Reference Antiandrogens, such as abiraterone (Zytiga), bicalutamide (Casodex), flutamide, and nilutamide (Nilandron).

Hormone therapy is commonly used with radiation therapy. It may be used alone with metastatic cancer.

Chemotherapy

• Cabazitaxel
• Reference Carboplatin
• Reference Cisplatin
• Reference Docetaxel
• Reference Etoposide
• Reference Mitoxantrone
• Reference PaclitaxelReference

Chemotherapy may be helpful when prostate cancer no longer responds to hormone therapy.

Immunotherapy

Vaccines such as sipuleucel-T (Provenge) use cells from a man's own body to stimulate his immune system. This can slow the growth of cancer cells.

Pain-relief and appetite-stimulant drugs

Pain-relief and appetite-stimulant drugs may be used when prostate cancer has spread to other parts of the body.

• Reference Steroids, such as hydrocortisone or prednisone, control pain and improve appetite.
• Radioactive drugs such as samarium-153 and strontium-89 are called radionuclides. They are absorbed near the area of bone pain. Then the radiation that is released helps relieve the pain caused by tumors that have spread to the bone.
• Denosumab (Xgeva) and Reference bisphosphonate drugs, such as pamidronate (Aredia) and zoledronic acid (Zometa), may help relieve bone pain and prevent Reference osteoporosis Opens New Window, which is sometimes caused by long-term hormone therapy.

Pain medicines are made that specifically treat mild, moderate, and severe pain, as well as different types of pain such as burning and tingling. To learn more, see:

Reference Reference Cancer: Controlling Cancer Pain.

For more information, see the topic Reference Cancer Pain.

Medicines for treating side effects

Hormone therapy can cause loss of sexual desire, Reference hot flashes Opens New Window, enlarged and painful breasts, and erection problems.

• For men who have erection problems after surgery, medicines such as sildenafil (Viagra), tadalafil (Cialis), or vardenafil (Levitra) may be helpful. Using medicines soon after surgery may help men regain sexual function. Talk with your doctor about your situation.
• Taking a temporary break from hormone therapy can make some side effects go away.
• To relieve breast pain, the anti-estrogen breast cancer medicine called Reference tamoxifen or radiation treatment is commonly used. Tamoxifen can also help reverse breast growth. Also, it causes hot flashes.
• For hot flashes, taking a certain kind of Reference antidepressant may help. Paroxetine or venlafaxine may help with hot flashes. But they have different side effects. So if you are having a problem with hot flashes, talk with your doctor.

What to think about

Antiandrogen hormone therapy also may cause diarrhea, breast tenderness, and nausea. Cases of liver problems, some serious, have been reported.

Hormone therapy can also affect the bones, making them thin and brittle and more likely to break. Medicines such as bisphosphonates and denosumab may help prevent bone loss during long-term hormone therapy.

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