Prostate cancer treatment has changed dramatically over the past few decades. For men whose prostate cancer has spread beyond the prostate (metastatic prostate cancer), we now have more treatment options than ever before — and these advances are helping men live longer and better-quality lives.

This newsletter explains, in simple terms, how metastatic prostate cancer is treated today and how decisions are made.

Prostate cancer cells are strongly driven by testosterone, the main male hormone. For many years, the foundation of treatment for advanced prostate cancer has been to lower testosterone levels — a strategy known as androgen deprivation therapy (ADT).

When testosterone is reduced to very low (“castrate”) levels, prostate cancer can often be controlled for a significant period of time.

Decades ago, testosterone reduction required surgical removal of the testicles. Thankfully, this is now rarely needed.

Today, we use medications called LHRH analogues, which switch off testosterone production through hormonal feedback in the body.

Common examples include:

These are given as injections every 1, 3, or 6 months, depending on the preparation.
For many men, these medications control metastatic prostate cancer effectively, particularly in the early stages.

Treatment decisions are never “one size fits all.” We consider:

In general:

Every plan is personalised.

For men with more extensive metastatic disease, chemotherapy has been shown to improve survival.

The main chemotherapy drug used is:

Chemotherapy is often given early, alongside hormone therapy, rather than waiting until later. This combined approach can lead to better long-term outcomes in selected patients.

In recent years, powerful oral medications have become available that block testosterone’s effect at the cancer cell level. These are called androgen receptor pathway (ARP) inhibitors.

Examples include:

When added to hormone therapy (and sometimes chemotherapy), these drugs have been shown to extend survival and delay disease progression.

For men with high-volume or aggressive metastatic disease, evidence shows that combination therapy works better than single treatments alone.

A typical modern approach may include:

This “triple therapy” aims to:

Metastatic prostate cancer and long-term hormone therapy can weaken bones.

To help protect bone strength, some men are prescribed medications such as:

These reduce the risk of fractures and bone-related complications.

An exciting newer treatment option for selected men is Lutetium-PSMA therapy.

This treatment builds on PSMA PET scans, which show where prostate cancer has spread in the body. The therapy:

This can be effective for men whose cancer no longer responds to standard hormone therapy and chemotherapy.

Possible side effects include dry mouth, as PSMA is also taken up by salivary glands.

At present, metastatic prostate cancer is not usually curable.
However, with modern treatments, many men achieve long-lasting remission, often for years.

The goal of treatment is to:

Today’s treatment options include:

Ongoing research continues to refine the best combinations, timing, and sequencing of these treatments.

The management of metastatic prostate cancer has advanced enormously. With careful, individualised treatment planning, many men are living longer and fuller lives than ever before.

If you have questions or concerns about your prostate health or treatment options, speak with your urologist or feel free to contact The Prostate Clinic.