Prostate Cancer

Diagnosed With Metastatic Castration-Resistant Prostate Cancer: What’s Next?

If you have metastatic castration-resistant prostate cancer, the hormone therapy you’ve been taking is no longer controlling the disease as it should. Here’s what you should know.
Diagnosed With Metastatic Castration-Resistant Prostate Cancer: What’s Next?
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Updated on March 20, 2025
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The term metastatic castration-resistant prostate cancer (mCRPC) refers to a cancer that has spread (metastasized) beyond your prostate gland and for which hormone therapy is no longer effective in stopping or slowing the progression of the cancer. In the past, this was known as hormone-refractory and androgen-independent prostate cancer, but these terms are rarely used now.

This type of prostate cancer can be very hard to treat, even when doctors catch it early. “This cancer escapes control,” says Michael S. Cookson, MD, a urologic oncologist, as well as a professor of and the chair of urology at the University of Oklahoma College of Medicine in Oklahoma City. “[MCRPC is] like a car that keeps moving, even though you’re pushing on the brakes in the form of hormone therapy.”

It’s common for hormone therapy, known as androgen deprivation therapy (ADT) or “chemical castration,” to stop working after a few years. The goal of the therapy is to block testosterone from stimulating the cancer to keep growing. The term “castration resistant” refers to a cancer that is no longer responding to ADT.

According to some research, mCRPC accounts for about 1 to 2 percent of all prostate cancer cases worldwide.

 But it’s hard to pin down exact numbers, partly because newer, more sensitive imaging technologies are now able to find smaller cancer cells beyond the prostate gland that couldn’t be found before. So the same cancer that would have been considered nonmetastatic before is considered metastatic today, explains Scott T. Tagawa, MD, a medical oncologist at NewYork-Presbyterian Hospital and professor of urology at Weill Cornell Medicine in New York City.

“Our scans are getting better,” says Dr. Tagawa. “When we just had X-rays, we missed small things. Then we got MRIs and CT scans, and we still missed some things. But now that we have more specific PET scans, we can see things we couldn’t see before.” And finding cancer sooner means treating it sooner.

New Treatment Options for Metastatic Castration-Resistant Prostate Cancer

Treatment for mCRPC has undergone a quiet revolution in the past decade. Many new treatments can extend life expectancy and improve quality of life.

Even with the latest developments for mCRPC, treatment guidelines still recommend that most people stay on ADT and add on one of the latest approved therapies:

  • Lutetium Lu 177 vipivotide tetraxetan (Pluvicto) for mCRPC delivers radiation through an IV to cancer cells, with limited damage to surrounding tissues.
  • Talazoparib (Talzenna) is approved for use with enzalutamide (Xtandi) as a daily pill to treat cancers with homologous recombination repair (HRR), a gene mutation that occurs in about 25 percent of people with mCRPC.

  • Docetaxel (Taxotere), a type of chemotherapy, was the first approved therapy to prolong survival for men with mCRPC.
  • Cabazitaxel (Jevtana), a chemotherapy given along with prednisone, is an option when docetaxel is ineffective.
  • Sipuleucel-T (Provenge) processes your immune cells outside the body, essentially turning them into a vaccine. The processed cells are then returned to your body during treatments several times a week. It’s primarily for men who have few or no cancer symptoms.
  • Abiraterone acetate/niraparib (Akeega) and enzalutamide (Xtandi) are hormone therapies for mCRPC that target male hormones in different ways than traditional hormone therapies. They are given as pills and have been shown to lengthen survival.
  • Radium Ra 223 dichloride (Xofigo) is an infusion of radioactive material that attacks the cancer cells within bones.

What Kind of Doctor Treats mCRPC?

Metastatic castration-resistant prostate cancer is a complicated disease, and treatment for it may be different for each person. That’s why it’s important to have a team of doctors and specialists to keep your treatment — and you — on track.

Your oncology team may include doctors specializing in different areas of oncology, such as radiation oncology and medical oncology, as well as urologists, nurse practitioners, nutritionists, and other health specialists. And with so many new treatments coming on board, doctors must consider several factors, including your symptoms, personal preferences, and other health conditions, when figuring out your best next steps.

It’s also important for your care team to review the medicines you’ve already taken for prostate cancer and plan the sequence of the treatments you’ll take next. Getting the order right is crucial, because certain drugs can make subsequent treatments for mCRPC either more or less effective.

Your care team should watch you closely to determine whether you have resistance to any medications, so they can make changes quickly if necessary.

You’ll also want key specialists to talk to each other about your treatment options before you start a new therapy, so they can determine exactly how your cancer is progressing and interpret results from imaging tests. Your care team should come up with an individualized treatment plan that considers the different benefits and risks, as well as the costs, of your options. It should also include any clinical trials to consider.

Quality of Life With Metastatic Castration-Resistant Prostate Cancer

People with mCRPC, or any advanced prostate cancer, may experience urinary problems, bone pain, fatigue, and weight loss — or possibly no symptoms at all. It’s different for everyone and depends largely on the size of the growth and where the cancer has spread.

Be sure to talk to your doctors about any symptoms and side effects you’re experiencing, so they can find the right ways to alleviate them. You should also ask your care team about options for palliative care, which is focused on relieving pain and other symptoms.

Because it can be very stressful to have advanced prostate cancer, it’s important to have an open and honest conversation with your care team. Discuss what you’re worried about and what’s important to you.

The Takeaway

  • Metastatic castration-resistant prostate cancer is an advanced prostate cancer that has already spread and isn’t responding to hormone therapy.
  • Recent advancements in treatments for mCRPC offer promising options that can improve your longevity and quality of life.
  • Always communicate openly with your healthcare team about your symptoms and treatment plans to find the most effective approach for you.

Additional reporting by Andrea Peirce and Larry Buhl.

EDITORIAL SOURCES
Everyday Health follows strict sourcing guidelines to ensure the accuracy of its content, outlined in our editorial policy. We use only trustworthy sources, including peer-reviewed studies, board-certified medical experts, patients with lived experience, and information from top institutions.
Resources
  1. Hormone Therapy for Prostate Cancer. National Cancer Institute. October 4, 2024.
  2. Shore N et al. Systematic Literature Review of the Epidemiology of Advanced Prostate Cancer and Associated Homologous Recombination Repair Gene Alterations. The Journal of Urology. April 1, 2021.
  3. Health Professionals Who Are Part of a Cancer Care Team. American Cancer Society. August 8, 2024.
  4. Prostate Cancer — Advanced. Urology Care Foundation. April 2024.
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