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Prostate cancer

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Treatment of stage IV prostate cancer

The following are treatment options for stage IV prostate cancer. The types of treatments given are based on the unique needs of the person with cancer.

Hormonal therapy

Hormonal therapy is the primary treatment for stage IV prostate cancer. Up to 85% of men with advanced prostate cancer will respond to hormonal therapy.

The types of hormonal therapy are:

  • luteinizing hormone-releasing hormone (LHRH) agonists
    • leuprolide (Lupron, Lupron Depot, Eligard)
    • goserelin (Zoladex)
    • buserelin (Suprefact)
    • triptorelin (Trelstar)
  • LHRH antagonist
    • degarelix (Firmagon)
  • anti-androgens
    • flutamide (Euflex)
    • bicalutamide (Casodex)
    • nilutamide (Anandron)
    • abiraterone acetate (Zytiga)
    • enzalutamide (Xtandi)
  • surgical removal of the testicles (orchiectomy)

Radiation therapy

Radiation therapy may be offered for stage IV prostate cancer:

  • to relieve the urinary symptoms caused by the prostate tumour
  • to relieve pain in areas where the prostate cancer has spread to the bone (bone metastases)

External beam radiation therapy is not given for 4–6 weeks after a transurethral resection of the prostate (TURP), to reduce the risk of scarring in the urethra (urethral stricture).

Surgery

TURP may be offered for stage IV prostate cancer. This surgery relieves the urinary symptoms caused by the prostate tumour.

Biological therapy

Biological therapy may be offered for stage IV prostate cancer. The type of biological therapy that may be given to men with stage IV prostate cancer is denosumab (Xgeva).

Denosumab may be used:

  • to help prevent bone fractures in men with cancer that has spread to the bones
  • to help prevent spread of cancer to the bones in men who have rising PSA levels but no signs that cancer has spread to the bones

Bisphosphonates

Bisphosphonates can be used for prostate cancer that has spread to the bone to relieve bone pain or prevent fractures in men with advanced castrate-resistant prostate cancer. The bisphosphonate used is zoledronic acid (Zometa).

Clinical trials

Men with prostate cancer may be offered the opportunity to participate in clinical trials. For more information, go to clinical trials.

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