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.

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
An alternative option for patients with a slow PSA doubling time and/or limited life expectancy is surveillance
Clinical trials
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)
Hormone therapy + 2nd-generation hormone therapy*
Hormone therapy + docetaxel
Clinical trials
Non-metastatic castration-resistant prostate cancer
(Rising PSA but no detectable tumors on imaging in patients who had previous hormone therapy)
Hormone therapy + 2nd-generation hormone therapy*
Clinical trials
Metastatic disease; resistant to hormone therapy Sipuleucel-T (if minimal symptoms)
Abiraterone or enzalutamide
Radium-223 (for treatment of symptomatic bone metastases)
Taxane chemotherapy (docetaxel or cabazitaxel)
Clinical trials
Patient has exhausted all therapeutic options Platinum chemotherapy
Pembrolizumab (if MMR-deficient or MSI-high)
Clinical trials
Bone protection Denosumab
Zolendronic acid
Clinical trials

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

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

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