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Prostate Cancer: Treating Cancer That Has Spread

Cancer that has spread beyond the prostate (stage 4) can often be treated. Treatment can keep the cancer under control and help ease problems it's causing. It might include one or more of these:

  • Hormone therapy

  • Targeted therapy

  • Chemotherapy

  • Radiation therapy

  • Surgery

  • Immunotherapy

  • Medicines for cancer in the bones

  • Medicines for pain control

  • Clinical trial

Hormone therapy

Man talking a pill with large glass of water.

Hormone therapy can slow the growth and spread of the cancer. Testosterone and other male hormones can cause prostate cancer to grow. Hormone treatments can include:

  • Anti-androgens. These medicines keep the cancer cells from using testosterone to grow. They're given as pills.

  • CYP17 inhibitors. These medicines slow down prostate cancer cells' (and other body cells') ability to make hormones. They're given as pills.

  • Luteinizing hormone-releasing hormone (LHRH) agonists or antagonists.  These medicines reduce the amount of testosterone made by the testicles. They're given as shots (injections), pills, or small implants placed under the skin.

  • Bilateral orchiectomy. This surgery removes both the testicles. The testicles are the main source of testosterone.

Targeted therapy

Targeted therapy medicines work on certain genes or proteins found in or on cancer cells. These targets often help the cells grow and spread. By blocking them, targeted therapy can help control prostate cancer. Special lab tests must be done on the cancer cells to look for the changes that these drugs work on. They're used along with hormone therapy and taken as pills.


Chemotherapy (chemo) may help ease symptoms and control the cancer. Chemo destroys cancer cells anywhere in the body. Chemo for prostate cancer is given through an IV (intravenous). It might be used along with hormone therapy. Or, it may be used if hormone therapy stops working. Chemo can help slow the growth of cancer and help people live longer. By shrinking the tumor, it can help relieve pain and other symptoms, too.

Radiation therapy

Radiation uses high-energy beams to kill cancer cells. It may be used to treat symptoms and control the cancer for as long as possible. For instance, by shrinking a tumor, it may help ease pain, bleeding, trouble passing urine, or other symptoms.


A surgery called transurethral resection of the prostate (TURP) might be used to control problems passing urine. A long, thin surgery tool called a resectoscope is put in through the penis to remove the prostate tissue that's blocking the urethra. The urethra is the tube that goes from the bladder through the penis so urine can come out of the body.


Immunotherapy works with the immune system to attack cancer cells and slow their growth. Vaccine therapy may be an option for some people with advanced prostate cancer that has stopped responding to hormone therapy, but isn't causing major problems. The vaccine is made specifically for each person. It helps the immune system attack cancer cells. It does not cure the cancer, but it may help a person live longer.

Medicines for cancer in the bones

Medicines can help slow or treat the spread of prostate cancer to the bones. If prostate cancer spreads, it often goes to the bones first. This can cause pain, fractures, and other problems. Different types of bone-modifying medicines can be used. Some of them contain radiation.

Medicines for pain control

Prostate cancer that has spread may cause pain. This pain can and should be treated. Many of the treatments listed above can help relieve cancer pain. There are many kinds of medicines that can also help. Controlling pain can help you better enjoy life and do the things you want and need to do. Talk with your provider if you have pain. Also talk about the side effects of pain medicines and what you can do to help prevent or manage them.

Clinical trials

Most experts agree that treatment in a clinical trial is a good option for advanced prostate cancer. This way you can get the best treatment available now and may also get the treatments that are thought to be even better. Most of the new and promising treatments are only available in clinical trials. Your healthcare provider can talk with you about whether a clinical trial might be a good option for you.

Online Medical Reviewer: Jessica Gotwals BSN MPH
Online Medical Reviewer: Kimberly Stump-Sutliff RN MSN AOCNS
Online Medical Reviewer: Todd Gersten MD
Date Last Reviewed: 12/1/2022
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