Quick Answer: What Drugs Are Used for Prostate Cancer?
Modern prostate-cancer drug treatment is much broader than “hormone therapy and chemotherapy.” Depending on the stage, previous treatment, symptoms, imaging and tumour genetics, treatment may include:
- androgen deprivation therapy (ADT) with an LHRH/GnRH agonist or antagonist;
- androgen-receptor pathway inhibitors (ARPIs) such as abiraterone, enzalutamide, apalutamide or darolutamide;
- chemotherapy such as docetaxel or cabazitaxel;
- PARP inhibitors and other biomarker-directed drugs for selected genetic alterations;
- radioligand therapy such as lutetium-177 PSMA therapy (Pluvicto) in appropriately selected PSMA-positive disease;
- radium-223 in selected patients with bone-predominant metastatic disease;
- sipuleucel-T in selected metastatic castration-resistant disease; and
- other biomarker-directed treatments in uncommon molecular subgroups.
There is no single “best prostate cancer drug.” The correct regimen depends on whether disease is localized, locally advanced, metastatic hormone-sensitive, non-metastatic castration-resistant or metastatic castration-resistant.
2026 guideline note: Metastatic hormone-sensitive disease and castration-resistant disease have different treatment pathways. When disease becomes castration resistant, ADT is generally continued. Drug choice depends on prior therapies, symptoms, performance status, genomic results and availability. Discuss early germline and tumor testing; eligibility for PARP inhibitors or PSMA radioligand therapy is specific, not universal. See the EAU treatment guideline.
Prostate Cancer Drug Treatment Has Changed Dramatically
The old version of this page divided prostate-cancer medicines into only three groups: hormone therapy, chemotherapy and an herbal mixture called PC-SPES.
That framework is now obsolete.
Modern treatment increasingly combines systemic medicines earlier, uses tumour genetics to select targeted therapy and uses PSMA imaging to identify men who may benefit from radioligand treatment.
In the United States, prostate cancer remains the second-leading cause of cancer death in men, after lung cancer. However, many prostate cancers are localized and highly treatable, while modern systemic therapy has substantially expanded options for advanced disease.
Do All Men With Prostate Cancer Need Drugs?
No.
Drug therapy is only one part of prostate-cancer management.
Depending on stage and risk, options can include:
- active surveillance;
- radical prostatectomy;
- radiotherapy;
- systemic drug treatment;
- or combinations of these approaches.
Many men with low-risk localized prostate cancer do not need immediate medication at all.
Read our prostate cancer stages guide to understand how stage, PSA and Grade Group influence treatment planning.
1. Androgen Deprivation Therapy (ADT)
Most prostate cancers depend at least partly on androgen-receptor signaling.
ADT reduces testosterone to a castrate range or blocks the body’s production/signaling of androgens.
Medical ADT commonly uses:
- GnRH/LHRH agonists such as leuprolide;
- GnRH antagonists such as degarelix; or
- oral GnRH antagonists such as relugolix.
Surgical removal of the testicles (orchiectomy) can produce a similar testosterone-lowering effect but is irreversible.
When Is ADT Used?
ADT can be used:
- with radiotherapy for selected intermediate-, high-risk or locally advanced disease;
- for regional lymph-node-positive disease;
- for metastatic hormone-sensitive disease;
- after recurrence in selected situations; and
- as the ongoing hormonal backbone when prostate cancer becomes castration-resistant.
ADT does not have a universal “85–90% tumour shrinkage” rate. Response varies substantially among patients and disease states.
Important ADT Side Effects
Possible long-term adverse effects include:
- hot flashes;
- loss of libido;
- erectile dysfunction;
- loss of muscle mass;
- weight and metabolic changes;
- insulin resistance/diabetes risk;
- bone loss and fractures;
- fatigue;
- anemia; and
- possible cardiovascular effects in susceptible patients.
Current EAU guidance recommends monitoring bone health, PSA, testosterone, kidney function, metabolic risk factors and treatment complications during long-term ADT.
2. Modern Androgen-Receptor Pathway Inhibitors (ARPIs)
Modern ARPIs suppress prostate-cancer androgen signaling more effectively than older anti-androgens.
| Drug | How it works | Examples of current use | Important adverse effects |
|---|---|---|---|
| Abiraterone | Blocks CYP17 and androgen synthesis. | Used with prednisone/prednisolone in several advanced-disease settings. | Hypertension, low potassium, fluid retention, liver abnormalities. |
| Enzalutamide | Potent androgen-receptor inhibitor. | Used in metastatic hormone-sensitive, non-metastatic CRPC and mCRPC settings. | Fatigue, falls, hypertension, drug interactions; rare seizures. |
| Apalutamide | Potent androgen-receptor inhibitor. | Used in metastatic hormone-sensitive disease and high-risk non-metastatic CRPC. | Rash, fatigue, falls/fractures, hypothyroidism. |
| Darolutamide | Androgen-receptor inhibitor with limited blood-brain-barrier penetration. | Used in metastatic hormone-sensitive disease and non-metastatic CRPC. | Fatigue and drug-specific interactions/adverse effects. |
3. Metastatic Hormone-Sensitive Prostate Cancer: ADT Alone Is Usually Not Enough
One of the biggest changes in prostate-cancer treatment is that medically fit men with newly diagnosed metastatic hormone-sensitive disease are generally offered treatment intensification.
