Advanced prostate cancer: your questions answered about the disease affecting Bill Turnbull

RIP Bill Turnbull
January 1956 – August 2022

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What is advanced prostate cancer?

Advanced prostate cancer means some of the prostate cancer cells have moved away from the area around the prostate to further away – to bone, for example. You might also hear it called metastatic or secondary prostate cancer.

Even when prostate cancer cells are in a different area of the body, they’ll still look and behave like prostate cancer cells and so can respond to prostate cancer treatments. (Find out more details in this factsheet.)

How will I know if I have advanced prostate cancer?

Some men may experience no symptoms, while others' symptoms will depend on where the cancer is in the body. To diagnose advanced prostate cancer, men will have one or more whole-body scans. This might be a bone, CT, whole-body MRI or PET scan. (This factsheet talks about how prostate cancer is diagnosed.)

How is advanced prostate cancer treated?

Because prostate cancer cells have spread further away from the prostate, men with advanced disease need treatments that can reach the prostate cancer cells throughout the body (known as systemic treatment).

The standard first-line treatment is hormone therapy, usually combined with a chemotherapy drug called docetaxel, for men who are fit enough to have it. There are a series of other treatments men may have after this if needed (find out more about options after initial hormone therapy in this factsheet).

What is hormone therapy?

Testosterone (a hormone mainly produced by the testicles) stimulates prostate cancer cells to grow and divide. So hormone therapy aims to stop testosterone getting to prostate cancer cells, a bit like 'starving' them. There are several different types of hormone therapy, which you can read more about in this factsheet.

Men may experience side effects as a result of having low testosterone levels. They can include hot flashes (sweats), loss of libido (sex drive) and fatigue (tiredness). The degree to which men are affected varies. (Read more about side effects and some of the practical aspects of being on hormone therapy in this booklet.)

What is chemotherapy?

It refers to a large group of drugs used for different types of cancer. They work by damaging rapidly dividing cells, causing them to die. The most common chemotherapy drug for advanced prostate cancer is docetaxel. Treatment is given as a drip, once every three weeks, for six or 10 doses (called cycles). Some men may also go on to have another type of chemotherapy, called cabazitaxel. 

What are the side effects?

While most men will experience some (mostly mild) side effects, not every man will experience the same ones, or to the same extent. Common side effects of docetaxel include tiredness, taste changes, hair loss (which grows back after chemotherapy has finished), and effects on the bone marrow, which means men are more at risk of developing an infection.

Men are closely monitored throughout their course of chemotherapy. Treatment may be adjusted or delayed if a man experiences problems or side effects to minimise the chances of them happening again. Medication may also be prescribed to help with side effects. (Read more about chemotherapy in this factsheet.)

What is the aim of treatment for advanced prostate cancer?

The aim is to control the cancer for as long as possible with a sequence of treatments, since it's not currently possible to get rid of advanced prostate cancer altogether. How a man will respond to a particular treatment and for how long is very difficult to predict. Your oncology team will discuss any changes in how your cancer is responding to treatment with you.

How will I know if the treatment is working?

You’ll have regular visits to the clinic to discuss how you are and regular PSA tests, too – usually every three months to start with. After some time, you may have phone calls with a member of your hospital team rather than going in, or your PSA might be monitored by your GP.

If you have advanced prostate cancer, the PSA can occasionally go up and then come down again, so oncologists will usually look for a pattern over at least three readings before considering a change in treatments – unless a man has other signs or symptoms. Some men will also have scans, especially if their PSA rises or they develop new or worsening symptoms which may be caused by cancer.

What happens if my first treatment stops working?

There are a series of treatments which men may have, including anti-androgens (usually bicalutamide), a new type of hormone therapy (either abiraterone or enzalutamide), radium 223 for men who have bone pain, and further chemotherapy (such as cabazitaxel) or radiotherapy. (Read more about these options in this factsheet.

What about clinical trials?

Your hospital team may talk to you about clinical trials or you can ask about them if you’re interested. Participation is voluntary, and information about a trial should be provided in an unbiased way to help you decide if you want to be involved. Not all men will be suitable for every trial, and men can be referred to another hospital if a trial isn’t available locally.

You can find a list of clinical trials on Cancer Research UK’s website, along with the Clinical Trials Gateway. Trials open and close regularly so the list will often change. Our factsheet can also tell you more.

What can I do to help myself?

Eating a healthy diet – with plenty of fresh fruit and vegetables – and being active has been shown to be beneficial for men with advanced prostate cancer. They help combat fatigue, minimise weight gain, keep bones strong, improve muscle strength and lift your mood. (Read more about diet and activity in this factsheet and our booklet about living with prostate cancer.)

My mood is low – what can I do?

It’s normal to feel low, tearful or angry from time to time if you’ve been diagnosed with advanced prostate cancer. But for some men, these feelings become overwhelming. Don’t be afraid to ask for help. There is lots of support out there, and the right kind of support can have a dramatic effect on how you feel.

As well as telling your GP and hospital team how you’re feeling, you can contact our Specialist Nurses free on 0800 074 8383 to talk things through. Eating well, staying active and setting goals can also help with mood. Macmillan Cancer Support have some useful online information about dealing with emotions.

Some people find it helpful talking to others who are going through the same thing. So you might like to consider going to a support group, joining our online community or speaking to a trained One-to-one support volunteer.

I’m supporting someone with advanced prostate cancer. Where can I get information and support?

If you’re close to someone with advanced prostate cancer, you might find this publication helpful. Our Specialist Nurses are also here to support you, not just the man who has been diagnosed. We also have One-to-one support volunteers with experience of caring for men with advanced prostate cancer, and you can chat to others in a similar situation on our online community. 

Speak to your GP if you’re struggling with supporting a loved one, as it’s important you look after yourself too.