“Stage 4 disease is incurable, and men who have stage 4 will either die of the disease, or their disease will be fought to a draw, and they will die of something else,” said Otis Brawley, MD, chief medical officer of the American Cancer Society. “Many of these men will do well with treatment.” About two-thirds of men who receive a diagnosis of stage 4 prostate cancer will die within five years. However, these men already are of advanced age, Dr. Brawley said. The median age of a man with a typical prostate cancer diagnosis is about 66, but the median age of a man with a stage 4 prostate cancer diagnosis is in the mid-seventies. Treating Stage 4 Prostate Cancer Your treatment may involve one or more of the following methods: Hormone therapy for stage 4 prostate cancer. Prostate cancer growth is fueled by male hormones. Hormone therapy uses medication or surgery to reduce the levels of male hormones in your bloodstream. The National Cancer Institute considers hormone therapy the mainstay treatment for stage 4 prostate cancer.
How it works. Doctors can prescribe drugs that either reduce the amount of hormones produced by the testicles or block the hormones from functioning properly. Another option involves the surgical removal of the testicles, a procedure called orchiectomy.How long it takes. Drug therapy is ongoing, as hormone levels must be kept continually low lest the cancer spring back, Brawley said. Orchiectomy is normally performed as an outpatient procedure, and its effects are permanent.Effectiveness. Early treatment of stage 4 prostate cancer using hormone therapy can improve your short-term chances of survival by 14 percent. It is not a cure, but the therapy can cause a striking response in some patients. Hormone therapy also is effective when used in combination with radiation therapy, where it may improve your chances of five-year survival by a third.
How it works. “They take white cells from the man, mail the cells off to a factory, treat those white cells, send them back, and then they are reinfused into the same man,” Brawley said. “You’re treating these white cells to look at the cancer as the enemy and fight the prostate cancer.“How long it takes. White cells are drawn, treated with Provenge, and reinfused three times over six weeks, Brawley said.Effectiveness. Provenge may add about four months to life expectancy.
Chemotherapy for prostate cancer. This method of treating stage 4 prostate cancer involves cancer-killing drugs that are injected into the vein or taken by mouth.
How it works. The most commonly used form of chemotherapy involves treatment with the chemo drug docetaxel combined with the steroid drug prednisone, Brawley said. Cabazitaxel is another chemo drug used to treat prostate cancer.How long it takes. Chemotherapy is performed in cycles of a few weeks in length. You then will have a rest period during which your body is given a chance to recover from the treatment.Effectiveness. These chemo drugs may add three or four months to a prostate cancer patient’s life expectancy.
Surgery for stage 4 prostate cancer. Surgery is often used to try and cure early stage prostate cancer, but by stage 4, it is mainly an option to help relieve symptoms like bleeding or difficulty urinating.
How it works. Doctors may choose to completely remove the prostate, a procedure called a radical prostatectomy. In stage 4 prostate cancer, doctors sometimes perform a more limited procedure called a transurethral resection of the prostate, or TURP. With TURP, the doctor only removes the inner part of the prostate gland that surrounds the urethra, which relieves pressure that causes difficulty with urination.How long it takes. A radical prostatectomy will require a hospital stay of a few days following surgery. You’ll have to limit your activities for three to five weeks. After TURP, you can usually leave the hospital in one or two days and return to normal activity within one to two weeks.Effectiveness. Surgery is only used to ease symptoms and cannot on its own extend life expectancy.
Radiation for stage 4 prostate cancer. As with surgery, radiation therapy normally is not used on its own to attempt to cure or halt the progress of stage 4 prostate cancer. Instead, it is mainly used to treat pain.
How it works. A beam of radiation is focused onto specific cancer tumors, particularly ones that are causing pain or discomfort.How long it takes. Doctors typically use just one dose of radiation therapy to help relieve pain, although it can be repeated as needed.Effectiveness. Radiation may spare you the need for a lot of narcotic drugs, Brawley said. “It is amazing how well radiation helps with pain.”
Because new drugs are being developed all the time, you might also want to talk to your doctor about the possibility of joining a clinical trial for treatment with an experimental medication or other therapy.
