Treatment of Hormone-Resistant Prostate Cancer
At some point, patients who have taken hormone therapy, or are currently on hormone therapy, may see their PSA levels rise, and sites of metastatic cancer are seen on conventional imaging scans. This is called metastatic castration-resistant prostate cancer (mCRPC). This means that the cancer is growing despite low testosterone. It is sometimes referred to as hormone-resistant prostate cancer (HRPC). Standard hormone therapy alone is not enough for these patients, and they need to use additional treatments.
There is another state of prostate cancer called non-metastatic castration-resistant prostate cancer (nmCRPC). This occurs when patients who are taking hormone therapy see their PSA levels rise (meaning that cancer is developing resistance to hormone therapy), but conventional imaging scans (e.g., CT/MRI and bone scan) do not show any sites of prostate cancer. Today, patients with nmCRPC have three treatment options to add to ongoing treatment with standard hormone therapy: apalutamide, darolutamide, and enzalutamide. These have been shown to significantly delay progression to metastatic disease and to lengthen survival. Talk to your doctor about whether one of these drugs may be right for you. In some cases, monitoring the PSA while continuing hormone therapy may be an option for men at low risk of developing metastatic disease, particularly those with longer PSA doubling times (greater than 10 months).
Many treatment options are available for mCRPC. Click on the links below to learn more:
- Androgen Receptor Pathway Inhibitors
- Chemotherapy
- PARP Inhibitors
- Pembrolizumab
- PSMA Radionuclide Therapy
- Radium-223
- Sipuleucel-T
- External Beam Radiation Therapy
- Other Bone-Targeting Treatments
This information may seem overwhelming at first. But it represents a lot of hope: as prostate cancer gets smarter, research gets smarter too.
Make sure to talk to your doctor about all of the possibilities, as research and our understanding of prostate cancer are constantly evolving. Sometimes, understanding why a certain option is not best for you can help you understand your treatment plan. Ongoing clinical trials are testing whether it may be useful to introduce each of these treatments even earlier in the course of disease progression.
Remember: Clinical trials are available at all stages of prostate cancer. Ask your doctor if a clinical trial might be right for you.
Last Reviewed: 12/2023