Hormone Therapy, Theranostics, and Other Systemic Therapies for Prostate Cancer
Overview of prostate cancer systemic therapies
Your care team may recommend systemic therapies to treat prostate cancer. These treatments are most often for metastatic prostate cancer that has spread.
We also use these therapies for prostate cancer that’s only in the prostate gland. Prostate cancer systemic therapies may be used with radiation when the tumor is aggressive.
You may have neoadjuvant (NEE-oh-A-joo-vant) therapy, which is treatment you get before another treatment.
You may have adjuvant (A-joo-vunt) therapy, which is treatment you get after another treatment. It’s used to kill any cancer cells that may be left.
You may have hormone therapy before, during, and after radiation to:
- Make radiation work better.
- Lower the risk of prostate cancer coming back or spreading.
Your treatment plan is based on your overall health, the cancer’s stage and size, and the tumor’s genetics.
MSK’s medical oncologists (cancer doctors) use the latest methods to treat prostate cancer. This includes research studies of drugs, also known as clinical trials.
Talk with an MSK Care Advisor. We're here 24 hours a day, 7 days a week.
Hormone therapy for prostate cancer
What is hormone therapy?
Hormone therapy drugs can kill or block the growth of prostate cancer cells. MSK experts have developed many of these therapies to treat prostate cancer.
Prostate cancer cells are fueled by hormones such as testosterone. Testosterone and other hormones like it are called androgens (an-DRUH-jenz). They help the prostate cancer cells to grow and spread.
Hormonal therapy treats prostate cancer by:
- Lowering how much testosterone your body or the cancer makes.
- Blocking the effect of testosterone on the prostate cancer cells.
Your doctor may recommend hormone therapy to treat:
- Prostate cancer before, during, and after radiation therapy. This makes radiation work better. For people at higher risk of the cancer coming back, it can also raise the chances of a cure.
- Prostate cancer that recurs (comes back) after surgery or radiation.
- Prostate cancer that has spread outside the prostate.
Hormone therapy may be used alone or with another type of hormone therapy. You may also have hormone therapy with other prostate cancer systemic therapies.
Learn more about hormonal therapy for prostate cancer.
Types of hormone therapy for prostate cancer
Luteinizing hormone-releasing hormone (LHRH) agonists and antagonists. These drugs block the signal that tells your testicles to make testosterone. They’re given by injection (shot) or in pill form. Examples are:
- Leuprolide (Lupron®)
- Goserelin (Zoladex®)
- Degarelix (Firmagon®)
- Relugolix (Orgovyx®)
Androgen receptor pathway inhibitors (ARPIs). Examples are:
- Abiraterone (Zytiga®)
- Enzalutamide (Xtandi®)
- Apalutamide (Erleada®)
- Darolutamide (Nubeqa®)
Abiraterone lowers the amount of testosterone made in a prostate cancer cell. Other ARPIs work by stopping testosterone from getting to the cancer cells. These drugs work very well for people just diagnosed with metastatic prostate cancer. ARPIs also are a good option if your medicine to lower your testosterone levels stopped working.
MSK experts developed many ARPIs used to treat prostate cancer. We'll talk with you about the best options for you. We’ll also help you manage prostate cancer hormone therapy side effects.
Some prostate tumors may become resistant (stop responding) to treatment that lowers your testosterone level. ARPI therapies no longer work. This is called androgen pathway modulation resistant (APMR) disease.
MSK treats APMR disease with other systemic therapies, such as theranostics, targeted therapy, and chemotherapy. You also may be able to join one of MSK’s many clinical trials.
Prostate cancer hormone therapy side effects
Hormonal therapy for prostate cancer can cause side effects. The side effects may go away over time during your treatment. Sometimes they last many months after hormone therapy ends. You may have some or none of these prostate cancer hormone therapy side effects:
- Hot flashes or sweating.
- Fatigue (feeling very tired or having less energy than usual).
- Erectile dysfunction (having trouble getting or keeping an erection).
- Less interest in having sex.
- Diarrhea (watery or loose bowel movements).
- Constipation (having fewer bowel movements than usual).
- General pain.
- Breast tenderness or breast tissue growth.
- Weight gain.
- Muscle weakness.
- Less mental sharpness.
- Cardiovascular disease.
- Lower bone mineral density.
Your care team will talk with you about side effects from hormone therapy and how to care for them. MSK offers treatments that can help you feel better. Examples are therapies from our Male Sexual & Reproductive Medicine Program and Integrative Medicine and Wellness Service.
Theranostics for prostate cancer
What is theranostics?
Theranostics (THAYR-uh-NAH-stiks) is a form of radiation therapy. Theranostics is delivered as a systemic therapy that uses therapy and diagnostic tools. It uses targeted imaging molecules to find cancer cells. Then those same molecules deliver radiation right to those cells.
