Yes, there are several pills used to treat prostate cancer. In fact, oral medications now play a central role at nearly every stage of the disease, from early cases that haven’t spread to advanced cancer that no longer responds to standard hormone suppression. The specific pill your doctor recommends depends on the stage, how the cancer is behaving, and in some cases your genetic profile.
Hormone Therapy in Pill Form
Most prostate cancers depend on testosterone to grow. The oldest approach to cutting off that fuel supply involved injections given at a doctor’s office every one to three months. Since 2020, an oral alternative called relugolix has offered the same testosterone suppression in a once-daily pill taken at home. In a large phase 3 trial, relugolix achieved superior sustained testosterone suppression compared to the standard injection (leuprolide). It also suppresses testosterone within hours of the first dose and allows levels to bounce back quickly once treatment stops, which matters for quality of life and sexual function. Injectable versions can take months or even years for testosterone to normalize after discontinuation.
When surveyed, patients across all subgroups preferred a daily pill at home over injections every few months at a clinic. Mode of administration was the single most influential factor in treatment choice, accounting for 30 to 40 percent of the variation in what patients preferred.
Anti-Androgen Pills
A newer class of oral drugs blocks testosterone from reaching cancer cells directly, rather than lowering testosterone levels in the blood. Three of these second-generation anti-androgens are FDA-approved: enzalutamide, apalutamide, and darolutamide. All three are daily pills, and each has been tested across different stages of prostate cancer.
Enzalutamide has the broadest set of approvals, covering cancer that has spread and is still responding to hormone therapy, cancer that has stopped responding but hasn’t yet spread visibly, and metastatic cancer that no longer responds to hormone treatment at all. Darolutamide covers a similar range. Apalutamide is approved for non-metastatic cancer that has become resistant to standard hormone therapy.
The survival benefits are significant. In the ARAMIS trial, darolutamide extended the time before cancer spread by a median of 22 months compared to placebo (40.4 months versus 18.4 months). The other two drugs showed comparable benefits in their respective trials. These pills are typically added on top of ongoing testosterone suppression therapy, not used alone.
Abiraterone: Blocking Testosterone Production
Abiraterone works differently from the anti-androgens above. Instead of blocking the testosterone receptor on cancer cells, it shuts down an enzyme the body uses to manufacture testosterone in the first place. This hits testosterone production not just in the testicles but also in the adrenal glands and within tumor tissue itself.
There’s one catch: because abiraterone disrupts hormone production broadly, it also lowers cortisol, a hormone your body needs for basic metabolic functions. To compensate, it’s always taken alongside a low-dose steroid pill (prednisone, twice daily) that replaces the missing cortisol. So abiraterone means two pills rather than one, but both are oral and taken at home.
Targeted Pills for Specific Genetic Mutations
Some prostate cancers carry mutations in genes responsible for repairing damaged DNA, most notably BRCA1 and BRCA2 (the same genes linked to breast and ovarian cancer risk). For men whose advanced cancer has these mutations, a class of oral drugs called PARP inhibitors can be effective. These pills exploit the cancer’s inability to fix its own DNA, causing tumor cells to die.
Two PARP inhibitors are approved for prostate cancer. Olaparib is taken twice daily and is approved for men with mutations in several DNA repair genes whose cancer has progressed on other hormonal treatments. Rucaparib, also twice daily, is specifically for men with BRCA1 or BRCA2 mutations who have already tried both hormonal therapy and chemotherapy. Genetic testing of the tumor (and sometimes a blood test) is required before these drugs can be prescribed.
Common Side Effects of Oral Treatments
Because these pills all work by manipulating hormones or DNA repair, their side effects overlap with what you’d expect from lowering testosterone or stressing the body’s repair systems. The most common across the board include fatigue, hot flashes, loss of interest in sex, and erectile dysfunction. Many men also experience loss of bone density over time, which can raise fracture risk. Enzalutamide and apalutamide specifically carry a higher fracture risk noted in their safety profiles.
Anti-androgens can cause diarrhea, nausea, and breast tenderness. Abiraterone and other drugs that interfere with hormone synthesis may cause skin rashes, itching, and with long-term use, possible liver effects that require monitoring through blood tests. Weight gain, changes in blood sugar and cholesterol, mood shifts, and loss of muscle mass are also reported across many of these medications. None of these side effects are guaranteed, but most men on long-term oral therapy will experience at least a few of them.
What These Pills Cost
Oral prostate cancer drugs are expensive. For Medicare patients, median annual out-of-pocket costs have been around $11,626 for enzalutamide and $9,275 for abiraterone, though the range varies enormously by insurance plan. Some Medicare Part D plans brought annual abiraterone costs as low as $1,379, while others pushed it above $13,000.
A major change took effect in 2025: the Inflation Reduction Act now caps total out-of-pocket spending on Part D prescriptions at $2,000 per year. For men on Medicare taking these drugs, that represents a dramatic reduction in costs. If you have private insurance, coverage varies, but most major plans cover these medications with specialty-tier copays. Manufacturer assistance programs also exist for many of these drugs and can significantly reduce what you actually pay.
Which Pill, and When
The specific oral medication that fits your situation depends on a few key factors: whether the cancer has spread, whether it still responds to testosterone suppression, and your genetic profile. For men with localized or early-stage disease, a daily hormone suppression pill like relugolix may be enough alongside radiation. For advanced disease, one of the anti-androgens is typically added. And for men with DNA repair mutations whose cancer has progressed through other treatments, PARP inhibitors become an option.
Current national treatment guidelines list abiraterone, enzalutamide, apalutamide, and darolutamide as standard oral options across various stages of advanced prostate cancer. Your oncologist will sequence these based on what you’ve already tried and how the cancer is responding. In many cases, men move through more than one of these medications over the course of treatment.