Bright red bleeding following prostate surgery indicates which of the following?

What treatments can I have?

Men with advanced prostate cancer may be offered different treatments to help with different things. Some treatments aim to keep the cancer under control, while others aim to help manage symptoms caused by the cancer. 

Treatments to control advanced prostate cancer

If you’ve just been diagnosed with advanced prostate cancer, you may be offered the following treatments:

• chemotherapy with hormone therapy
• hormone therapy alone
• clinical trials.

Chemotherapy with hormone therapy

Chemotherapy uses anti-cancer drugs to kill cancer cells, wherever they are in the body. It won’t get rid of your prostate cancer, but it aims to shrink it and slow down its growth. You might be offered chemotherapy at the same time as, or soon after, you start having hormone therapy. This helps many men to live longer, and may help delay symptoms such as pain.

You need to be quite fit to have chemotherapy. This is because it can cause side effects that are harder to deal with if you have other health problems. Read more about chemotherapy.

Hormone therapy

Hormone therapy will be a life-long treatment for most men with advanced prostate cancer.

Prostate cancer usually needs the hormone testosterone to grow. Hormone therapy works by either stopping your body from making testosterone, or stopping testosterone from reaching the cancer cells. This usually causes the cancer to shrink, wherever it is in the body. Hormone therapy can also help control symptoms of advanced prostate cancer, such as bone pain.

Hormone therapy can cause side effects – speak to your doctor or nurse about ways to manage these. Read more about hormone therapy, and its side effects.

Clinical trials

There are clinical trials looking at new treatments for men with advanced prostate cancer and new ways to use existing treatments. Clinical trials aren’t suitable for everyone and there may not be any in your area. You can ask your doctor or nurse if there are any trials you could take part in, or speak to our Specialist Nurses. Read more about clinical trials.

Radiotherapy to the prostate

Some men who have just been diagnosed with advanced prostate cancer may be offered external beam radiotherapy as part of their first treatment. This is where high-energy X-ray beams are directed at the prostate from outside the body. The X-ray beams damage the cancer cells and stop them from dividing and growing. Read more about radiotherapy for advanced prostate cancer.

Radiotherapy to the prostate isn’t suitable for all men with advanced prostate cancer. If it isn’t suitable for you, you might be offered a type of radiotherapy to help manage symptoms instead. 

Further treatments to control the cancer

Your first treatment may help keep your cancer under control. But over time, the cancer may change and start to grow again. If this happens you might be offered other treatments, including:

• more hormone therapy
• more chemotherapy
• radium-223 (Xofigo®)
• clinical trials

More hormone therapy

Your prostate cancer may respond well to other types of hormone therapy, such as abiraterone (Zytiga®), enzalutamide (Xtandi®), steroids or oestrogens, or to a combination of treatments.

More chemotherapy

If you’ve had hormone therapy on its own as a first treatment, you might be offered a chemotherapy drug called docetaxel (Taxotere®). This may help some men to live longer, and can help to improve and delay symptoms. If you’ve already had docetaxel, you might be offered more docetaxel or another chemotherapy drug called cabazitaxel (Jevtana®).

Radium-223 (Xofigo®)

This is a type of internal radiotherapy that may be an option if your cancer has spread to your bones and is causing pain. A radioactive liquid is injected into your arm and collects in bones that have been damaged by the cancer. It kills cancer cells in the bones and helps some men to live longer. It can also help to reduce bone pain and delay some symptoms, such as bone fractures. Read more about radiotherapy for advanced prostate cancer.

Treatments to help manage symptoms

Treatments to help manage symptoms caused by advanced prostate cancer include:

• pain-relieving drugs
• radiotherapy
• bisphosphonates
• complementary therapies

Pain-relieving drugs

There are lots of different types of pain-relieving drugs, such as tablets, patches and injections. Your doctor or palliative care nurse will help you find what’s best for you.

Some men worry about becoming addicted to pain-relieving drugs. But this is uncommon in men with prostate cancer. Read more about managing pain in advanced prostate cancer.

Radiotherapy

Radiotherapy can help control symptoms by slowing down the growth of the cancer. Radiotherapy to help control symptoms is sometimes called palliative radiotherapy.

The most common type of radiotherapy used to reduce symptoms is external beam radiotherapy. This is high-energy X-ray beams targeted at the area being treated from outside the body. It can help to manage symptoms such as pain, blood in your urine or discomfort from swollen lymph nodes. It’s also used to treat metastatic spinal cord compression.

You might have slightly more pain during treatment, and for a few days afterwards, but this should soon get better. It can take a few weeks for radiotherapy to have its full effect.

If your prostate cancer is causing bone pain, you may be offered radium-223 to help reduce the pain and delay some other symptoms.

Read more about radiotherapy for advanced prostate cancer.

Bisphosphonates

Bisphosphonates are drugs that are sometimes used to help strengthen bones that have become weak or thin. This may be caused by cancer that has spread, but can also happen if you’re having hormone therapy. Bisphosphonates can also be used to treat bone pain if other pain-relieving treatments aren’t helping, or to treat hypercalcaemia. Read more about bisphosphonates.

Complementary therapies

Complementary therapies may be used alongside medical treatment. They include acupuncture, massage, yoga, meditation, reflexology and hypnotherapy. Some people find they help them deal with cancer symptoms and side effects of treatment, such as tiredness or hot flushes. But the evidence for most complementary therapies isn’t very strong.

Some complementary therapies have side effects or may interfere with your cancer treatment. So make sure your doctor or nurse knows about any complementary therapies you’re using or thinking of trying. And make sure that any complementary therapist you see knows about your cancer and treatments.

Some complementary therapies are available through hospices, GPs and hospitals. But if you want to find a therapist yourself, make sure they are properly qualified and belong to a professional body. The Complementary and Natural Healthcare Council have advice about finding a therapist.

Macmillan Cancer Support and Cancer Research UK have more information about different therapies and important safety issues to think about when choosing a therapy.