Prostate cancer: metastasis and treatment

Once cancer has spread to other parts of the body, it is impossible to get rid of it entirely. The purpose of treatment is to halt its progression and to reduce the impact of the cancer on vital functions. 

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Surgery and radiotherapy for the prostate alone are not sufficient. Hormone therapy needs to be resorted to. Prostate cancer develops under the influence of testosterone, i.e. it is hormone-dependent. Treatment still consists of suppressing the production of testosterone in order to slow down the progression of the cancer. 

This is done by means of castration. This can take place surgically: the surgeon removes the area of the testicles that produces testosterone. This may also be achieved through pharmaceutical treatment with molecules called “LHRH agonists” or LHRH antagonists”, which are sometimes combined with antiandrogens (testosterone is an androgen). 
This stops the prostate cancer from progressing for several years. 
If this hormonal treatment is not enough, it will be necessary to resort to chemotherapy. 
 
Where metastases develop in the bones, the patient may experience severe bone pain. The doctor may also prescribe medications called bisphosphonates that firstly alleviate pain and secondly reduce the risk of fractures. 
 
Monitoring after treatment involves measuring PSA levels, potentially in addition to a rectal examination. Follow-up generally takes place between six weeks and three months after treatment. 
It is repeated every six months but can take place every three months in the case of elevated PSA. The probability of prostate cancer reoccurring is highest over the first five years.