Prostate Cancer with Bone Metastasis: How Is It Treated as of 2026?

In metastatic prostate cancer that has spread to bone, hormone therapy forms the backbone of treatment, with the goal being long-term disease control rather than cure. This is typically combined with stronger agents or chemotherapy, bone-protective drugs, and palliative radiation therapy for pain relief.

Key Summary

• In metastatic prostate cancer, hormone therapy that blocks male hormones forms the core of treatment, and it has become standard practice to combine it with anti-androgen agents or chemotherapy from the outset.
• If bone metastasis is present, bone-protective drugs and pain-relieving radiation therapy are also considered as additional options.
• Once hormone therapy stops working, other drug classes, chemotherapy, or PSMA-targeted radioligand therapy are considered.
• If a genetic alteration such as BRCA is identified, a matched targeted therapy may be used.
• Korea's 5-year relative survival rate for prostate cancer is 96.9%, but this is a nationwide aggregate figure (National Cancer Registry Statistics 2019–2023) and does not predict individual outcomes at the metastatic stage.

How Is Bone Metastasis Confirmed?

• For higher-risk cases, bone scans or PSMA PET are used to check for metastasis to bone and lymph nodes. PSMA PET is an imaging test that detects metastasis using the PSMA target, and if conditions are met, it may lead to radioligand therapy using the same target.
• Cases that have spread to bone or other organs are classified as metastatic, and treatment is determined by considering PSA level, Gleason score (grade group), and stage together with risk group, age, life expectancy, and comorbidities.

What Is the Treatment Sequence for Metastatic Disease?

• Step 1: Hormone therapy that blocks male hormones is started. This comes in injectable and oral forms.
• Step 2: Combining a stronger anti-androgen agent or chemotherapy from the start is now the current standard approach.
• Step 3: If bone metastasis is present, bone-protective drugs and pain-relieving radiation therapy are added.
• Step 4: Once hormone therapy stops working, other drug classes, chemotherapy, or PSMA-targeted radioligand therapy are considered.
• Step 5: If a DNA repair gene alteration such as BRCA is present, a matched targeted therapy is considered.

What Are the Side Effects of Hormone Therapy?

• Hormone therapy can cause hot flashes, decreased libido, fatigue, loss of muscle mass with increased body fat, and decreased bone density. For this reason, it is common to combine exercise with regular bone density testing.
• When chemotherapy is given together, fatigue, low blood cell counts, and numbness in the hands and feet tend to come and go with each cycle. These effects vary by individual, and the care team adjusts medications and dosages based on symptoms.

FAQ — Can It Still Be Treated Even if It Has Spread to Bone?

Metastatic prostate cancer can be managed for a long time with hormone therapy as its core treatment. Combining drugs from the start has become standard, and bone-protective drugs together with pain-relieving radiation therapy are also used. However, it's important to understand that this stage is not aimed at a cure.

FAQ — I Was Only Recommended Hormone Therapy in Russia. Are There Other Options?

If no metastasis has been confirmed and the disease is still localized, curative-intent treatment with surgery or radiation may be possible in some cases. However, if bone metastasis has already been confirmed, hormone therapy remains the central treatment, and the remaining treatment direction can be clarified after a comprehensive review of the stage, risk group, and the duration of hormone therapy already received.

Sources and Notes

This article was written based on National Cancer Registry Statistics 2019–2023 (Central Cancer Registry, National Cancer Center Korea) and general information at the level of NCCN patient guidelines. This content is intended to provide general medical information, and actual diagnosis, treatment methods, and outcomes may vary depending on individual condition. Accurate diagnosis and treatment should always be determined through consultation with your medical team.