Prostate Cancer medications & treatments

Medically reviewed by  Jamie Winn, PharmD

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Prostate cancer is the second most common cancer among men behind skin cancer. In 2020, an estimated 1.4 million people worldwide were diagnosed with prostate cancer. Over 250,000 of those diagnosed were in the U.S. Around 1 in 8 American men will be diagnosed with prostate cancer in their lifetime. While there are successful treatments available, almost 33,000 men die from prostate cancer every year. It is the second leading cause of cancer death in men in the U.S.

What is prostate cancer?

Prostate cancer begins when healthy cells in your prostate gland start to grow uncontrollably. The prostate is a walnut-shaped gland found only in males. It is located between the base of the penis and the rectum. It surrounds the urethra, which is a tube that carries urine and semen through the penis and out of the body. The prostate produces the seminal fluid that helps protect and transport sperm.

Prostate cancer is usually a very slow-growing cancer that can sometimes cause no symptoms or complications. Almost all cases are a type of cancer called adenocarcinoma, which grows in the tissues of glands. Rarely, other types of cancer can originate in the prostate, including:

• Small cell carcinomas
• Neuroendocrine tumors
• Transitional cell carcinomas
• Sarcomas 

Prostate cancer causes

It is not clear what exactly causes prostate cancer but some factors that increase your risk of developing it include:

• Age. Prostate cancer is rare in men younger than 40. Diagnosis most commonly starts at age 50 and almost 60% of cases are diagnosed in men who are 65 or older.
• Race. Prostate cancer is diagnosed in African-American men and Caribbean men of African ancestry than in men of other races. Black men are also more likely to die from prostate cancer than white men.
• Location. Prostate cancer occurs most often in North America, northwestern Europe, Australia, and the Caribbean.
• Family history. If you have a father or brother with this condition, it more than doubles your risk of developing it. Familial prostate cancer makes up almost 20% of all cases.
• Inherited gene mutations. If you inherit mutations for breast cancer genes (BRCA1 and BRCA2) or other gene mutations (Lynch syndrome), it can increase your risk of prostate cancer.
• Agent Orange exposure. The U.S. Department of Veterans Affairs (VA) links exposure to this chemical used in the Vietnam War to an increased risk of prostate cancer.
• Obesity. Being overweight seems to increase your risk of developing prostate cancer, although more research is needed to confirm this risk.
• Prostatitis. It is thought that having inflammation of the prostate may increase your risk of developing prostate cancer. More research is needed in this area as well.

How is prostate cancer diagnosed?

If your doctor suspects you might have prostate cancer, they may ask you about any symptoms you are having and your family history.

Prostate cancer symptoms

Early-stage prostate cancer may not have any signs or symptoms. As it progresses, you may experience:

• Frequent and urgent need to urinate, especially at night
• Weak, dribbling urine flow that can start and stop
• Painful urination
• Erectile dysfunction or painful ejaculation
• Blood in your urine or semen
• Bowel incontinence (cannot control your urine flow or bowel function)
• Pain or stiffness in your lower back, hips, pelvis, or thighs

Having urinary symptoms is not a definitive diagnosis of prostate cancer. There are other conditions such as prostatitis and benign prostatic hyperplasia (BPH or enlargement of the prostate) that cause some of the same symptoms.

Screening is one of the best ways to detect prostate cancer before any symptoms appear. There is no standard test for prostate cancer screening but the two tests that are commonly used are:

• Prostate-specific antigen (PSA) test. During this test, a small amount of blood is drawn from your arm and a PSA level is measured. PSA is a substance that is produced by the prostate and found mostly in your semen. There is a small amount that is released into your bloodstream. An elevated level can indicate cancer, inflammation, or infection.
• Digital rectal exam (DRE). For a DRE, your doctor will insert a gloved, lubricated finger into your rectum to examine your prostate for any abnormalities such as bumps or hard areas.

If your screening tests are abnormal, further tests are needed to confirm your diagnosis of prostate cancer. The only test that can make a definitive diagnosis is a prostate biopsy. A biopsy involves the removal of a tissue sample from your prostate gland to examine it for cancer cells. During the biopsy, your doctor will usually look at the prostate using an imaging test such as transrectal ultrasound (TRUS) or magnetic resonance imaging (MRI).

