Overview of treatment for advanced prostate cancer

INTRODUCTION

Widespread use of screening using serum prostate specific antigen (PSA) has led to an increasing proportion of prostate cancers that are localized at diagnosis, and fewer patients present with metastatic disease. As an example, between 1984 and 1991, 30 to 40 percent of men presented with advanced disease [1]; at present, only 5 percent have distant metastases at the time of diagnosis [2]. (See "Screening for prostate cancer", section on 'Effectiveness of prostate cancer screening'.)

Despite the more frequent diagnosis of treatment of prostate cancer at an early stage, the majority of men whose disease recurs do not have a potentially curative treatment option. Prostate cancer remains the second most common cause of cancer death in men in the United States.

An overview of treatment approaches for men with advanced prostate cancer is presented here. More detailed discussions of individual aspects of treatment are discussed in other topics as noted below. An overview of treatment for localized disease is presented separately. (See "Overview of treatment for clinically localized prostate cancer".)

CLINICAL SETTINGS

The choice and timing of systemic therapy for men with prostate cancer depends upon the extent of disease, as well as the history of prior treatment.

Metastatic disease — For men with disseminated disease, bone metastases are the most common site of involvement. The objective of therapy is control of disease while maintaining quality of life. The initial approach is generally androgen deprivation therapy (ADT). (See 'Androgen deprivation' below.)