Prostate Cancer: Your Treatment Options

When prostate cancer spreads to distant parts of your body—most likely the bones, but sometimes the lungs and liver—several questions may be top of mind. Things like, “What’s going to happen to me?” “Will I see my children grow up?” “Am I going to be in pain?”

You may even wonder if anything can be done for you. Happily, the answer is a resounding YES! Treatments for metastatic prostate cancer have come a long way and are getting better every day. That means you can expect fewer side effects and enjoy better results. The therapy you choose may even put you in remission, which means tumor cells cannot be detected on imaging tests.

And with many exciting new treatments currently in development, researchers hope to extend the lifespan of men with advanced prostate cancer further than ever.

So remember, life will go on—and to make the most of it, explore the following options with your healthcare team to come up with a personalized treatment approach that works for you.

Hormone therapy
The basics: Testosterone can fuel the growth of prostate cancers, so the goal of hormone therapy is to either shut down your body’s testosterone production or stop your tissues from using this hormone. Some testosterone-suppressing medications are taken as pills or implanted under the skin, but many are injected (anywhere from once monthly to once yearly). According to the American Cancer Society, prostate cancers often become resistant to these treatments if they’re exposed to them nonstop—so some doctors now recommend intermittent hormone therapy, instead.

It might be right for you if: Your cancer has metastasized. “Androgen deprivation [ADT] can take away pain, make tumors shrink and add years to a man’s life,” says Eric Klein, MD, chairman of Cleveland Clinic’s Glickman Urological and Kidney Institute.

What you should know: Hormone therapy has some significant side effects. “It can cause hot flashes, loss of libido, loss of muscle mass and other symptoms,” says Alvin Goh, MD, director of advanced laparoscopic and robotic urologic surgery at the Methodist Hospital Cancer Center in Houston. And long term, it can raise your risk of bone thinning and heart disease. Fortunately, many of these side effects can be treated, so don’t try to tough it out—report any symptoms to your doctor.

Radiation therapy
The basics: External beam radiation therapy (EBRT) involves destroying cancer cells by hitting them with high-energy radiation (such as X-rays or gamma rays). Beams of radiation are focused on the prostate gland from a machine outside the body. The treatments are painless and take only a few minutes each, but you may need up to five sessions per week over a period of seven to nine weeks to get the best benefit.

It might be right for you if: You are undergoing hormone therapy. Some doctors pair radiation with hormone therapy for better results.

What you should know: Fatigue, rectal burning and tenderness, and a frequent urge to urinate are common side effects, and they can last several months. The risk of incontinence is less with EBRT than with surgery, but the risk of erection problems is roughly the same. “I opted for a newer radiation treatment that uses gamma rays and requires only five 45-minute treatments,” says Warren Forman, 69, a New York attorney. “The toughest part was trying to stay awake during treatments so I could keep my body still—and the only side effect was the feeling that I had to go to the bathroom a lot during the first month.”

The basics: Chemotherapy drugs target and destroy cancer cells. Although they are usually injected into a vein, some can be taken in pill form. Once these drugs enter the bloodstream, they spread throughout the body and can destroy prostate cancer cells wherever they find them.

Oncologists—MDs who specialize in cancer care—give chemo in cycles, with each period of treatment followed by a period of rest so your body has time to recover. Each treatment-and-rest cycle typically lasts several weeks.

It might be right for you if: Your cancer has spread and hormone therapy has stopped working.

What you should know: Chemo can cause side effects, such as low white blood cell count (called neutropenia, which can lead to infection), anemia, low platelets, nausea and fatigue. Fortunately, many can be prevented or treated and most subside after treatment ends.