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 primary hormonal therapy, and from there follow a similar path as men who were diagnosed at an earlier stage and had subsequent disease progression.

Disease Stage Treatments to Consider Once This Stage is Reached
Rising PSA but no detectable tumors on imaging Hormone therapy
Radiation to prostate bed if prior surgery
Surveillance
Hormone-naïve metastatic disease Hormone therapy
Hormone therapy + abiraterone
Hormone therapy + docetaxel
Metastatic disease;
resistant to primary hormone therapy
(castration-resistant prostate cancer)
Sipuleucel-T (if minimal symptoms)
Abiraterone or enzalutamide
Radium-223 (for treatment of bone metastases)
Taxane chemotherapy (docetaxel and cabazitaxel)
Patient has exhausted all therapeutic options Platinum chemotherapy
Pembrolizumab (if MMR-deficient or MSI-high)
Clinical trials of targeted therapies matched to tumor
Bone protection Denosumab
Zolendronic acid

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


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