Prostate cancer cells sometimes break away from the prostate gland and spread to other parts of the body, including the bones and lymph nodes. This is called advanced (metastatic) prostate cancer. There are no cures for metastatic prostate cancer, but treatments can slow the cancer’s growth, prolong life and improve symptoms. These include hormone therapy, radiation, chemotherapy and immunotherapy.
A new type of treatment that boosts your own immune system to fight the cancer is also available at MSK. Called sipuleucel-T, or Provenge, it uses your own immune cells to target and kill cancer cells that have spread from the prostate to other parts of the body.
Symptoms of metastatic prostate cancer depend on where the cancer has spread and how much it has grown. You may have pain or problems passing urine, blood in the urine or muscle weakness. X-rays, CT scans and MRI scans can help diagnose the extent of the tumor. Bone scans can show if the cancer has spread to the bones. A bone scan is an imaging test that measures the amount of radioactive material in your bones and provides information about whether there is cancer there.
When the cancer has only spread slightly outside the prostate, it may be treated with local treatments, which remove or destroy only the area of the tumor and nearby tissue. These may include surgery and radiation. They may also be combined with drugs that reduce the levels of male sex hormones, which fuel prostate cancer cells. Hormone therapy, which lowers androgens, is usually given along with other therapies to control the disease for as long as possible. Its side effects can include hot flashes, changes in sex drive and erectile dysfunction, and heart problems with long-term use. A drug called abiraterone can help prevent the loss of bone density and muscle mass that often happens with hormone therapy.
If the cancer has spread widely beyond the prostate, other treatments are needed to control it as best as possible. These are called systemic therapies. They are given by mouth or intravenously and travel through the bloodstream to attack cancer cells throughout the body. There are many systemic therapies for prostate cancer, and several that work well became available recently, including some at MSK.
Your doctor will discuss your options and the risks and benefits of each. Talk with your doctors about the goals of each treatment, its chances of working and its effect on urinary, bowel and sexual function. This type of discussion is called shared decision-making. It is important to understand how the different choices might affect recurrence, survival and quality of life. This can help you and your doctor decide on the right treatment for you. You should also ask your doctor about participating in clinical trials. This is the fastest way to get access to new and promising treatments for your cancer. It is also a good idea to talk to other people with metastatic prostate cancer and their families to learn what treatments worked for them.