Because male hormones, such as testosterone (a type of androgen), help prostate cancer grow, this type of therapy works to lower those hormone levels. ADT is used to treat prostate cancer that has returned after surgery and radiation therapy or cancer that has spread to other parts of the body. However, ADT eventually stops controlling the cancer. Non-surgical ADT therapies are either injected or taken by mouth.
Surgical castration is an operation that removes both testicles. It is considered a hormone therapy because it’s removing the main source of testosterone production. When the testicles are removed, the cancer tends to stop growing or shrinks for a period of time. It’s a permanent procedure, and can’t be reversed, but also tends to be one of the less expensive androgen-reducing treatment options.
Prostatectomy is a different surgical procedure that removes all or part of the prostate and seminal vesicles. Sometimes cancer begins in, or spreads to, the lymph nodes. Lymph nodes exist in many places in the body and may need to be removed from the pelvic area during a prostatectomy. The goal is to reduce the risk of the cancer from spreading to other parts of the body. This procedure may cause sexual problems, because nerves can be damaged during the process. Difficulty controlling the passage of your urine may also occur. Some of these symptoms may resolve with time. Medications and other solutions may also be considered to resume normal sexual and bladder function.
Second-generation hormone therapy works to reduce the effects of androgen when your regular anti-androgen therapies have stopped working. This type of therapy can block an enzyme that stops the testicles and other parts of the body from making testosterone. It can also interfere with androgen receptors that receive and transmit signals, which may reduce tumor growth. Second-generation hormone therapy is taken by mouth.
Radiopharmaceuticals are used to treat the cancer that has spread to the bone. After being injected into a vein (intravenously or IV), the medicine travels throughout the body, and mainly settles in areas of bone that have been affected by cancer. Unlike external beam radiation therapy (EBRT), a type of radiation that focuses on one area at a time, this treatment can treat many bones affected by cancer at the same time.
There are two different types of radiopharmaceuticals used in treating prostate cancer—alpha-emitting and beta-emitting. Alpha-emitters are much more powerful in killing cancer cells than beta-emitters. Alpha-emitters have a short-range of radiation that focuses on killing cancer cells to reduce the size of tumors. Because of their short range, they limit damage to nearby healthy cells. Beta-emitters have a longer range of radiation that may hurt nearby healthy cells.
Chemotherapy may be used when prostate cancer has spread outside of the prostate gland and hormone therapy isn’t working. Its goal is to destroy cancer cells by stopping them from growing or dividing into more cancer cells. Because chemotherapy targets cells that divide quickly, it can affect fast-growing cells in the:
Chemotherapy is injected into a vein intravenously or taken by mouth. It’s delivered through the bloodstream to reach cancer cells all over the body. This type of treatment can lead to many different side effects.
Immunotherapy uses a person’s own immune system to fight cancer. The immune system is made up of cells like the ones in your blood. The immune system cells travel through your body to protect it from germs that cause infections. These cells can be used to fight and kill cancer cells.
Radiation uses x-ray beams or small radioactive pellets also known as “seeds” placed (implanted) inside the prostate. These kill cancer cells by destroying the part responsible for controlling how cells grow and divide.
Radiation therapy can be used to:
External beam radiation therapy (EBRT), a type of radiation, provides relief from the most painful symptoms of bone metastases.
Cancer can break down the bone. That’s why there are treatments specifically designed to help manage the effects on the bone in people with advanced prostate cancer.
Bisphosphonates are used to protect the bone from these damaging effects by stopping or slowing down the cancer cells. Bisphosphonates may also increase bone mass density. This lowers the chance of a serious bone incident such as a fracture. Bisphosphonates are given through the vein intravenously (IV) or by injection under the skin (subcutaneously).
RANK ligand inhibitors also help prevent fractures by binding to the RANK ligand and blocking the activity of cells called osteoclasts, building up bone strength and density (thickness). Given subcutaneously (given under the skin—not in the vein), they help lessen the cancer's effects on the bone in patients with advanced prostate cancer.
Another type of supportive care are beta-emitting radiopharmaceuticals. Please refer to section Radiopharmaceuticals for more details.
A PSA test is the most common way to determine a prostate cancer diagnosis. Many doctors and organizations recommend PSA screening for men as young as 40 years old who are at a higher risk.
If you have already been treated for prostate cancer, the PSA test may be used to determine if the prostate cancer has returned.
In advanced prostate cancer, studies have shown that PSA should not be used alone to determine long-term outcomes, like living longer. The PSA level also does not predict whether or not a man will have symptoms. Other factors should be considered before your doctor recommends a treatment approach.