Once the biopsy has confirmed the presence of cancer cells, your doctor will determine if it has spread (metastasis), and if so, what other parts of the body it is affecting. This process is called staging. The stage assigned is based on the results of DRE, PSA testing, and Gleason score. These results can help determine whether further scans or x-rays are needed. The Gleason scoring system is the most common prostate cancer grading system used. It assigns a numerical number base on how likely the cancer is to grow and spread quickly.

Stages of prostate cancer

• Stage I: This early stage is slow growing and only involves the prostate gland. Your Gleason score and PSA levels are typically low.
• Stage II: The tumor is still found only in the prostate but can have an increased risk of growing and spreading. PSA levels are typically low or medium.
• Stage III: There is evidence of localized spread to nearby lymph nodes or seminal vesicles. It is always more likely to keep growing and spreading. Your PSA levels are typically high.
• Stage IV: The cancer has spread to other parts of the body such as distant lymph nodes, bones, or other organs. These cancers are often difficult to treat.

What are some prostate cancer treatment options?

Your treatment plan will depend on several factors including the stage of cancer when you’re diagnosed, how fast it is growing, and your overall health.

Active surveillance

This is used in the early stages or low-risk patients. This usually involves a PSA test every 6 months and a DRE once a year. It may also include a prostate biopsy every 1 to 3 years. If your tests show signs of the cancer becoming more aggressive or spreading, treatment should be started immediately.

Watchful waiting

This approach is similar to active surveillance but requires much less testing. It can be used in older adults and those with life-threatening illnesses who are expected to live less than 5 years. This is mainly used to help with symptom control and to improve your quality of life.

Surgery

Surgery is a common choice to try to cure prostate cancer and it typically involves removing the prostate gland and some surrounding lymph nodes. The main type of surgery is a radical prostatectomy. In this procedure, your surgeon operates through a single incision (cut) to remove the prostate and nearby tissues.

Another surgery that is rarely performed is an orchiectomy or surgical removal of your testicles. This will drastically reduce your testosterone levels which will help slow the growth of your prostate cancer.

Radiation therapy

This therapy uses high-energy x-rays or other types of radiation to kill cancer cells. The main types of radiation treatments used include:

• External-beam radiation therapy. This is the most common type of radiation therapy and it involves using a machine located outside of your body to focus energy beams on your prostate. This is usually performed 5 days a week for several weeks.
• Brachytherapy. This internal radiation therapy involves placing radioactive seeds directly into your prostate. Brachytherapy can be used alone if you have early-stage prostate cancer that is relatively slow growing. It can also be combined with external-beam radiation therapy if you have a high risk of it spreading outside of the prostate.
• Intensity-modulated radiation therapy (IMRT). This therapy uses CT scans to form a 3D picture of the prostate to direct a specified amount of radiation to the exact area that is affected. This helps reduce the risk of damaging any surrounding tissues and organs.
• Proton therapy. Also called proton beam therapy, it is very similar to external-beam therapy, except it uses protons instead of x-rays.

Focal therapy

• Cryotherapy. Also called cryosurgery or cryoablation, it involves freezing and killing prostate cancer cells as well as most of the prostate. It is sometimes used if your cancer has returned after radiation therapy.
• High-intensity focused ultrasound (HIFU). This therapy uses ultrasound energy to heat and kill the prostate cancer cells while limiting damage to the surrounding healthy tissue.

Hormone therapy

Also called androgen deprivation therapy (ADT), they work to block the uptake of androgens and suppress male hormones such as testosterone. It is typically used for advanced and metastatic prostate cancer. There are several types of hormone therapy including:

• LHRH Agonist. Luteinizing hormone-releasing hormone (LHRH) agonists such as Lupron Depot (leuprolide), Zoladex (goserelin), and Trelstar (triptorelin) are injected as small implants under the skin. Depending on which medication is used, they may be given once a month or once a year. They can cause your testosterone to briefly rise before falling to very low levels. This testosterone “flare” can cause symptoms such as bone pain, or trouble urinating.
• LHRH antagonist. These medications, also called gonadotropin-releasing hormone (GnRH) antagonists, can be used to treat advanced prostate cancer. They do not produce the flare seen in LHRH agonists. Examples include Firmagon (degarelix) and Orgovyx (relugolix).
• Androgen receptor (AR) inhibitors. These medications, also called anti-androgens, can help block the action of testosterone in prostate cancer cells. Examples include Casodex (bicalutamide), Erleada (apalutamide), and Nubega (darolutamide).
• Androgen synthesis inhibitors. Medications such as Zytiga (abiraterone acetate) target an enzyme called CYP17 and stop adrenal glands and some prostate cancer cells from making testosterone.

