Medications to Treat Advanced Prostate Cancer

Advanced prostate cancer refers to cancer that has spread beyond the prostate to nearby areas or to other parts of the body. It is also called stage 4 prostate cancer when it has spread to other parts of the body. The most common places for prostate cancer to spread include the bones and lymph nodes. Treatment will typically not cure advanced prostate cancer, but it can manage symptoms and extend life.^1,2

Many medicines are used to treat advanced prostate cancer. Doctors often suggest a combination of different drug types, including:^1-3

• Chemotherapy drugs
• Hormone therapy drugs
• Immunotherapy drugs
• Radiopharmaceuticals
• Targeted therapy drugs

Many doctors recommend hormone therapy as part of the initial treatment for advanced prostate cancer, either alone or in combination with other medicines. But everyone’s situation is different. Talk to your doctor about the risks and benefits of each option. Side effects of each type of drug vary depending on the specific drug you are taking, and not all side effects are listed here. Research is ongoing to understand the best ways to combine different drugs.¹

Chemotherapy drugs

Chemotherapy drugs work by killing cells that divide very quickly, including prostate cancer cells. Chemotherapy drugs may be a good treatment option for advanced prostate cancer if there is a lot of cancer outside the prostate. They may be combined with hormone therapies.^2,4

Chemotherapy drugs used to treat certain forms of prostate cancer include:^3-5

• Docetaxel (Taxotere®)
• Cabazitaxel (Jevtana®)
• Mitoxantrone (Novantrone®)
• Carboplatin (Paraplatin®)

Docetaxel is often the first chemotherapy drug used. It may be combined with prednisone or another steroid.⁴

Chemotherapy drugs cause side effects because they do not kill just cancer cells. They can also kill healthy cells. Depending on the specific chemotherapy drug used, common side effects may include hair loss, mouth sores, nausea, and increased infections.⁴

Hormone therapy drugs

Hormone therapy drugs work by stopping production of testosterone. They may also stop testosterone from reaching prostate cancer cells. Prostate cancer cells need testosterone to grow. So, hormone therapy leads to the shrinking or slowed growth of prostate cancer cells.^2,6

Hormone therapy drugs approved to treat certain forms of advanced prostate cancer include:^3,5,6

• Luteinizing hormone-releasing hormone (LHRH) agonists – leuprolide (Lupron Depot®, Eligard®, Camcevi®), goserelin (Zoladex®), triptorelin (Trelstar®). These drugs reduce the amount of testosterone the testicles make.
• LHRH antagonists – degarelix (Firmagon®), relugolix (Orgovyx®). These drugs also reduce the amount of testosterone the testicles make.
• CYP17 inhibitors – abiraterone (Zytiga®), ketoconazole. CYP17 inhibitors stop testosterone production in other parts of the body.
• First-generation anti-androgens – flutamide, bicalutamide (Casodex®), nilutamide (Nilandron®). Anti-androgens prevent testosterone from attaching to prostate cancer cells. They may be combined with LHRH agonists as a first-line therapy.
• Second-generation anti-androgens – enzalutamide (Xtandi®), apalutamide (Erleada®), darolutamide (Nubeqa®)

Common side effects of hormone therapy drugs include erectile dysfunction, hot flashes, and lower sex drive. Some of these side effects can be prevented or treated effectively.⁶

Immunotherapy drugs

Immunotherapy drugs use your immune system to kill prostate cancer cells. Cancer cells can survive by hiding from the immune system. Immunotherapy can boost the immune system’s ability to find and kill prostate cancer cells. Immunotherapy drugs are often used if other drugs do not work.^2,7

Immunotherapy drugs used to treat certain forms of advanced prostate cancer include:^3,5,7

• Cancer vaccines – sipuleucel-T (Provenge®)
• Immune checkpoint inhibitors – pembrolizumab (Keytruda®), dostarlimab (Jemperli®)

Immune checkpoint inhibitors can be used only in prostate cancer if cancer cells have certain changes (mutations). Fever, chills, fatigue, nausea, and cough are common side effects.⁷

Radiation drugs (radiopharmaceuticals)

Radiation drugs carry a small amount of radioactive material to cancer cells. They can affect prostate cancer cells anywhere in the body. Some are designed to settle in the bones and treat prostate cancer cells there. These drugs damage cancer cell DNA. This causes cancer cells to stop growing.^2,8

Radiation drugs used to treat certain forms of advanced prostate cancer include:^3,5,8

• Drugs that target PSMA – lutetium Lu-177 vipivotide tetraxetan (Pluvicto®)
• Drugs that target bones – radium-223 (Xofigo®), samarium-153 (Quadramet®), strontium-89

Pluvicto may work only for prostate cancer that has the “prostate-specific membrane antigen” (PSMA). Your doctor will perform tests to ensure your cancer cells have PSMA. Common side effects of radiation drugs include fatigue, dry mouth, and nausea.⁸

Targeted therapy drugs

Targeted therapy drugs attack specific parts of cancer cells that make them unique compared to healthy cells. This reduces damage to healthy cells. Targeted therapy drugs treat advanced prostate cancer by blocking proteins that repair DNA. This causes cancer cells with certain genetic changes to stop growing.^2,9

Targeted therapy drugs that treat certain forms of advanced prostate cancer include:^3,5,9

• Rucaparib (Rubraca®)
• Olaparib (Lynparza®)
• Talazoparib (Talzenna®)
• Niraparib + abiraterone (Akeega®) (combination of a PARP inhibitor (niraparib) and an antiandrogen (abiraterone))

Common side effects of targeted therapy drugs include nausea, vomiting, diarrhea, and fatigue. More serious side effects are possible.⁹

Other medicines

Talk to your doctor about other drugs to help treat advanced prostate cancer symptoms. They may suggest different drugs depending on your symptoms. These may include:^1-3

• Bone-building drugs – denosumab (Xgeva®), zoledronic acid (Zometa®)
• Pain medicines

Before beginning treatment for advanced prostate cancer, tell your doctor about all your health conditions and any other drugs, vitamins, or supplements you take. This includes over-the-counter drugs.