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Castration-resistant prostate cancer (CRPC)
Hearing that the cancer has become castration-resistant is hard, but it isn't the end of options. Many treatments can still help you feel well and spend time with the people you love.
ℹ️ General information to help you and your loved ones talk with your care team, not medical advice. Read our disclaimer.
The quick guide
What it means: The cancer grows even with very low testosterone. ADT usually continues, and other drugs are added.
How it's found: A rising PSA or growth on scans while testosterone is at castrate level. Genetic testing (BRCA and other repair genes, MSI) is recommended.
How common it is: Many men with advanced prostate cancer reach this stage after some time on hormone therapy.
How treatment works
🌱 Early-stage
- If there's no spread on standard scans (non-metastatic CRPC), apalutamide, darolutamide or Xtandi can delay spread.
🔁 Advanced or metastatic
- An AR drug not used before, or docetaxel or cabazitaxel chemo.
- PARP inhibitors such as Lynparza for BRCA or other repair-gene changes.
- Pluvicto (PSMA-targeted radioligand) for PSMA-positive cancer, radium-223 for bone spread, sipuleucel-T, and Keytruda for MSI-H.
Approvals depend on stage and prior treatment. Your care team will decide what fits you.
Drug guides
Biomarker tests that matter
- AR and PSMA
- BRCA1 and BRCA2
- HRD (homologous recombination deficiency)
- MSI-H / dMMR
- PSA (prostate-specific antigen)
Side effects you may notice
- Fatigue (extreme tiredness)
- Nausea and vomiting (CINV)
- Neutropenia (low blood counts and infection risk)
- Neuropathy (numbness and tingling)
- Distress (anxiety and worry)
❓ Questions you and your loved ones can ask
- Has my tumor had genetic testing?
- Am I a candidate for Pluvicto or a PARP inhibitor?
- How can we manage bone health?
Back to Prostate cancer overview. Other types: Hormone-sensitive prostate cancer, Early-stage prostate cancer by risk group.
Written by the Cancer Side Effects Guide team from FDA labels and leading cancer centers. Not medical advice. · Last updated: October 15, 2026 · How we write