Current EAU guidance recommends ADT combined with an appropriate ARPI such as:
- abiraterone plus prednisone;
- apalutamide;
- enzalutamide; or
- darolutamide in appropriate patients.
For selected chemotherapy-fit men—especially some with de novo, high-volume or high-risk metastatic disease—a triplet regimen may be discussed:
- ADT;
- docetaxel; and
- an ARPI such as abiraterone or darolutamide.
Current EAU guidance does not recommend ADT monotherapy for most fit men presenting with metastatic disease when combination therapy is appropriate.
4. Chemotherapy
Docetaxel
Docetaxel remains an important chemotherapy for prostate cancer.
It is used in:
- selected metastatic hormone-sensitive disease as part of combination/triplet treatment; and
- metastatic castration-resistant prostate cancer (mCRPC), particularly when cytotoxic therapy is appropriate.
Possible side effects include:
- low white-blood-cell counts and infection risk;
- fatigue;
- hair loss;
- neuropathy;
- nail changes;
- fluid retention; and
- other chemotherapy toxicities.
Cabazitaxel
Cabazitaxel is an important later-line chemotherapy option, particularly after prior docetaxel.
EAU strongly recommends cabazitaxel for appropriate men previously treated with docetaxel, and it is particularly valuable when mCRPC progresses quickly after an ARPI.
5. Non-Metastatic Castration-Resistant Prostate Cancer
Castration-resistant prostate cancer means the disease progresses despite testosterone already being suppressed to the castrate range.
When conventional imaging shows no metastases but PSA is rising rapidly, current guideline-supported options for men at high metastatic risk include:
- apalutamide;
- darolutamide; or
- enzalutamide.
ADT is continued while one of these drugs is added.
6. PARP Inhibitors and Genetic Testing
Modern advanced prostate-cancer treatment increasingly depends on genomic testing.
Some prostate cancers contain mutations in homologous-recombination repair genes such as BRCA1 or BRCA2.
Depending on the exact mutation, previous treatment and regulatory indication, PARP-based options may include:
- olaparib;
- rucaparib;
- olaparib combined with abiraterone;
- niraparib combined with abiraterone; or
- talazoparib combined with enzalutamide.
These medicines are not interchangeable for every patient. Genetic eligibility and prior therapies matter.
7. Newer Biomarker-Directed Therapy: PTEN-Deficient Disease
In June 2026, the FDA approved capivasertib (Truqap) with abiraterone and prednisone for adults with metastatic androgen-pathway-modulation-naïve/sensitive prostate cancer whose tumours are PTEN-deficient by an FDA-authorized test.
This is another example of prostate cancer moving toward biomarker-selected therapy rather than one treatment for everyone.
8. PSMA-Targeted Radioligand Therapy — Pluvicto
Lutetium Lu 177 vipivotide tetraxetan (Pluvicto) carries radioactive lutetium directly to prostate-cancer cells expressing PSMA.
A PSMA PET scan is used to determine whether enough tumour expresses the target.
Pluvicto was initially used primarily in advanced PSMA-positive mCRPC.
Its role has expanded substantially:
- in March 2025 the FDA expanded its mCRPC indication to selected patients after an ARPI who were appropriate to delay taxane chemotherapy; and
- on July 31, 2026, the FDA approved Pluvicto with ARPI therapy for adults with PSMA-positive metastatic androgen-pathway-modulation-naïve/sensitive prostate cancer.
This July 2026 approval is one of the most important recent changes in systemic prostate-cancer treatment.
9. Radium-223
Radium-223 is a radioactive medicine that targets areas of increased bone turnover.
It can be used in selected men with castration-resistant prostate cancer involving bone, particularly when there are no visceral metastases and the treatment setting is appropriate.
It is not a general treatment for every patient with bone metastases.
10. Sipuleucel-T
Sipuleucel-T is an autologous cellular immunotherapy available for selected men with metastatic castration-resistant prostate cancer who are asymptomatic or only minimally symptomatic.
It is not conventional chemotherapy and is not suitable for every advanced patient.
11. Pembrolizumab and Rare Molecular Subgroups
A small proportion of prostate cancers have molecular abnormalities such as:
- microsatellite instability-high (MSI-H); or
- mismatch-repair deficiency (dMMR).
