Prostate cancer

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Treatments for metastatic prostate cancer

Metastatic prostate cancer includes stage 4 and recurrent disease when the cancer has spread beyond the tissues surrounding the prostate to other parts of the body. The following are treatment options for metastatic prostate cancer. Your healthcare team will suggest treatments based on your needs and work with you to develop a treatment plan.

Hormonal therapy

Hormonal therapy is the main treatment for metastatic prostate cancer. It may be given along with radiation therapy or chemotherapy.

The types of hormonal therapy used are:

Radiation therapy

Radiation therapy may be offered for metastatic prostate cancer.

External beam radiation therapy is the type of radiation therapy most often used. It is often given together with hormonal therapy. External beam radiation therapy may be used:

  • as the main treatment to destroy cancer cells
  • to relieve urinary problems caused by the tumour
  • to relieve pain where the cancer has spread to the bones (called bone metastases)

Systemic radiation therapy with radium-223 (Xofigo) may be offered to men who have castrate-resistant prostate cancer that has spread to the bones. Castrate-resistant prostate cancer means that it comes back or doesn’t go away after treatment with hormonal therapy.


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


Chemotherapy may be offered for metastatic prostate cancer with or without hormonal therapy. Chemotherapy may be used when:

  • hormonal therapy is working (called castrate-sensitive prostate cancer)
  • hormonal therapy isn’t working (called castrate-resistant prostate cancer)

Docetaxel (Taxotere) and prednisone are most often used to treat metastatic prostate cancer. These drugs can be used to treat men with either castrate-sensitive or castrate-resistant prostate cancer.

If docetaxel and prednisone are no longer working for castrate-resistant prostate cancer, you may be treated with cabazitaxel (Jevtana) or mitoxantrone.

Treatments for bone metastases

When prostate cancer spreads to other parts of the body, it most often spreads to the bones. The most common treatments for 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.

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) agonist

A drug that stimulates the pituitary gland to produce more luteinizing hormone (LH).

The pituitary gland produces luteinizing hormone (LH), which in turn stimulates the testicles to produce testosterone. A LHRH agonist causes the pituitary gland to overproduce LH until it eventually stops responding to the drug. When the pituitary gland stops producing LH, the testicles stop producing testosterone.

Also called LHRH agonist.

anti-androgen therapy

Treatment with drugs that stop the production or block the actions of androgens (male sex hormones).

Anti-androgen therapy may be used to treat prostate cancer.


A female sex hormone that causes the female sex characteristics to develop (such as breasts) and is necessary for reproduction.

Estrogen is made mainly by the ovaries. Small amounts of estrogen are also made in the adrenal glands. It may also be produced in the lab to treat certain conditions or as a type of birth control.

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.