A guide to prostate cancer therapy

Finding out you have prostate cancer can be stressful and overwhelming. Many find it difficult to cope with all the new information and decisions in front of them.

Doing some research into your cancer can help you feel more in control. Better understanding your options gives you the means to reflect on your own goals and priorities so you feel empowered to take an active role in your cancer therapy.

We’ve made this easier for you by summarizing some important information and defining some key terms below.

What is prostate cancer?

Prostate cancer is a cancer that starts with the growth of a cancerous (also called “malignant”) tumour in your prostate.

Your prostate is a walnut-sized gland located below your bladder and in front of your rectum. Its job is to make a fluid that becomes part of semen.

Prostate cancer starts growing in prostate cells but over time can spread outside of the prostate.

What happens when prostate cancer spreads?

Over time, tumours can grow and spread outside your prostate into other parts of your body.

In advanced prostate cancer, tumours may be found in nearby organs, like your urethra or bladder. As the cancer progresses, tumours may be found farther away in places like your lymph nodes, bones, lungs, liver, or brain.

When your prostate cancer has spread to other parts of the body, it’s referred to as “metastatic.”

What are my treatment options for advanced prostate cancer?

Several different types of treatments can be used for advanced prostate cancer. Prostate cancer therapy is very personalized. Your treatment plan should be determined through a collaborative conversation between you and your doctor.

Which treatments are right for you depend on a few factors, like the stage and type of your cancer, your symptoms, your age and overall health, the possible side effects of each treatment, and your personal priorities and preferences.

“Androgens”, such as testosterone, are hormones that mainly come from the testicles and help prostate cancer cells to grow.

There are several therapies that work by lowering the amount of testosterone in your body. This leads to decreased symptoms associated with prostate cancer.

These therapies might be referred to by doctors as “androgen deprivation therapy” or “ADT.”

Other therapies can be taken in addition to ADT, after the failure of ADT, or after surgical castration. They work by blocking the activity of androgens or stopping your body from making androgens, which in turn helps slow the growth of prostate cancer.

These therapies are referred to as “androgen-receptor-axis-targeted therapies” or “ARATs.” Depending on how they work, they may be called “androgen synthesis inhibitors” or “anti-androgens.”

When prostate cancer has spread to other parts of the body, chemotherapy might be used.

Chemotherapy anticancer drugs are delivered through an intravenous (IV) infusion to stop the growth or division of cancer cells.

The specific drugs, doses, and schedule of chemotherapy are chosen by your doctor depending on your specific cancer.

Radiation therapy can be used in combination with other treatments. Radiation therapy involves using one of several different methods to aim high-energy rays or particles at cancer cells to destroy them.

What side effects are there with these treatments?

Like with any drug, side effects can happen with any type of prostate cancer treatment. Side effects can depend on the type of treatment, the dose you are taking, and what other medications you take. Side effects can also vary from person to person, where some people have many side effects while others have few or none at all. Your doctor can give you a list of the possible side effects specific to your treatment.

Here is a list of some of the side effects for each type of treatment:


Most common side effects:

  • General/joint/muscle/back pain
  • Hot flashes/sweats
  • Emotional/psychiatric changes
  • Worsening urinary symptoms
  • Reduced sex drive/impotence
  • Injection site reactions
  • Weight gain
  • Increase in blood liver enzymes
  • Decrease in testicular size

Serious warnings & precautions:

  • Worsening of prostate cancer symptoms at beginning of treatment
  • Bone thinning (called osteoporosis)
  • Changes in heart rhythm (QT prolongation)
  • Injection site injuries that can in rare cases cause severe bleeding


Most common side effects:

  • Fatigue
  • High blood pressure
  • Skin rash/dry skin/itch
  • Headaches
  • Vomiting/nausea/diarrhea
  • Changes in taste
  • Flu-like symptoms
  • Hot flash
  • Bruising
  • Fracture
  • Weight changes
  • Urinary tract infection
  • Joint pain/swelling
  • Mood changes

Serious warnings & precautions:

  • Seizures
  • Posterior reversible encephalopathy syndrome (reversible swelling in the back of the brain)
  • High blood pressure, low blood potassium, and peripheral edema (swelling of the legs or hands caused by retaining fluid)
  • Liver failure
  • Risk in people with history of heart problems

Most common side effects:

  • Nausea, diarrhea, vomiting, constipation
  • Fatigue
  • Hair loss, nail changes
  • Shortness of breath, cough
  • Change in sense of taste
  • Fever
  • Weakness
  • Rash
  • Decreased appetite
  • Sores in the mouth
  • Nerve/muscle/joint/back pain
  • Low blood platelets/red and white blood cell counts
  • Infections
  • Fluid retention
  • Blood in the urine
  • Injection site reactions

Serious warnings & precautions:

  • Severe or life-threatening allergic reactions
  • Gastrointestinal reactions (such as bleeding, perforation, enterocolitis) that can lead to death
  • Low white blood cell count that can be life-threatening
  • Higher risk of severe or life-threatening side effects in patients with liver disease
  • Risk of new (second) cancers, including blood cancers (such as acute myeloid leukemia)

Most common side effects:

  • Fatigue
  • Bowel problems (diarrhea, blood in stool, rectal pain/burning/leakage)
  • Bladder problems (frequent urination, burning with urination, urinary incontinence)
  • Sexual problems including erectile dysfunction
  • Pain and swelling between scrotum and rectum
  • Blood in urine

Please note that this list of side effects is not exhaustive.

Head and brain illustration

Brain fog and cancer.

Many people with cancer say they experience problems with mental tasks like concentrating, remembering things, or multitasking. This is colloquially called “brain fog.” Your doctor may call it “cancer-related cognitive impairment.”

Brain fog varies from person to person depending on different factors like age, mental health history, and the specific type of cancer and treatment(s). Everybody’s experience of brain fog is different, but it’s very common to feel frustrated. Sometimes the stress of a cancer diagnosis alone can cause brain fog. Sometimes brain fog is brought on by procedures or medications for your cancer.

Brain fog can be managed with help from your care team. If you or your close friends or family notice that you have signs of brain fog, you should let your doctor know so they can help you pinpoint the cause and find solutions.

When you better understand your stage/type of cancer and your treatment options, you and your doctor can collaboratively decide the best treatment plan for you.

It’s important to communicate all your questions and concerns to your doctor. Ask them to share their experience and expertise with each treatment option, such as the risks and benefits, how you get it, what the possible side effects are, and how it might affect your lifestyle.

It’s equally important to share your personal preferences and priorities when it comes to your cancer therapy and your lifestyle. Each person’s experience is unique. Sharing what you’ve learned with your doctor will ensure all your needs and concerns are being considered.

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Malignant tumour = A tumour that is cancerous. The opposite is “benign,” which describes a tumour or growth that isn’t harmful

Metastatic prostate cancer = When cancer has spread to distant parts of the body outside of the prostate

Androgens = Male hormones that are produced in the testicles and adrenal glands. E.g., testosterone

Androgen deprivation therapy (ADT) = Treatments that lower the amount of testosterone in the body

Androgen-receptor-axis-targeted therapies (ARATs)

Androgen synthesis inhibitors = ARATs that work by stopping androgens from being made

Anti-androgens = ARATs that work by blocking the activity of androgens

Cancer-related cognitive impairment = Difficulties communicating, thinking, learning, solving problems, and remembering things during cancer and/or cancer treatment