Prostate Cancer, Advanced or Metastatic

Medications

Medicines may be used to slow the growth of prostate cancer and to relieve your symptoms.

Prostate cancer often needs the male hormone testosterone to grow. Hormone therapy uses special drugs to block the production or action of testosterone and may cause the cancer to shrink. This can improve your symptoms. Hormone therapy may be given before or after radiation or surgery to remove the prostate.

Chemotherapy is the use of drugs to control cancer's growth or relieve pain. Often the drugs are given through a needle in your vein, and your blood vessels carry the drugs through your body. Sometimes the drugs are available as pills you can swallow. Sometimes they are given through a shot, or injection.

Chemotherapy usually involves two or more drugs given together. This is done to lower the chances that the cancer cells will become resistant to the drugs. It is most often used when prostate cancer is hormone-resistant.

Hormone therapy usually works well at first to stop cancer growth. But in most cases the cancer returns in a few years. At this point, the cancer is called hormone-resistant. This means it will no longer get better with hormone therapy. When this happens, other kinds of hormone treatment may work. If the cancer continues to grow, chemotherapy may be the next choice.

Medication Choices

Hormone therapy

• LH-RH agonists/GnRH agonists, such as leuprolide (Lupron) and goserelin (Zoladex)
• Antiandrogens, such as flutamide (Eulexin), nilutamide (Nilandron), and bicalutamide (Casodex)

Hormone therapy for prostate cancer also includes orchiectomy, which is the surgical removal of the testicles. Hormone therapy is rarely used alone. More commonly, it is used with radiation therapy.

Chemotherapy

• Docetaxel
• Mitoxantrone
• Estramustine
• Paclitaxel
• Etoposide

Having chemotherapy with docetaxel and other medicine helps men with metastatic hormone-resistant prostate cancer live longer. A study with 1,006 men found that chemotherapy with docetaxel taken along with prednisone showed longer survival and a better quality of life.¹¹

Pain-relief and appetite-stimulant drugs

Pain-relief and appetite-stimulant drugs may be used when prostate cancer has spread to other parts of the body.

• Steroids, such as hydrocortisone or prednisone, control pain and improve appetite.
• Radioactive drugs such as strontium-89 and samarium-153 are called radionuclides. They are absorbed near the area of bone pain, and the radiation that is released helps relieve the pain caused by tumors that have spread to the bone.
• Bisphosphonate drugs such as alendronate (Fosamax), pamidronate disodium (Aredia), and zoledronic acid (Zometa) may help relieve bone pain and prevent osteoporosis, which is sometimes caused by long-term hormone therapy.¹⁶

Pain medicines are made that specifically treat mild, moderate, and severe pain, as well as different types of pain such as burning and tingling. To learn more, see:

Cancer: Controlling cancer pain.

For more information, see the topic Cancer Pain.

Medicines for treating side effects

Hormone therapy can cause loss of sexual desire, hot flashes, enlarged and painful breasts, and erection problems.

• For men who have erectile problems after surgery, medicines such as sildenafil (Viagra), vardenafil (Levitra), or tadalafil (Cialis) may be helpful.
• Taking a temporary break from hormone therapy can make some side effects go away.
• To relieve breast pain, the anti-estrogen breast cancer medicine called tamoxifen or radiation treatment is commonly used. Tamoxifen can also help reverse breast growth. It also causes hot flashes.
• For hot flashes, taking a certain kind of antidepressant may help.¹⁷ Gabapentin or venlafaxine may also help with hot flashes. But they have different side effects, so if you are having a problem with hot flashes, talk with your doctor.

What To Think About

Antiandrogen hormone therapy also may cause diarrhea, breast tenderness, and nausea. Cases of liver problems, some serious, have been reported.

When surgery or hormone therapy reduces the body's hormones, the bones may begin to lose their mineral density. Bone mineral density refers to how many minerals—which make your bones stronger—are in your bones. Bones that become thin and brittle are more likely to break, and studies show that hormone therapy increases the likelihood of broken bones.¹⁸ Pills or shots of a medicine called bisphosphonate can help prevent bone loss during long-term hormone therapy. These medicines may also help men whose prostate cancer has spread to the bones. Regular exercise also helps. For more information, see the topic Osteoporosis.

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Author:	Bets Davis, MFA	Last Updated: July 1, 2008
Medical Review:	E. Gregory Thompson, MD - Internal Medicine Christopher G. Wood, MD, FACS - Urology/Oncology
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