Prostate cancer

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Treatments for castrate-resistant prostate cancer

Sometimes hormonal therapy stops working against prostate cancer. When cancer comes back or doesn’t go away after hormonal therapy, it is called castrate-resistant (hormone-refractory) prostate cancer. Your doctor will know that you have castrate-resistant prostate cancer if a blood test shows that your prostate-specific antigen (PSA) level is rising and your testosterone level is low.

The following are treatment options for castrate-resistant prostate cancer. Your healthcare team will suggest treatments based on your needs and work with you to develop a treatment plan.

Hormonal therapy

Some type of hormonal therapy is usually continued if the PSA level is rising but there are no other signs of prostate cancer.

Adding an anti-androgen

A luteinizing hormone–releasing hormone (LHRH) agonist or an LHRH antagonist is usually given as the first hormonal therapy to treat prostate cancer. Some men may also choose to have their testicles removed (called an orchiectomy) as hormonal therapy for prostate cancer. If the cancer comes back or doesn’t go away after these hormonal therapies, you may be offered an anti-androgen drug. You will continue to take an LHRH agonist or antagonist while you are taking an anti-androgen.

Men who have castrate-resistant prostate cancer with a high risk of the cancer spreading may be offered apalutamide (Erleada).

Stopping an anti-androgen

If you are already taking an anti-androgen, sometimes the prostate cancer will stop growing for a while if you stop the anti-androgen therapy.


Some men may be offered estrogens for castrate-resistant prostate cancer when other hormonal therapies stop working. But this treatment isn’t used very often.


Chemotherapy may be used to treat castrate-resistant prostate cancer that is causing symptoms. The chemotherapy drugs most commonly used are docetaxel (Taxotere) with prednisone. But if docetaxel and prednisone are no longer working, you may be given cabazitaxel (Jevtana) or mitoxantrone.

Radiation therapy

Radiation therapy may be offered for castrate-resistant prostate cancer.

External beam radiation therapy may be offered to relieve pain from bone metastases.

Systemic radiation therapy with radium-223 (Xofigo) is injected into the bloodstream. The radiation travels through the blood to where the cancer has spread. It gives off radiation, which kills the cancer cells. Radium-223 may be offered to men who have castrate-resistant prostate cancer that has spread to the bones.

Treatments for bone metastases

When prostate cancer spreads to other parts of the body, it most often spreads to bones. The most common treatments for castrate-resistant prostate cancer that has spread to the bones are:

  • bisphosphonates
  • denosumab (Xgeva) – a type of monoclonal antibody therapy
  • external beam radiation therapy
  • systemic radiation therapy with radium-223

Find out more about bone metastases, including treatments and supportive therapies.


A transurethral resection of the prostate (TURP) removes part of the prostate through the urethra. It is used to relieve urinary problems caused by an enlarged prostate pressing on the urethra.


Corticosteroids are steroid hormones that act as an anti-inflammatory by reducing swelling and lowering the body’s immune response (the immune system’s reaction to the presence of foreign substances). Corticosteroids are sometimes given with chemotherapy to help chemotherapy work better and to lessen the side effects of chemotherapy. Corticosteroids may also be used alone if a person is too sick to have chemotherapy. They can help slow the growth of prostate cancer cells and relieve symptoms such as pain.

Prednisone and dexamethasone (Decadron, Dexasone) are the corticosteroids most often used to treat prostate cancer.

If you can’t have or don’t want cancer treatment

You may want to consider a type of care to make you feel better without treating the cancer itself. This may be because the cancer treatments don’t work anymore, they’re not likely to improve your condition or they may cause side effects that are hard to cope with. There may also be other reasons why you can’t have or don’t want cancer treatment.

Talk to your healthcare team. They can help you choose care and treatment for advanced cancer.

Clinical trials

Many clinical trials in Canada are open to men with prostate cancer. Clinical trials look at new ways to prevent, find and treat cancer. Find out more about clinical trials.

luteinizing hormone–releasing hormone (LHRH)

A hormone that controls the production of sex hormones in males and females.

The hypothalamus produces luteinizing hormone–releasing hormone (LHRH), which stimulates the pituitary gland to produce luteinizing hormone (LH). In turn, LH stimulates the testicles to produce testosterone and the ovaries to produce estrogen and progesterone.

Also called gonadotropin-releasing hormone.

monoclonal antibody therapy

Treatment that uses monoclonal antibodies to detect and treat cancer.

Monoclonal antibodies are substances produced in the lab that can find and bind to a particular target molecule (antigen) on a cancer cell. They can be used alone, or they can be used to deliver drugs, toxins or radioactive material directly to a tumour.