Treatments for metastatic castration-sensitive prostate cancer

Castration-sensitive prostate cancer (CSPC) is cancer that is being controlled by keeping the testosterone level as low as would be expected if the testicles were removed (called the castrate level). Metastatic prostate cancer is prostate cancer that has spread to other parts of the body.

The goal of treatment is to help you live longer and try to improve your quality of life. Your healthcare team will suggest treatments based on your needs and work with you to develop a treatment plan.

Treatment options for metastatic castration-sensitive prostate cancer may include a combination of the following:

• hormone therapy
• radiation therapy
• surgery to relieve symptoms
• chemotherapy
• treatments for bone metastases
• watchful waiting

Hormone therapy is the main treatment for metastatic castration-sensitive prostate cancer. It decreases the levels of hormones or blocks certain hormones to slow the growth and spread of cancer cells. Hormone therapy may be given along with radiation therapy or chemotherapy.

Hormone therapies may be used on their own or combined and include:

• a luteinizing hormone-releasing hormone (LHRH) agonist
• an LHRH antagonist
• an anti-androgen
• an androgen synthesis inhibitor
• an orchiectomy (surgery to remove the testicles)

Find out more about hormone therapy for prostate cancer.

Radiation therapy may be offered for metastatic hormone-sensitive prostate cancer. It uses high-energy rays or particles to destroy cancer cells.

External radiation therapy is the type of radiation therapy most often used. It is often given together with hormone therapy. External radiation therapy may be used:

• to relieve urinary (peeing) problems caused by the tumour
• to relieve pain where the cancer has spread to the bones (called bone metastases)

Find out more about radiation therapy for prostate cancer.

A transurethral resection of the prostate (TURP) removes part of the prostate through the urethra. It may be done to help relieve urinary problems caused by an enlarged prostate pressing on the urethra.

Find out more about surgery for prostate cancer.

Chemotherapy may be offered for metastatic castration-sensitive prostate cancer. It uses anticancer drugs to destroy cancer cells.

Docetaxel combined with darolutamide (Nubeqa) and prednisone are the drugs used most often. They are used along with hormone therapy.

Find out more about chemotherapy for prostate cancer.

When prostate cancer spreads to other parts of the body, it most often spreads to the bones. The most common treatments for prostate cancer that has spread to the bones are:

• bisphosphonates, such as zoledronic acid (Zometa)
• denosumab (Xgeva), which is a type of monoclonal antibody therapy
• corticosteroids, such as prednisone and dexamethasone
• external radiation therapy
• systemic radiation therapy with radium-223 dichloride (Xofigo)
• a procedure to stabilize a collapsed bone (called kyphoplasty)
• pain medicines

Find out more about bone metastases, including treatments and supportive therapies.

Watchful waiting may be a treatment option for older men (who aren't expected to live long and whose cancer is not causing symptoms) or for those who are unable to have treatment because of other health conditions.

Find out more about watchful waiting for prostate cancer.

You may want to consider a type of care to make you feel better without treating the cancer itself. This may be because the cancer treatments don’t work anymore, they’re not likely to improve your condition or they may cause side effects that are hard to cope with. There may also be other reasons why you can’t have or don’t want cancer treatment.

Talk to your healthcare team. They can help you choose care and treatment for advanced cancer.

Talk to your doctor about clinical trials open to people with prostate cancer in Canada. Clinical trials look at new ways to prevent, find and treat cancer. Find out more about clinical trials.