What are the treatment options for metastatic prostate cancer?

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Last updated: May 19, 2025 • View editorial policy

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From the Guidelines

Treatment of metastatic prostate cancer should prioritize androgen deprivation therapy (ADT) with treatment intensification, as strongly recommended by the NCCN Guidelines for Prostate Cancer 1. The primary approach to treating metastatic prostate cancer involves systemic therapy aimed at controlling cancer growth and managing symptoms.

  • The treatment options include:
    • Androgen deprivation therapy (ADT) with medications like leuprolide, goserelin, or degarelix
    • Combination of ADT with other agents such as abiraterone acetate, enzalutamide, apalutamide, or docetaxel chemotherapy for metastatic hormone-sensitive prostate cancer
    • Novel hormonal therapies, chemotherapy with docetaxel or cabazitaxel, radium-223 for bone metastases, or PARP inhibitors like olaparib for patients with certain genetic mutations when the disease progresses to castration-resistant prostate cancer
  • Supportive care is essential throughout treatment, including bone-targeted agents like zoledronic acid or denosumab to prevent skeletal-related events.
  • Treatment selection depends on the patient's performance status, comorbidities, disease burden, prior therapies, and molecular characteristics of the tumor, with the goal of extending survival while maintaining quality of life, as outlined in the ESMO clinical practice guidelines for diagnosis, treatment, and follow-up of prostate cancer 1 and the ESMO consensus conference guidelines 2012 1.
  • The American Society of Clinical Oncology recommendations for the initial hormonal management of androgen-sensitive metastatic, recurrent, or progressive prostate cancer also support the use of ADT as the primary treatment approach 1.

From the FDA Drug Label

  1. 3 Prostate Cancer Docetaxel Injection in combination with prednisone is indicated for the treatment of patients with metastatic castration-resistant prostate cancer.

  2. 3 Prostate Cancer For metastatic castration-resistant prostate cancer, the recommended dose of Docetaxel Injection is 75 mg/m2 every 3 weeks as a 1 hour intravenous infusion. Prednisone 5 mg orally twice daily is administered continuously [see Dosage and Administration (2.7)].

Treatment of metastatic prostate cancer: Docetaxel Injection in combination with prednisone is indicated for the treatment of patients with metastatic castration-resistant prostate cancer. The recommended dose is 75 mg/m2 every 3 weeks as a 1 hour intravenous infusion, with prednisone 5 mg orally twice daily administered continuously 2.

From the Research

Treatment Options for Metastatic Prostate Cancer

  • Androgen deprivation therapy (ADT) is a cornerstone treatment for metastatic prostate cancer, which can be done either surgically or medically 3
  • The use of gonadotropin-releasing hormone agonists (GnRH-A) is a common approach for ADT, with various options available, including goserelin, triptorelin, buserelin, histrelin, and leuprorelin 4
  • Combination therapies, such as ADT, androgen receptor signaling inhibitors (ARSI), and chemotherapy, have been established for hormone-sensitive prostate cancer and have led to significant benefits in overall survival 5
  • For patients with metastatic castration-resistant prostate cancer, new therapeutic approaches, including ARSI, PARP inhibitors, and Lu-PSMA radioligand therapy, have been developed and have improved survival after progression under chemotherapy 5

Role of Radiotherapy in Metastatic Prostate Cancer

  • Radiotherapy to the prostate has been investigated in the oligometastatic setting, with studies showing that the addition of radiotherapy to ADT and another systemic treatment option can lead to improved outcomes in patients with low-volume metastatic hormone-sensitive prostate cancer 6, 7
  • The use of radiotherapy in combination with ADT and other systemic treatments has led to a paradigm change in the management of metastatic prostate cancer 7

Selection of Treatment Options

  • The selection of treatment options for metastatic prostate cancer should be individualized, taking into account the patient's comorbidities, preferences, and disease characteristics 6, 4
  • A holistic approach is necessary to determine the most appropriate treatment combination and sequence for each patient 6

References

1
Guideline

Guideline Directed Topic Overview

Dr.Oracle Medical Advisory Board & Editors, 2025

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Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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