Treatment for advanced prostate cancer continues to improve, offering new hope to patients and their families. New therapies are helping men live longer and experience better outcomes. As treatment advances, the conversation is shifting from survival to long-term survivorship.

Doctors still have the broadest range of treatment options when prostate cancer is detected before it spreads. New treatments are also improving both the length and quality of life for men diagnosed at a later stage. If you are between the ages of 45 and 50, schedule an appointment with your primary care physician to discuss prostate cancer screening and your individual risk.

The gold-standard treatment for prostate cancer

The recommended treatment for prostate cancer depends on the tumor’s stage, risk level and other individual factors. Doctors may recommend active surveillance for some localized cancers unlikely to grow quickly. More aggressive localized or locally advanced cancers may require surgery, radiation or a combination of radiation and hormone therapy.

Hormone therapy often forms the foundation of treatment for metastatic prostate cancer that has spread beyond the prostate. Doctors may combine it with chemotherapy or newer medications based on the cancer’s characteristics. This personalized approach enables the care team to treat the disease as effectively as possible while preserving the patient’s quality of life.

Depriving prostate tumors of testosterone

Researchers at the University of Chicago discovered decades ago that prostate tumors often depend on androgens, a group of hormones that includes testosterone, to grow. Lowering testosterone can shrink tumors, slow the cancer’s progression and help patients live longer. This discovery laid the foundation for hormone therapy in prostate cancer care.

Surgical removal of the testicles was once a common way to lower testosterone, but it did not block all androgen production in the body. The adrenal glands and other tissues can also produce small amounts of androgens that may fuel prostate cancer. Today, medications can reduce androgen production or prevent cancer cells from using these hormones, rather than surgical removal.

Androgen deprivation therapy lowers testosterone levels or blocks its effects throughout the body. This treatment offers a nonsurgical way to slow hormone-dependent cancers. Doctors may also use androgen receptor pathway inhibitors to target the cancer more completely.

In the past, doctors often prescribed one medication at a time and switched to another when the cancer stopped responding. Research now shows that certain patients benefit when doctors attack the cancer earlier with multiple treatments. This intensified approach can delay disease progression and improve survival.

Treatment may include single, double, triple or quadruple therapies, based on how aggressive the cancer is, where it has spread and how the patient responds. Every treatment can cause side effects, but patients have not experienced more side effects when multiple therapies are used together. The care team monitors each patient closely and adjusts treatment to balance cancer control with overall well-being.

Advances in prostate cancer treatment

Personalized medicine uses a person’s genetics, health history, lifestyle and disease characteristics to guide treatment decisions. It helps doctors identify therapies that may work particularly well against an individual tumor. This approach has created promising new options for men with advanced prostate cancer.

Researchers discovered that some prostate cancers have DNA changes also seen in certain breast cancers. These shared genetic characteristics have opened the door to treatments originally developed for other cancers. Genetic testing can now help doctors identify which patients may benefit from these targeted therapies.

BRCA1 and BRCA2 are genes that normally help repair damaged DNA. Changes in these genes can prevent cells from repairing DNA damage properly, allowing cancer to develop. Some men with prostate cancer carry these mutations and may benefit from medications called PARP inhibitors.

A new treatment path with PARP inhibitors

PARP inhibitors take advantage of the body’s normal response to DNA damage. When DNA is damaged in a healthy cell, the cell activates repair mechanisms to help it survive. Many tumors, including those with BRCA mutations, cannot repair themselves normally, so PARP inhibitors further block the repair process and make it harder for cancer cells to survive.

The use of PARP inhibitors has grown as researchers have learned that up to 40% of men with advanced prostate tumors may have changes in these DNA repair pathways. This discovery opens an exciting new path for treatment. PARP inhibitors are among the first therapies to improve patient outcomes without targeting testosterone or other hormones.

The importance of DNA genetic testing

Genetic research and testing form the foundation of personalized medicine and should be routinely performed for men who meet specific criteria. Testing now extends beyond BRCA and can include a panel of 150 genes, including mismatch repair genes and other DNA repair genes. Once testing identifies the mutation and the genetic pathway it affects, doctors can match that specific prostate cancer variant to a treatment designed to target it.

Treatment breakthrough for advanced metastatic prostate cancer

Better imaging now helps doctors locate prostate cancer that older scans may miss. Doctors have traditionally used bone scans and CT scans to look for cancer throughout the body. PET scans use a small amount of radioactive material called a tracer to show where cancer may be active.

Prostate-specific membrane antigen (PSMA) is a protein found at high levels on many prostate cancer cells. A PSMA PET scan uses a radioactive tracer that binds to this protein. This scan helps doctors see small areas of cancer, even when PSA levels remain relatively low.

PSMA-targeted radioligand therapy

PSMA helps the care team locate prostate cancer cells and enables targeted treatment of those same cells. In PSMA-targeted radioligand therapy, a specialized molecule travels through the body, identifies PSMA-positive cells and delivers radiation directly to them. This therapy is available to certain patients with advanced metastatic prostate cancer, and researchers continue to study how it may benefit additional patients at earlier stages.

Conversation shift from survival to survivorship

Advanced metastatic prostate cancer has historically been considered treatable but not curable. Today’s therapies are helping many men live longer and maintain a better quality of life. These advances enable doctors and patients to plan for long-term health rather than focusing solely on immediate survival.

Long-term treatment can affect heart health and bone strength. Care teams now address these potential side effects earlier and monitor patients throughout treatment. This proactive approach helps men protect their overall health while continuing to manage prostate cancer.

Prostate care at Endeavor Health

Endeavor Health provides personalized prostate cancer care, using sophisticated imaging, genetic testing and targeted therapies that offer new hope to men with advanced disease. Early detection still offers the widest range of treatment options, and your primary care doctor can help you understand your risk. Schedule a prostate cancer screening today to protect your health and future.