These abnormalities can create eligibility for immune-checkpoint therapy such as pembrolizumab under tumour-agnostic FDA indications.
This is another reason molecular testing matters in advanced disease.
12. Bone-Directed Medicines
Prostate cancer and long-term ADT can both affect bone.
Depending on the clinical setting, doctors may use medicines such as:
- denosumab; or
- zoledronic acid.
These drugs are used to reduce skeletal complications in appropriate advanced-disease settings or to manage treatment-related osteoporosis/fracture risk when indicated.
They are not direct substitutes for anticancer systemic therapy.
How Are Drugs Chosen for Metastatic Castration-Resistant Prostate Cancer?
There is no universal sequence.
Current guideline-based treatment selection considers:
- previous ADT/ARPI treatment;
- previous chemotherapy;
- how rapidly the cancer progressed;
- symptoms;
- performance status and frailty;
- bone-only versus visceral disease;
- PSMA PET findings;
- BRCA/HRR and other genomic findings;
- blood counts and organ function;
- other medical conditions; and
- patient preferences.
EAU specifically advises against simply sequencing one androgen-receptor-targeted drug after another when cross-resistance makes benefit unlikely.
Do Hormone Drugs Cure Advanced Prostate Cancer?
Usually not by themselves.
ADT and ARPIs can produce major and sometimes prolonged responses, but metastatic prostate cancer eventually develops resistance in many patients.
The aim of modern systemic therapy is to:
- prolong survival;
- delay progression;
- prevent complications;
- reduce cancer-related symptoms; and
- maintain quality of life as much as possible.
See our comprehensive advanced prostate cancer guide.
What Happened to PC-SPES?
The old version of this page listed PC-SPES as one of three main prostate-cancer drug categories.
It should no longer be presented as a treatment option.
PC-SPES was an eight-herb product formerly promoted for prostate cancer. NCI reports that some batches were found to contain prescription drugs including:
- diethylstilbestrol (DES);
- warfarin; and
- indomethacin.
The product was withdrawn from the market, the original manufacturer is no longer operating and PC-SPES is not FDA-approved for cancer treatment.
Is There a “Best” Prostate Cancer Drug?
No.
A drug that is highly appropriate for one patient may be ineffective or unsafe for another.
Examples:
- BRCA-mutated disease may make a PARP inhibitor especially relevant;
- PSMA-positive disease may make radioligand therapy possible;
- PTEN-deficient disease may now qualify for capivasertib-based treatment in a specific setting;
- a chemotherapy-fit patient with aggressive de novo metastatic disease may be considered for triplet treatment; and
- an older frail patient may require a very different balance of efficacy and toxicity.
Questions to Ask Your Oncology Team
- What exact stage and disease state do I have?
- Is my cancer still hormone-sensitive or is it castration-resistant?
- Should I receive ADT alone or combination treatment?
- Would an ARPI improve my outcome?
- Am I fit enough for docetaxel or cabazitaxel?
- Have I had germline and tumour genetic testing?
- Do I have a BRCA/HRR, MSI/MMR or PTEN alteration that changes treatment?
- Should I have PSMA PET imaging?
- Could I qualify for Pluvicto?
- How will we protect my bones, heart and metabolic health during treatment?
The most important change in prostate-cancer drug treatment is that we no longer choose medicines from one simple list. Treatment is increasingly determined by the disease state, previous therapies, PSMA imaging and the genetic characteristics of the tumour.
For metastatic hormone-sensitive prostate cancer, ADT alone is no longer the preferred approach for most fit patients. Adding an androgen-receptor pathway inhibitor—and in selected men chemotherapy—can improve outcomes.
Later in the disease course, genetic testing and PSMA imaging may open the door to PARP inhibitors, radioligand therapy and other targeted treatments. This makes reassessment important each time the disease changes.
Medical References
European Association of Urology. Prostate Cancer Guidelines, 2026: localized, locally advanced, metastatic hormone-sensitive, non-metastatic CRPC and metastatic CRPC systemic therapy.
U.S. Food and Drug Administration. Oncology approval notices, including July 31, 2026 Pluvicto + ARPI approval for PSMA-positive metastatic androgen-pathway-modulation-naïve/sensitive prostate cancer and June 12, 2026 capivasertib + abiraterone/prednisone approval for PTEN-deficient disease.
National Cancer Institute. PC-SPES PDQ: contamination, market withdrawal and lack of FDA approval.
American Cancer Society. Cancer Facts & Figures 2026.
Last evidence update: September 2026.
Medical information notice: Prostate-cancer drug selection is highly individualized and can change as the disease evolves. This article is educational and does not replace treatment planning by an oncology/urology team.