Treatment of Distant (Metastatic) Disease

Virginia Mason’s expert team uses a holistic approach to treat patients with prostate cancer, giving them the best chances of a positive outcome. Our treatment options include:

Hormone Therapy

These therapies block a patient’s source of testosterone, significantly slowing prostate cancer cells’ ability to grow. We often use this treatment for patients whose prostate cancer has spread to other parts of the body or has recurred despite treatment. We also use hormone therapy with radiation therapy for intermediate or high-risk localized prostate cancer because it enhances the effects of radiation on prostate cancer cells.

We administer hormone therapies in one of two ways:


This operation removes a patient’s testicles. Although it is a surgical treatment, orchiectomy is considered a hormonal therapy because it works by removing the main source of male hormones. Orchiectomy temporarily prevents or reduces the growth of most prostate cancers.

Orchiectomy Side Effects

Ninety percent of men who have had this operation have reduced or absent libido and impotence. Many men have hot flashes after surgery but these usually go away with time. Breast tenderness and growth of breast tissue may occur.

Luteinizing Hormone-releasing Hormone (LHRH) Analogs (Zoladex®, Lupron® or Viadur®)

These drugs decrease the amount of testosterone the testicles produce. Doctors perform injections monthly, quarterly or annually, depending on the patient. The drugs lower the level of testosterone as effectively as surgical removal of the testicles and are reversible.

Hormone Drug Side Effects

Side effects include reduced or absent sexual desire and impotence. Some men also have hot flashes, breast tenderness and growth of breast tissue. Long-term use of these medications also can cause osteoporosis, lowering of the red blood cell count (anemia), muscle atrophy or wasting, and fatigue.

Anti-androgens (Casodex® or Flutamide®)

Even after orchiectomy or during treatment with LHRH analogs, adrenal glands still produce a small amount of androgen, a male sex hormone. This is why doctors often prescribe anti-androgens pills, inhibiting prostate cancer by blocking the body’s ability to use androgens.

We often use this therapy in combination with orchiectomy or LHRH analogs. Doctors may also prescribe anti-androgens to block the temporary increase in testosterone “flare” with LHRH analogs.

Anti-androgens Side Effects

Side effects of anti-androgens in patients already treated with an orchiectomy or with LHRH agonists include diarrhea, loss of energy and nausea. Anti-androgens can also cause inflammation of the liver.

Intermittent Hormonal Therapy

All prostate cancer treated with hormonal therapy eventually becomes resistant to this treatment over a period of months or years. That’s why scientists are exploring the benefits of intermittent hormonal therapy. With this therapy, physicians closely monitor a patient’s PSA levels, only administering hormone therapy when PSA levels start to rise.


Chemotherapy destroys cancer cells. The role of this therapy is evolving as newer medicines are developed. Traditionally, chemotherapy is used for patients who have prostate cancer cells that have spread and after hormonal therapy has failed. However, chemotherapy is being evaluated in research settings for earlier-stage disease to see if it can be effective for patients at high risk for spread outside the prostate.

Chemotherapy Side Effects

The side effects of chemotherapy depend on the type of drugs used, the amount taken and the length of treatment. Temporary side effects include nausea, vomiting, loss of appetite, loss of hair and mouth sores. Because chemotherapy inhibits the bone marrow, patients may have low blood cell counts. This can result in an increased chance of infection, bleeding, bruising and fatigue. Most side effects disappear after treatment.