Theranostics both finds and treats cancer.
Theranostics is a new treatment for prostate cancer that:
- Spread beyond the prostate.
- Does not respond to hormonal and other types of systemic therapies.
Theranostics therapy is most often used for advanced prostate cancer.
Learn more about theranostics.
How does theranostics work?
Cancer cells can have a protein on their surface called prostate-specific membrane antigen (PSMA). Theranostic agents can find and attack cells with PSMA.
These special radioactive substances are called radioisotopes, tiny particles that give off radioactive energy.
There’s no better place to get theranostics than MSK:
- We helped discover PSMA.
- We developed imaging based on PSMA.
- We helped develop treatment based on PSMA.
MSK co-led clinical trials that developed a treatment called 177Lu-PSMA-617 (Pluvicto®). This molecule attaches to PSMA with radiation that kills the cancer cell.
If we only need to see the cancer cells more clearly, you may just have a PSMA-based imaging scan.
What is PSMA PET to diagnose prostate cancer?
Theranostics diagnoses prostate cancer by using a new way of taking images.
MSK experts were leaders in developing a new imaging technology called a PSMA PET. This new scan uses a radioactive molecule that attaches to prostate-specific membrane antigen (PSMA).
The PSMA PET scan lights up the PSMA on cancer cells. PSMA PET lets us clearly see cancer that’s metastatic (spreading) and needs treatment. We can find the prostate cancer cells sooner than older imaging technologies.
For example, standard bone imaging only shows damaged bone, not the cancer. Often, it finds cancer only after it already harmed the bones.
Similarly, CT scans and other imaging methods only spot large areas of cancer in other tissue types. By then, it’s already big enough to harm normal tissue.
What is PSMA PET to treat prostate cancer?
Theranostics for prostate cancer can also treat the prostate cancer. We replace the radioactive material we used to diagnose and find the cancer with one that can kill cancer.
The PSMA PET shows if there’s enough PSMA to make the cells respond to treatment.
At MSK, everyone gets a PSMA PET scan if:
- They’re at risk for getting metastatic prostate cancer.
- The cancer came back after treatment.
Learn more about PSMA-targeted therapy.
A bone scan shows no cancer in bones. This man was scheduled for surgery that would not have cured him.
A PSMA PET scan of this man shows metastatic prostate cancer all over his body that the bone scan missed.
Targeted therapy for prostate cancer
What is targeted therapy?
Targeted therapies are cancer treatments that target a tumor’s gene changes (mutations or variants). It’s a personal treatment plan just for the type of cancer you have. Targeted therapy medicines most often are given by mouth in pill form or through an IV into your vein.
You may have targeted therapy medicines alone, or targeted therapy along with other systemic treatments.
Targeted therapies also are called personal medicine, precision medicine, or precision oncology.
Prostate cancer research is finding more drugs that work by targeting certain proteins in cancer cells. These proteins are made by abnormal (not normal) genes and make prostate cancer cells grow and divide.
Targeted drugs attack the abnormal proteins in cancer cells. They slow or stop their growth. Most healthy cells are not affected.
Targeted therapy is used in treating metastatic (stage 4) prostate cancer.
Genomic testing for targeted therapy
Genomic testing tells us if a tumor has mutated cancer cells and which mutations may have caused the prostate cancer. This information lets us target those genes for treatment.
At MSK, genetic testing is a routine part of diagnosis for:
- People who have high-risk prostate cancer.
- Prostate cancer that came back after treatment.
This testing can be done on tumor tissue. We also can test your blood samples we collect during a visit.
Targeted therapies
Prostate cancer targeted therapies target either genetic changes or a protein on cancer cells.
PARP inhibitors: Poly (ADP-ribose) polymerase inhibitors are a type of targeted therapy called PARP inhibitors.
PARP inhibitors block the PARP protein inside cells that helps repair cell DNA. Prostate cancer cells use PARP to repair their DNA. But PARP inhibitors can stop them from doing that, and the cancer cells die.
PARP inhibitors treat prostate cancer that has a mutation (change) in the BRCA gene.
They treat prostate cancer that metastasized (spread). They also can treat prostate cancer if hormone treatments stopped working.
PARP inhibitors for prostate cancer include the drugs olaparib (Lynparza®) and rucaparib (Rubraca®).
Prostate cancer targeted therapies side effects
Common side effects of targeted therapy can include:
- Fatigue (feeling tired).
- Gastrointestinal (stomach and intestinal) problems. They include nausea (feeling like throwing up) and diarrhea (loose bowel movement).
- Low blood counts.
Some targeted therapy drugs have other side effects because they target proteins also found in normal cells.