Targeted therapy

This therapy focuses on the genetic and molecular characteristics of your specific tumor to create a customized treatment. Targeted therapy includes Rubraca (rucaparib) and Lynparza (olaparib), which are PARP (poly(ADP)-ribose polymerase) inhibitors.

Chemotherapy

Currently, taxane chemotherapy, along with prednisone, is the preferred therapy for men with metastatic prostate cancer that is progressing despite hormone therapy. Examples include Taxotere (docetaxel) and Jevtana (cabazitaxel).

Immunotherapy

Also called biologic therapy, immunotherapy uses medications to stimulate your immune system to recognize and destroy cancer cells more effectively. Provenge (sipuleucel-T) is a cancer vaccine that is made specifically for you. It is made by taking some of your immune cells, genetically engineering them to fight prostate cancer, and then reinfusing them back into you through a vein.

What is the best medication for prostate cancer?

The best treatment of prostate cancer will depend on the individual’s specific prostate cancer, medical history, medications that the individual is already taking that may potentially interact with prostate cancer medications, and the individual’s potential response to the treatment. It is advisable to always speak with your healthcare provider about the best medication for you. The table below includes a list of the most prescribed or over-the-counter prostate cancer medications approved by the Food and Drug Administration (FDA).

Best medications for prostate cancer

Your healthcare provider will determine the right dosage based on your response to the treatment, medical prostate cancer, weight, and age. Other possible side effects may exist; this is not a complete list.

What are the most common side effects of prostate cancer medications?

As with all medicines, those used for prostate cancer will have some side effects, depending on the class you are taking.

• Hormone therapy can commonly cause hot flashes, nausea, vomiting, weakness, weight gain, fatigue, elevated liver enzymes, and increased blood pressure.
• Targeted therapy with PARP inhibitors can cause nausea, fatigue, vomiting, diarrhea, constipation, elevated liver enzymes, and anemia.
• Chemotherapy medications can cause hair loss, anemia, infections, weakness, nausea, vomiting, diarrhea, and constipation.
• Immunotherapy used to treat prostate cancer can commonly cause chills, fever, fatigue, nausea, joint pain, headache, vomiting, and constipation.

What are some home remedies for prostate cancer?

There are no home remedies or natural ways to treat or prevent prostate cancer. If you are at an increased risk of prostate cancer try some of these self-care management techniques to improve your overall health and reduce your risk:

• Get regular prostate exams. Early detection can increase your chance of survival.
• Maintain a healthy weight. Obese men are at a greater risk of dying from prostate cancer, developing a more aggressive cancer, and experiencing disease recurrence after surgery or radiation therapy.
• Eat a nutritious diet. A low-fat diet rich in vitamins and antioxidants may decrease your risk of prostate cancer and also heart disease, diabetes, and obesity.
• Get regular exercise. Exercise decreases the risk of diabetes and obesity, which are risk factors for developing prostate cancer. Studies have shown that vigorous exercise also reduced the risk of prostate cancer recurrence.

Frequently asked questions about prostate cancer

How common is prostate cancer?

Prostate cancer is the second most common cancer in men in the U.S. behind skin cancer. It is the 4th most common cancer diagnosed worldwide. It is estimated that over 3 million American men are living with prostate cancer.

Who gets prostate cancer?

It is estimated that 1 in 8 men will be diagnosed with prostate cancer in their lifetime. Almost 60% will be diagnosed in men over the age of 65. In African-American men, 1 in 6 will be diagnosed and are more than twice as likely to die from the disease.

What is the outlook for people with prostate cancer?

Prostate cancer can be a serious disease, but most men diagnosed with prostate cancer do not die from it. More than 3.1 million men in the United States who have been diagnosed with prostate cancer are still alive today. The 5-year survival rate for men with prostate cancer in the U.S. is 98%. The 10-year survival rate is also 98%. When metastatic cancer has spread outside of the gland, one-third of men continue to survive after five years.

Related resources for prostate cancer

• Prostate cancer introduction. Cancer.net
• What is prostate cancer? Prostate Cancer Foundation
• What is prostate cancer? Cancer.org
• Prostate cancer overview. MayoClinic
• What is prostate cancer? Centers for Disease Control and Prevention