Advanced Prostate Cancer:
Understanding and Managing Later-Stage Disease

Advanced prostate cancer has spread beyond the prostate. This may be local spread to nearby tissues or distant spread (metastatic). While not usually curable, effective treatments can control disease, relieve symptoms, and help men live longer with good quality of life.

Types of Advanced Prostate Cancer

  • Locally advanced: cancer has grown outside the prostate to nearby structures
  • Metastatic: cancer has spread to distant sites, commonly bones or lymph nodes
  • Castration-resistant prostate cancer (CRPC): growth continues despite low testosterone from therapy

Common Treatments

  • Hormone therapy (androgen deprivation therapy)
  • Chemotherapy
  • Advanced hormone therapies (e.g., abiraterone, enzalutamide, apalutamide, darolutamide)
  • Radiopharmaceuticals for bone metastases
  • Immunotherapy (sipuleucel-T) for select men
  • Targeted therapy (e.g., PARP inhibitors) for specific mutations
  • Palliative treatments focused on symptom control

PSMA PET Scan

PSMA stands for Prostate-Specific Membrane Antigen, a protein found in high amounts on prostate cancer cells. A PSMA PET scan is a special imaging test that uses a small amount of radioactive tracer that sticks to PSMA. The scan highlights even tiny spots of prostate cancer that may have spread, making it much more sensitive than standard CT or bone scans.

Doctors use PSMA PET scans to:

  •  Check if cancer has spread beyond the prostate (staging)
  • Find cancer when PSA rises after treatment (recurrence)
  • Guide treatment decisions in advanced disease

Managing Symptoms and Side Effects

  • Pain management plans
  • Bone-strengthening drugs such as bisphosphonates or denosumab
  • Physical therapy and gentle exercise
  • Emotional and mental health support

Genetic Testing

Genetic (germline) testing checks for inherited mutations like BRCA1, BRCA2, ATM, and Lynch syndrome genes. Recommended for advanced or metastatic prostate cancer, informs treatment and family risk.

Living Well With Advanced Prostate Cancer

  • Work closely with a multidisciplinary team
  • Consider clinical trials
  • Seek support from family, peers, and advocacy groups
  • Maintain healthy lifestyle habits

Trusted Resources & Further Reading

Disclaimer: The information on this page is for educational purposes only and is not a substitute for professional medical advice. Always consult a qualified healthcare provider, such as a physician or urologist, about your personal care. Ask questions, seek multiple opinions if needed, and make decisions in partnership with your medical team.