Metastatic Prostate Cancer
Overview of metastatic prostate cancer
DR. NEAL RAKESH
At Memorial Sloan Kettering, there’s a lot of different options of things that we can do. So, there are the simple options, like physical therapy, acupuncture, medical marijuana, topical creams and ointments, and even medications. And oftentimes, these are very effective at treating pain. For the more severe pains, what we do is injections, so steroid injections or nerve blocks are very, very helpful. For the really, really bad pain, what we do is we work with our surgical colleagues to do implantable things, like spinal cord stimulators or pain pumps. At MSK, we’re here to help with all your cancer-related pain.
Talk with an MSK Care Advisor. We're here 24 hours a day, 7 days a week.
MSK experts have discovered new radioactive drugs to target and destroy prostate cancer cells that have spread. Theranostics is a safe option that works well for people with metastatic prostate cancer. MSK research has led to new drugs as treatments for prostate cancer that has spread.
Treatments for prostate cancer that spread
Your care team may offer you a few treatment options. You may have one treatment, or a few treatments together.
Your metastatic prostate cancer care plan will be based on the latest research and therapies. Our prostate cancer experts consider many factors when making your care plan, including:
- Any other health issues you may have.
- Where the prostate cancer has spread.
- What types of prostate cancer treatment you had before.
- Whether the cancer cells have predictive biomarkers.
We assess all these things and then find the best treatment choice for you. Metastatic prostate cancer treatments can include:
Hormone therapy works by slowing or blocking metastatic prostate cancer cells from growing. Androgens (an-DRUH-jenz) are a group of sex hormones. Testosterone is a type of androgen. If you have prostate cancer, testosterone can make the cancer cells grow.
Hormone therapy stops your body from making testosterone or blocks its effects on the prostate cancer cells. We often use hormone therapy for both approaches. The prostate tumor does not have the fuel it needs to grow.
When prostate cancer is called androgen pathway modulation sensitive (APMS), it means:
- The cancer depends on androgens to grow.
- We expect treatments that lower or block testosterone in the androgen pathway to respond to hormone therapy.
Over time, some prostate cancer cells may stop responding to hormone therapy. This is called androgen pathway modulation resistant (APMR) prostate cancer. If this happens, our prostate cancer experts have other treatment options.
Learn more about hormone therapy.
Chemotherapy is an important treatment option for prostate cancer that has metastasized.
Chemotherapy also can help you live longer and have less pain if the cancer has spread to your bones.
We can use chemotherapy to treat both androgen pathway modulation sensitive (APMS) and androgen pathway modulation resistant (APMR) prostate cancers.
Learn more about chemotherapy.
Theranostics is a form of radiation therapy. It’s delivered as a systemic therapy that uses therapy and diagnostic tools.
Theranostics is a new treatment for prostate cancer that spread or did not respond to other treatments. It’s most often used for advanced prostate cancer.
Radioactive substances called radioisotopes are tiny particles that give off energy. Theranostics uses these radioisotopes to both find and treat cancer.
Radium-223 dichloride (Xofigo®) is a radioisotope that’s injected (put) through a needle into your vein. We may use radium-223 if prostate cancer cells stop responding to hormone therapy and have spread to the bone. It does not work in prostate tumors that spread to other parts of the body.
Prostate-specific membrane antigen (PSMA) is a protein found in high amounts on the surface of prostate cancer cells. Theranostic agents can find and attack PSMA-positive cells. The PSMA-targeted radioisotopes can treat tumors both in the bone and other tissues, such as the lung and lymph nodes.
Immunotherapy is a form of cancer treatment that boosts your immune system’s natural ability to fight cancer. Your immune system will then attack cancer cells, much the same way it attacks bacteria or viruses.
A type of immunotherapy drug called immune checkpoint inhibitors helps the body’s immune cells kill cancer cells.
We rarely treat prostate cancer with immunotherapy, but it may help some people with a certain genetic mutation (change).
We may do genetic testing on the prostate cancer tumor for genetic mutations. We’ll look for mismatch repair deficiency (dMMR) or microsatellite instability–high (MSI-H). Checkpoint inhibitors may treat a few prostate cancers that have MSI-H/dMMR tumors.
Other immunotherapy treatments include sipuleucel-T (Provenge®). Researchers are developing more advanced immunotherapy treatments, such as CAR T-cell therapy and bispecific T-cell engagers (BiTEs).
Learn more about immunotherapy.
MSK is among the country’s first academic institutions with a laboratory just for making alpha-emitting radiopharmaceuticals to treat cancer. Our new lab in Manhattan is testing a type of radioactivity called alpha emitters, a radiopharmaceutical that’s the most powerful form of theranostics.
One targeted therapy is called 177Lu-PSMA-617 (Pluvicto®). This therapy has a molecule that attaches to prostate-specific membrane antigen (PSMA). It delivers radiation that kills the cancer cell.
At MSK, we give an imaging test to everyone:
- At risk for metastatic prostate cancer
- Who had cancer that came back
This imaging test, a PSMA-directed PET scan, uses new technology to find PSMA on cancer cells. It shows if there’s enough PSMA to make the cells respond to treatment.
This therapy treats metastatic castration-resistant prostate cancer that spread, and hormone and chemo treatment stopped working.
Learn more about PSMA-targeted therapy
Common questions about metastatic prostate cancer
Prostate cancer that has spread to the bones can cause fractures (breaks) and a lot of pain. That’s why MSK started a special clinic for treating people with metastatic bone cancer. The clinic has experts in:
- Surgery
- Radiation oncology
- Interventional radiology
- Rehabilitation medicine
- Pain management
MSK has many options that help with bone pain for people with prostate cancer that spread to your bones. They include radium-223, which targets the cancer in the bones. Other treatments, such as zoledronic acid and denosumab, help strengthen healthy bones to resist damage from the cancer.
MSK is researching new ways to treat advanced prostate cancer with fewer side effects. We’re working to find new options for people whose cancer returned after treatment.
We have a very strong research program for prostate cancer, with almost 20 research studies focusing just on metastatic prostate cancer.
Talk with your MSK care team about whether joining a clinical trial is right for you.
Brisk walking and other low-impact exercises can help get you through treatment. MSK research shows that exercise has major benefits for people being treated for cancer as well as for cancer survivors.
We know exercise therapy helps with the side effects of prostate cancer and its treatment. Exercise even may affect the spread of prostate cancer.
