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Advanced Prostate Cancer Treatments

Cancer that spreads outside the prostate gland to the lymph nodes, bones, or other areas is called metastatic prostate cancer.

About Advanced Prostate Cancer Treatments

Currently, no treatments can cure advanced prostate cancer. However, there are ways to help control its spread and related symptoms. Advanced Urology Associates offers the most state-of-the-art treatments and cancer care available.

Hormonal Treatment/Androgen Deprivation Therapy (ADT)

Male hormones, specifically testosterone, fuel the growth of prostate cancer. ADT is the first line treatment for aggressive or advanced prostate cancer.

Patients will be started on hormone/ADT treatments if:

  • The prostate cancer has spread too far to be cured by surgery or radiation, or if the patient is not a candidate to receive these treatments for various medical reasons.
  • The cancer remains or comes back after initial treatment with surgery or radiation therapy.

Examples of medications used to stop or slow down hormones:

  • Injectable options include: Eligard, Camcevi, Trelstar, Lupron & Firmagon
  • There is an oral option known as Orgovyx that is a once daily pill.

Oral Oncolytics

For patients with recurrent or metastatic prostate cancer, in addition to your hormone therapy injection, an oral, daily pill may be prescribed.

  • (NHT) or novel hormonal therapies will work along with the injections to further reduce testosterone production or by blocking the effect of testosterone.  These medications include:

    1. Zytiga (abiraterone) that is taken with a low dose of Prednisone.
    2. Xtandi (Enzalutamide), Erleada (Apalutamide) and Nubeqa (Darolutamide)

  • PARP inhibitors may be prescribed if a genetic mutation in the genes is found during genetic testing. This includes Lynparza (Olaparib).

Side effects of these therapies include
Fatigue, hot flashes, breast pain or enlargement, cholesterol level changes, erectile dysfunction and lower libido, diarrhea and / or constipation, increase in belly fat, joint pain, swelling, increased risk of osteoporosis, and cardiovascular events.

Radiation Treatment

Radiation can target specific sites where cancer has metastasized, most commonly the bone. It can be used alone or in combination with hormone therapy or immunotherapy. The radiation can relieve bone pain and can slow the growth of cancer. It can take up to several weeks for pain to lessen.


An orchiectomy is a surgical procedure to remove both testicles, the main source of male hormones, such as testosterone, to decrease the amount of hormone being made. This is mostly used after surgical removal of the prostate has failed.

Bone Health

Once prostate cancer spreads to the bone, it can potentially become a painful process, but there is hope through treatment.

  • Xgeva-treatment that stops proteins from signaling bone removal within the skeletal system for use in men with bone metastases from prostate cancer. The body naturally destroys old bone material while making new bone material. The drug slows the process of destroying bone and interrupts skeletal damage to the bones by spreading prostate cancer cells. This inhibits bone loss and fractures and relieves pain from prostate cancer in the bone.
  • Prolia-indicated for patient with prostate cancer, on hormone therapy, which has not spread to the bone.

Possible side effects of bone treatments include fatigue, diarrhea, nausea, and weakness.

Men should also take Calcium plus vitamin D to help strengthen the bones. The vitamin D helps absorb more of the calcium into the bones.

  • A bone density test (Dexa scan) will be ordered to check for evidence of Osteopenia or Osteoporosis to qualify for these treatments.

Advanced Metastic Castrate-Resistant Prostate Cancer

Eventually, most patients with advanced prostate cancer stop responding to hormone therapy. The cancer cells become castrate resistant and grow strong enough that hormone therapies have a lessening effect on the cancer. This is known as castrate-resistant prostate cancer.

However, there are several other treatment options, including:

  • Immunotherapy-Provenge (sipuleucel-T)
  • Secondary or inhibitor/blocker hormone therapy • Antifungal agent
  • Xofigo (radium Ra-223 dichloride)

PROVENGE® for Advanced Prostate Cancer Treatment

Advanced Urology Associates are a Certified Treatment Center for PROVENGE for advanced prostate cancer treatment

Advanced urology is proud to offer advanced prostate cancer patients PROVENGE® (sipuleucel-T), the only personalized treatment that is clinically proven to extend life in certain men with advanced prostate cancer.

Once a patient becomes castrate resistant they may be a candidate to begin Sipuleucel-T (PROVENGE), PROVENGE is a “vaccine” for advanced prostate cancer that helps extend life and is the only FDA approved immunotherapy. Unlike vaccines against infections like measles or mumps, immunotherapy is designed not to prevent, but to treat prostate cancer by using your own immune system to fight the disease. It is designed to activate the immune cells to best identify prostate cancer cells as abnormal cells or invader cells in your body. The immune system has a hard time finding the cancer cells because they look a lot like normal cells to the immune system and cancer cells may give off signals that manipulate the immune system into leaving them alone. Most prostate cancer cells contain phosphates which the immunotherapy recognizes and commands the body to attack.

The PROVENGE process involves extracting white blood cells from your blood, reprogramming them by “training” them in a lab to destroy and fight prostate cancer. The newly “trained” cells are then reinfused back into the body a few days later. Since the original cells are from you, there is little chance of the body rejecting the therapy. This process delivers a treatment designed just for you.

Learn more about PROVENGE

Antifungal Agent

Ketoconazole, an antifungal agent, inhibits adrenal and testicular synthesis of testosterone when used at high doses. Response rates in a second line setting are 20%-40% with significant side effects. Doses range from 200mg 3 times a day to 400mg three times a day. The drug must be given with hydrocortisone to prevent adrenal insufficiency.

Xofigo® for Advanced Prostate Cancer Treatment

Xofigo Advanced Prostate Cancer TreatmentIf several areas of the skeletal system are affected and are causing pain, radiation can be administered in the blood stream by a minute injection in the vein (IV), once a month for a total of six injections. Xofigo is used in men with castrate resistant prostate cancer, metastatic only to the bones. Xofigo contains the radioactive material radium 223. It goes to the areas in the bones that are growing quickly from the bone metastases. It gives off a strong energy, but has a short range that does limited damage to healthy cells around it. It slows progression of the cancer and gives some relief to bone pain for a certain length of time.

Xofigo can be absorbed by other organs, primarily the bone marrow and digestive system, which may result in side effects in those healthy tissues.

Learn more about Xofigo

Dr. Aaron Berger

Aaron Berger, M.D.

Board Certified Urologist
Chief Medical Officer and Director of Clinical Research

Dr. Berger serves on the leadership team and is the current Chief Medical Officer and Director of Clinical Research of Associated Urological Specialists (AUS). He has a special interest in prostate cancer from robotic surgery to state of the art treatments of advanced and metastatic prostate cancer. Dr. Berger leads the Advanced Prostate Cancer Clinic offering state-of-the-art therapies for patients with advanced or metastatic prostate cancer.

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Advanced Prostate Cancer Center Patient Education pamphlet from Advanced Urology Associates

Advanced Prostate Cancer Center

The Advanced Urology Prostate Cancer Center offers the most state-of-the-art treatments and cancer care available.

Advanced Prostate Cancer Center Patient Education Booklet

Questions About Advanced Prostate Cancer Treatments?

If you have questions about advanced prostate cancer treatments at Advanced Urology call 815.409.4930 or request an appointment today.