Treatment Guideline Chart

Prostate cancer is the cancer that occurs in the male's prostate.

It is the most common cancer in men >50 years of age.

Signs and symptoms include weak urinary stream, polyuria, nocturia, hematuria, erectile dysfunction, pelvic pain, back pain, chest pain, lower extremity weakness or numbness and loss of bowel or bladder control.

Supportive Therapy

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


  • 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
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