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Advanced Prostate Cancer

Advanced disease refers to prostate cancer that has spread beyond the prostate and is unlikely to be cured with surgery or radiation alone.

Men diagnosed with metastatic prostate cancer (their disease has already spread beyond the prostate by the time of diagnosis), will often not undergo local treatments of the primary prostate tumor, such as surgery or radiation. Instead, their therapeutic journey might start with hormone therapy, and from there follow a similar path as men who were diagnosed at an earlier stage and had subsequent disease progression.

Treatment Options for Advanced Prostate Cancer

Disease Stage Treatments to Consider Once This Stage is Reached
Rising PSA but no detectable tumors on imaging
No previous hormone therapy or adjuvant radiotherapy after surgery
• The standard of care is the use of salvage radiotherapy with or without hormone therapy
• Alternative option for patients with a slow PSA doubling time and/or limited life expectancy is surveillance
Hormone-sensitive metastatic disease
Cancer has spread outside the prostate and is responsive to hormone therapy
• Hormone therapy
• Hormone therapy + radiation to prostate bed (newly diagnosed and with low-volume metastatic disease) +/- androgen directed therapy* or docetaxel
• Hormone therapy + androgen directed therapy* (for high-volume disease)
• Hormone therapy + docetaxel (for high-volume disease)
Non-metastatic castration-resistant prostate cancer
Rising PSA but no detectable tumors on imaging in patients who had previous hormone therapy
• Observation + continued hormone therapy for select patients
• Hormone therapy + androgen directed therapy*
Metastatic castration-resistant prostate cancer
Tumors detectable on imaging despite hormone therapy
• Abiraterone or enzalutamide
• Radium-223 (for treatment of symptomatic bone metastases)
• Docetaxel chemotherapy
• Cabazitaxel chemotherapy
• Sipuleucel-T (if minimal symptoms)
• Olaparib or rucaparib (if DNA damage repair gene mutations are present, primarily BRCA1 and BRCA2)
Patient has exhausted all therapeutic options • Platinum chemotherapy
• Pembrolizumab (if MMR-deficient, MSI-high, or TMB-high)
Bone protection • Denosumab
• Zolendronic acid

*Discuss the options in this medication class with your doctor.

Note: At every stage, you can talk to your doctor about whether there is an active clinical trial that might be right for you. Find out more about clinical trials here.

For more information about these options, download or order a print copy of the Prostate Cancer Patient Guide.

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