Your care team will talk with you about what side effects to expect. They have a lot of experience in managing side effects. They offer treatments that can help you feel better. Examples are drugs that help with nausea, and integrative medicine treatments.
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Chemotherapy for metastatic (stage 4) prostate cancer
What is chemotherapy (chemo)?
Chemotherapy (chemo) is a treatment that uses strong medicine to stop or slow cancer cells from growing. Prostate cancer chemo drugs can be taken by mouth as pills. Chemo also can be injected (put) through a drip into your vein. The medicines travel in your bloodstream to kill cancer cells anywhere in the body.
Chemotherapy medicines may help people whose prostate cancer has spread, by slowing or controlling the cancer’s growth. This can help people live longer and improve quality of life.
Types of chemotherapy for prostate cancer
Docetaxel (Taxotere®) is a standard chemotherapy drug to treat prostate cancer. When we learn the cancer has spread, we can add Docetaxel along with the first hormonal therapies we use. We also may use Docetaxel if hormone therapy stops working.
Cabazitaxel (Jevtana®) is another chemo drug that’s often used if docetaxel does not work or stops working.
Chemo is given in cycles. Most chemo cycles for metastatic prostate cancer are 3 weeks long. After each cycle, you’ll have a rest period to give you time to recover from any side effects.
Your oncologist (cancer doctor) will talk with you about how long you'll need to have chemotherapy for prostate cancer.
Prostate cancer chemotherapy side effects
Chemotherapy most often works by attacking cells that divide very fast. It can harm cancer cells. But it also can harm healthy cells that divide fast, such as cells that make your hair grow.
Here are some possible side effects from prostate cancer chemo:
- Fatigue (feeling very tired).
- Not wanting to eat.
- Neuropathy (numbness or tingling in hands and feet).
- Low blood counts.
Whether you have side effects from prostate cancer chemotherapy depends on your treatment plan.
Your MSK care team will help you manage prostate cancer chemotherapy side effects. We have more information on managing the side effects of chemo. We have ways to help manage nausea during chemotherapy.
Our supportive care team will manage the symptoms and side effects of cancer treatment.
Which MSK locations offer chemotherapy?
Where you get chemotherapy depends on the kind you’re getting, where you live, and other things. At MSK, most people with prostate cancer get chemotherapy in an MSK outpatient (outside the hospital) center.
We know your life is busy and it’s stressful to fit chemotherapy sessions into your schedule. We offer chemotherapy at our locations in:
- New York City
- Long Island
- Brooklyn
- Westchester County
- New Jersey
Immunotherapy for prostate cancer
What is immunotherapy?
Immunotherapy is a form of cancer treatment. It boosts your immune system’s natural ability to fight cancer. Your immune system attacks cancer cells, much the same way it attacks bacteria or viruses.
Immunotherapy drugs release a brake on the immune system so it can start a stronger attack against cancer.
Prostate cancer rarely is treated with immunotherapy. Immunotherapy for prostate cancer may help some people with a certain genetic mutation (change). A type of immunotherapy drug called immune checkpoint inhibitors help the body’s immune cells kill cancer cells.
Genetic testing for prostate cancer tumors
At MSK, everyone with advanced prostate cancer has their tumor tested using MSK-IMPACT ®. It’s a genetic testing tool only offered at MSK. This testing looks for the most common mutations linked to prostate cancer.
Genomic testing tells us which mutations may have caused the prostate cancer. This information lets us target those genes for treatment.
MSK-IMPACT finds genetic changes and other tumor traits that other tests can miss. We routinely test for changes in more than 500 genes. We’ll also look for a genomic condition called microsatellite instability.
Some treatments do not work well on tumors with certain genetic changes. MSK-IMPACT tests for these mutations.
We may do genetic testing on the prostate cancer tumor for genetic changes (mutations). We’ll look for mismatch repair deficiency (dMMR) or microsatellite instability–high (MSI-H). They mean there are higher numbers of mutations within each cancer cell.
MSI-H/dMMR makes a tumor more likely to respond to immunotherapy for prostate cancer.
Checkpoint inhibitors may treat a small number of prostate cancers that have MSI-H/dMMR tumors.
Prostate cancer immunotherapy side effects
The most common side effects are caused by the immune system having a strong reaction to normal tissues. Side effects often are related to inflammation (swelling) in normal tissues. Prostate cancer immunotherapy side effects can include:
- Skin problems, such as a rash or itching.
- Chills, fatigue (feeling very tired), and other flu-like symptoms.
- Gastrointestinal problems, such as diarrhea (loose poop).
- Pain from swollen joints.
We can safely manage most immunotherapy for prostate cancer side effects if we treat them early. Sometimes, side effects can harm you. This can happen if they’re not treated right away and affect vital (very important) organs, such as the lungs.
MSK doctors are experts in caring for people who have side effects from immunotherapy.