Pharmacological Therapy

• Palliative ADT can be given to patients who are high-risk, very high-risk, regional or metastatic prostate cancer with a life expectancy of ≤5 years and men with disease progression during observation 
• Mitoxantrone may be used for patients with symptomatic metastatic castration-resistant prostate cancer (CRPC) who have contraindications to Cabazitaxel or Radium-223 therapy
• Denosumab and bisphosphonates (eg Alendronate, Pamidronate, Zoledronic acid) may be suggested in patients with metastatic CRPC with bone metastasis to help prevent bone fractures, metastases, and other skeletal complications
• May use analgesics for painful bone metastases and corticosteroids if with spinal cord compression

Radiation Therapy

• Single fraction external beam radiation therapy (EBRT) is recommended for palliation of uncomplicated, painful bone metastasis 
• Recommended dose:
  • Non-vertebral metastases: 800 cGy x 1 fraction
  • Widespread bone metastases: Sr-89 or Sm-153 with or without focal EBRT

Referral

• Refer patient and his family to facilities that can provide palliative care services that can assist both the patient and his family while dealing with prostate cancer
• Referral to pain clinics or palliative care team may also help in the symptomatic management of prostate cancer patients