Localized prostate cancer

• In most cases, this cancer is slow-growing and does not affect your lifespan.
• In many cases, the primary treatment will get rid of the cancer.
• In some cases, the cancer can be aggressive, evolve more quickly and spread elsewhere in the body
• In some cases, the cancer recurs after the primary treatment and other treatments become necessary.

Locally advanced prostate cancer

• In many cases, the primary treatment aims to eliminate the cancer.
• Treatment may involve a combination of therapeutic approaches.
• In some cases, the cancer recurs after the primary treatment and other treatments become necessary.

Metastatic prostate cancer

• This cancer cannot be cured.
• Hormone therapy can be effective in keeping your cancer under control for many years.
• Depending on its spread in the body, dual or triple therapy may be considered (e.g., standard hormone therapy + chemotherapy + next-generation hormone therapy)
• Developing resistance to hormone therapy calls for further treatments, often in combination
• Treatments can also relieve pain and symptoms related to metastases

Stages 1 and 2

Localized prostate cancer

The cancer is confined to the prostate only. The important thing here is to determine the risk of cancer progression (see Prognosis and survival). When it comes to localized prostate cancer, your treatment options are:

•  
• Active surveillance
• Radical prostatectomy (surgery) with or without pelvic lymph node dissection
• Radiotherapy (external or brachytherapy) with or without short/medium/long-term hormone therapy

Stage 3

Locally advanced prostate cancer

The cancer has started to spread beyond the prostate but has not gone too far. When it comes to locally advanced prostate cancer, your treatment options are:

• Radical prostatectomy and pelvic lymph node dissection
• Radical prostatectomy with adjuvant pelvic radiotherapy (after surgery)
• External beam radiotherapy combined with hormone therapy
• External beam radiotherapy combined with brachytherapy
• Hormone therapy alone

Stage 4

Metastatic prostate cancer

The tumor has invaded neighboring organs, lymph nodes, or more distant parts of the body. When it comes to metastatic prostate cancer, your treatment options are:

• Hormone therapy +/-
• Next-generation hormone therapy
• Chemotherapy
• External beam radiotherapy to the prostate
• Other treatment combinations
• Surgery to relieve symptoms
• Treatment of bone metastases
• Clinical trials

Recurrent

With or without metastases

Recurrent cancer refers to cancer that returns after radical prostatectomy or radiotherapy. Recurrence can be biochemical only (increase in blood prostate-specific antigen (PSA) levels) or clinical (appearance of metastases on imaging). When it comes to recurrence, your treatment options are:

Without metastasis

• Surveillance only (if biochemical recurrence is slow-growing)
• Radiotherapy +/- Hormone therapy
• Post-radiotherapy brachytherapy
• Hormone therapy

With metastasis

• Hormone therapy +/-
• Next-generation hormone therapy
• Chemotherapy
• External beam radiotherapy to the prostate
• Other treatment combinations
• Surgery to relieve symptoms
• Treatment of bone metastases
• Clinical trials

Treatments can aim to cure cancer or to halt or alleviate symptoms. You may receive a single treatment or a combination of treatments according to your preferences or personal values and depending on the stage and grade of the cancer you have (in other words, according to the degree and rate of cancer spread).

Here are the medications approved by Health Canada to treat prostate cancer. We will update the information as quickly as possible when new prostate cancer medications are approved in Canada.

Medications used in hormone therapy

The most common LH-RH analogues are:

• Leuprolide (Lupron, Lupron Depot, Eligard)
• Goserelin (Zoladex)
• Buserelin (Suprefact)
• Triptorelin (Trelstar)

The LH-RH antagonists are:

• Degarelix (Firmagon)
• Relugolix (Orgovyx)

The most common anti-androgens are:

• Bicalutamide (Casodex)
• Flutamide (Euflex)
• Cyproterone acetate (Androcur)
• Nilutamide (Anandron)

New generation hormone therapy:

• Abiraterone acetate (Zytiga)
• Apalutamide (Erleada)
• Enzalutamide (Xtandi)
• Darolutamide (Nubeqa)

Medications used in chemotherapy

• Docetaxel (Taxotere)
• Cabazitaxel (Jevtana)
• Mitoxantrone (Teva)
• Prednisone or Prednisolone

Medications used to treat symptoms related to bone metastases

• Denosumab (Xgeva)
• Zoledronic acid (Zometa)
• Alendronate (Fosamax)
• Pamidronate (Aredia)

Targeted medications

• Olaparib (Lynparza)
• Niraparib/ Abiraterone acetate (Akeega)
• Radium dichloride 223 (Xofigo)
• Lutetium (177Lu) (Pluvicto)

Nuclear imaging

• 68Ga PSMA PET scan (Illuccix)