Metastatic prostate cancer is cancer that has spread to other parts of the body. Treatments for metastatic prostate cancer are called systemic therapies. These drugs move throughout your body to attack cancer cells wherever they are. Some systemic therapies can reduce the side effects of metastatic disease. Given together, these treatments help people with metastatic prostate cancer live longer, better lives.
There are more treatment options for metastatic prostate cancer than ever before. Some drugs that work well became available recently. They include treatments for cancer that already spread at the time you are diagnosed. They also include treatments for cancer that spreads after radical prostatectomy surgery or radiation therapy.
The 3 main types of systemic therapy are hormone therapy, chemotherapy, and immunotherapy.
Hormone Therapy for Metastatic Prostate Cancer
Hormone therapy slows or blocks prostate cancer cells from growing. Testosterone is a male sex hormone. It’s made when hormones from your pituitary gland (a gland in your brain) cause your testes (testicles) to make sperm.
Testosterone can cause prostate cancer cells to grow. Hormone therapy lowers the amount of testosterone your testicles make. It also blocks the action of testosterone and other male hormones.
Some prostate tumors, however, become resistant to these drugs after months or years of treatment. This is called castration-resistant prostate cancer. There are more treatment options for castration-resistant prostate cancer than ever before.
Chemotherapy for Metastatic Prostate Cancer
Chemotherapy is medication that kills cancer cells, given by mouth or intravenously (put into your vein). Chemotherapy for prostate cancer is an important treatment option when the disease has metastasized (spread). If you have cancer that has spread to your bones, chemotherapy can help you live longer, with less pain. Docetaxel (Taxotere®) is considered the standard of care in chemotherapy for prostate cancer that is resistant to hormone therapy. It works by damaging the structure of prostate cancer cells.
Another chemotherapy drug for treating castration-resistant prostate cancer is cabazitaxel (Jevtana®). It’s also used by people with metastatic prostate cancer that has grown while they are taking docetaxel.
Immunotherapy for Metastatic Prostate Cancer
Immunotherapy uses the power of the immune system to target cancer cells. MSK has been a leader in developing immunotherapy treatments for many cancers.
The first immunotherapy treatment for people with advanced metastatic prostate cancer approved by the FDA was sipuleucel-T (Provenge®). The drug is made by removing a person’s immune cells and then engineering them to fight prostate cancer cells. The immune cells are then put back into the body. This drug can help people with metastatic prostate cancer live longer.
More recently, MSK led a clinical trial of a type of immunotherapy called checkpoint inhibitors. Researchers studied the checkpoint inhibitor pembrolizumab (Keytruda®). They found that a small number of people whose metastatic prostate cancers have a specific genetic alteration respond to Keytruda. Genetic testing of the tumor can tell us if someone with prostate cancer is likely to respond to the drug.
Systemic Radiation Treatments for Prostate Cancer
Another type of systemic therapy is called radiotherapeutics (or radiotherapies). It uses very small amounts of radioactive materials. MSK medical oncologists (cancer doctors) and nuclear medicine doctors work as a team to deliver this treatment to our patients.
A drug called radium-223 (Xofigo®) is used to treat advanced prostate cancer with bone metastases (cancer that has spread to the bones). Radium-223 delivers a very strong form of radiation to bone metastases. This drug has few side effects, and can help you live longer.
Newer radiation therapy treatments target prostate cancer cells instead of the surrounding bone. These drugs can treat bone metastases as well as disease in other areas of the body. One treatment uses a type of radiation called 177Lu-PSMA-617. It’s delivered to a prostate cancer protein that is called prostate specific membrane antigen (PSMA).
To see if this treatment will work, we use an imaging test called a PSMA PET scan. It shows us if there is enough PSMA on the prostate cancer for treatment with 177Lu-PSMA-617. This treatment can prevent bone fractures and help you live longer, with a better quality of life.
In 2022, the FDA approved this treatment for people who already had hormonal treatments and chemotherapy. MSK also has many clinical trials that research new radiotherapies for this disease.
Other Systemic Treatments for Prostate Cancer
Many other systemic therapies are in the late stages of development. MSK medical oncologists are developing new treatments for prostate cancer. Our patients can join our clinical trials to access them.