The term “advanced prostate cancer” does not describe just one type of disease, but several. It can be one of the following types of prostate cancer.

Locally advanced cancer – When it has started to spread beyond the prostate but has not gone too far. It may have barely breached the capsule boundaries, but it may also have reached neighboring tissues, such as the bladder, external sphincter, and rectum. For more information, click here.

Recurrent cancer – When it reappears after initial treatment (surgery, radiotherapy/brachytherapy) with or without metastases. For more information, click here.

Cancer with metastases – When it has spread to other regions of the body, distant from the prostate. Most often, prostate origin metastases establish themselves in the pelvic lymph nodes and bones. For more information, click here.

Castration-resistant prostate cancer or CRPC – When it continues to progress despite hormone therapy. For more information, click here.

The goal of treatment

The chosen treatment will depend on the type of advanced cancer and aim to either cure it or slow its long-term progression. The choice of treatment will depend on various factors.

• Your age and life expectancy
• Your Gleason score, stage, and PSA level
• Your past treatments
• The location of your recurrence, if applicable
• The presence of diseases such as cardiovascular disease or diabetes
• Your symptoms
• Your personal preferences

Additional palliative treatments may be added to reduce your symptoms or bone pain. To relieve pain, bone and other pain, analgesics, treatments to strengthen the bone, and even palliative radiation therapy are prescribed. If you have metastatic cancer, you will also need to take calcium and vitamin supplements D.

Bone health

Bisphosphonates

• Bisphosphonates, such as zoledronic acid (Zometa), can slow or halt the progression of bone destruction caused by metastases, thus reducing the risk of fractures.
• Used in patients with CRPC with bone metastases, bisphosphonates help reduce the risk of complications from metastases and limit the need for analgesics and palliative radiotherapy.

Biological Agent

A drug called denosumab (Xgeva) can be used instead of bisphosphonates to slow or stop bone loss caused by bone metastases.

• Denosumab is a monoclonal antibody that recognizes and attaches to what is called the RANK ligand, which is largely responsible for stimulating the cells that weaken bones, leading to bone fractures.
• By targeting and blocking RANKL, this degradation is slowed down.
• It has actually been shown to be slightly more effective than zoledronic acid in reducing bone complications in men with metastatic CPRC.
• Furthermore, it has also proven to be very effective in reducing bone loss (and thus preventing osteoporosis caused by medical castration) and the risk of fractures.

Palliative external radiation therapy

The radioactive rays of radiotherapy destroy the cells of metastases in the bone that cause pain (in the spine, hips, back, etc.). This does not change the course of the disease, but quickly relieves the patient, strengthens the bone, and consequently helps reduce the risk of fracture at the irradiated site.

Usually, palliative radiotherapy is used when pain relievers are not sufficiently effective or when there is a risk of bone fracture. However, the same spot cannot be irradiated twice. Therefore, often, doctors use radiotherapy as a last resort.

If pain returns to the irradiated area, pain relievers and treatments aimed at strengthening bones can provide some relief. It should be noted that these medications can be used at the same time as radiotherapy.

Palliative surgery

Transurethral Resection of the Prostate (TURP) – Transurethral resection of the prostate (TURP) may be an option for castration-resistant prostate cancer. This type of surgery helps relieve symptoms of urinary obstruction caused by prostate tumor.

Learn more about palliative care

To learn more about symptom control and managing financial, family, or psychological issues, click here.