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Metastatic Prostate Cancer Hormonal Therapy

Androgen deprivation therapy and modern combinations in advanced prostate cancer.

Written by: Saygı Hospital Health Guide Editorial Board
Last updated:

This content has been compiled by the Saygı Hospital Health Guide Editorial Board and is periodically reviewed by a specialist physician.

References (5)

This content is for informational purposes only and does not constitute medical advice. You can book an appointment at our Üroloji department. Book Appointment →

What is Metastatic Prostate Cancer Hormonal Therapy?

Metastatic prostate cancer (mPCa, mHSPC = metastatic hormone-sensitive prostate cancer) is the disease state where prostate cancer has spread to lymph nodes, bones, or visceral organs. Hormonal therapy (androgen deprivation therapy, ADT) is the cornerstone because prostate cancer initially shows androgen-dependent growth.

ADT options: surgical castration (bilateral orchiectomy - irreversible, rapid effect), LHRH agonists (leuprolide, goserelin - tumor flare must be considered, anti-androgen cover), LHRH antagonists (degarelix, relugolix - rapid effect, no flare), CYP17 inhibitor (abiraterone + prednisone). The treatment goal is testosterone level <50 ng/dL (preferably <20 ng/dL).

Modern intensified ADT combinations have proven effective in mHSPC: ADT + docetaxel (CHAARTED, STAMPEDE - especially high-volume), ADT + abiraterone (LATITUDE, STAMPEDE), ADT + enzalutamide (ARCHES, ENZAMET), ADT + apalutamide (TITAN). Triple therapy (ADT + docetaxel + abiraterone/darolutamide - PEACE-1, ARASENS) provides additional benefit. Median survival has been extended from 30 months in the ADT-only era to >60 months.

Symptoms

Bone metastasis: bone pain, pathologic fracture, spinal cord compression
Lymph node metastasis: lymphedema, urethral obstruction
Visceral metastasis (liver, lung): organ-related symptoms
Side effects of ADT: hot flashes, sweating
Loss of libido, erectile dysfunction
Osteoporosis, fracture risk
Sarcopenia, muscle weakness
Cognitive change, depression
Cardiometabolic findings: weight gain, insulin resistance
Hot flashes, fatigue

Risk Factors

PSA >20 ng/mL at diagnosis
Gleason 8-10 (high-grade)
Cribriform pattern, intraductal carcinoma
Multiple bone metastases (>4 lesions)
Visceral metastasis (liver, lung)
Family history (BRCA1/2, ATM mutation)
African ethnicity
Untreated localized cancer
Castration-resistant transition risk: short PSADT, visceral metastasis
Genetic susceptibility (HRR pathway mutations)

When to See a Doctor?

If you experience any of the following symptoms, seek medical attention promptly:

  • Severe bone pain (especially night, at rest)
  • Sudden lower extremity weakness, paresthesia (spinal cord compression - emergency)
  • Pathologic fracture
  • Hematuria, urinary obstruction
  • Sudden deterioration after starting hormonal therapy (tumor flare)
  • Cardiac symptoms during ADT
  • Severe hot flashes, depression interfering with daily life

Treatment Methods

01
ADT: LHRH antagonist (degarelix, relugolix) - first-line
02
LHRH agonist (leuprolide, goserelin) + first-month antiandrogen cover
03
Bilateral orchiectomy (rapid effect, low cost)
04
Combination: ADT + docetaxel 75 mg/m² × 6 cycle (high volume)
05
ADT + abiraterone 1000 mg + prednisone 5 mg (LATITUDE)
06
ADT + enzalutamide 160 mg (ARCHES)
07
ADT + apalutamide 240 mg (TITAN)
08
Triple: ADT + docetaxel + darolutamide (ARASENS)
09
Bone-modifying agent: zoledronic acid or denosumab (CRPC)
10
Calcium-vitamin D, weight-bearing exercise (osteoporosis prevention)
11
PSA, testosterone, ALP, scintigraphy/PSMA-PET follow-up every 3 months
12
Genetic test (BRCA, MSI - olaparib, immunotherapy candidacy)
13
Multidisciplinary urology-oncology council

Which Department to Visit?

You can visit our Üroloji department for these complaints. Our specialist physicians will create the most suitable treatment plan for you.

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Health Disclaimer: The information on this page is prepared for general informational purposes only. It does not replace medical diagnosis and treatment. Please consult your physician for your complaints. Saygı Hospital does not accept responsibility for actions taken based on the information on this page.