Prostate Cancer

Active surveillance can help people with localized low-risk or "favorable" intermediate-risk prostate cancer avoid unnecessary treatment. This approach involves monitoring the cancer and only pursuing treatment if there are signs of significant growth on MRI or changes in the cancer grade on biopsy. Your doctors will discuss the risks and benefits of active surveillance with you, considering your specific situation and preferences.

This usually includes:

• Monitoring your PSA levels
• Periodic digital rectal examinations
• Periodic imaging such as yearly MRIs with repeat prostate biopsies if needed 

In most cases of localized prostate cancer, surgery (referred to as a radical prostatectomy) can completely remove the tumor.  Surgery is an option for localized intermediate-risk prostate cancer that is considered “unfavorable” or for high-risk prostate cancer.  

The surgery is designed to remove the prostate, the seminal vesicles and the nearby pelvic lymph nodes to maximize your chance of cure. Most radical prostatectomies are done by minimally invasive techniques and when appropriate, we can also use nerve-sparing techniques that may help preserve erections and sexual function. 

Your surgery may be laparoscopic (minimally invasive robotic surgery with a small incision) or open (invasive surgery with a large incision). Your surgeon will discuss the risks and benefits of both approaches with you.  

Radiation therapy is also an effective way to treat prostate cancer. There are 2 types of radiation therapy for prostate cancer: External beam radiotherapy and brachytherapy.

External beam radiotherapy 
High-energy X-rays are given in 5-15 minute outpatient treatments. Treatments are customized to your disease and given in multiple sessions usually over 2-6 weeks. For more advanced prostate cancer, we may add hormonal treatment which can improve the success of radiation.

Should prostate cancer recur after surgery, radiation may sometimes also help as a second chance for a cure. Whether used instead of surgery or after surgery, your radiation oncologist can discuss the risks and benefits of with treatment with you.

The technical terms for this type of radiation include imaged guided radiation therapy (IGRT), intensity modulated radiation therapy (IMRT), and stereotactic body radiation therapy (SBRT). Ask your doctor which of these techniques are most appropriate for you.

Brachytherapy
Another strategy is to place radioactivity into the prostate, which lessens the amount of radiation to other normal tissues. It is used less Doctors place radioactive seeds into the prostate during brachytherapy, reducing radiation exposure to other normal tissues. Although used less frequently than external beam radiation, brachytherapy can be an effective option for the right patients. Ask your doctor whether this approach is suitable for you.

Hormone therapy is often used to treat advanced prostate cancer, shrinking the cancer and slowing its growth. It can also be combined with radiation therapy to treat higher-risk cancers, enhancing the effectiveness of the radiation. Hormone therapy works by blocking your body from producing testosterone, which prostate cancer cells rely on for growth. By reducing or blocking the effects of testosterone, prostate cancers can be effectively controlled for many years, even in advanced stages with spread to other organs like the bone.  

Hormonal treatments usually include long-acting injections that last several months and daily oral medications. When combined with radiation therapy for localized prostate cancer, hormone therapy typically lasts for 6-24 months. 

Chemotherapy can be used for metastatic prostate cancer when hormone therapy is no longer working well. Instead of blocking testosterone, chemotherapy targets fast-growing cells. People usually receive treatment intravenously (directly within a vein) every few weeks within a 28-day cycle, which gives the body time to recover in between sessions. 

Some drugs can find and mark your prostate cancer so that your immune system can treat it in a different way than it would with hormone therapy or chemotherapy. This newer treatment is usually used when prostate cancer has spread and isn't responding well to other medications. Talk to your doctor about how these drugs are being used today and about clinical trials you might join. 

This treatment is for prostate cancer that has spread and doesn't respond to hormones or chemotherapy. It uses a radioactive substance called lutetium-177 (Lu-177) connected to an antibody that sticks to the surface of prostate cancer cells. The treatment is given through a vein and targets cancer cells throughout the body.

If the cancer has only spread to the bone, another option is radium-223 (Ra-223) therapy. This treatment also uses a radioactive substance that mainly targets the bone and doesn't need an antibody.

Both treatments involve some radiation precautions, but they usually aren't a serious concern after 2-3 days. It's best to ask your doctor if these treatments might be right for you.

Clinical trials help advance prostate cancer treatment by testing new strategies to improve current standards of care. Ask your doctor if a clinical trial is appropriate for you.

The prostate is responsible for producing seminal fluid that nourishes sperm.

In the United States, prostate cancer is the most common cancer that affects only men and people assigned male at birth (AMAB). More than 230,000 new cases of prostate cancer are diagnosed each year.

Certain factors can make people more likely to develop prostate cancer. Some of these factors include:

• Race and ethnicity: African American men are more likely to develop prostate cancer than other ethnicities. 
• Family history: People with one immediate family member with prostate cancer have twice the increased lifetime risk. 
• Age: The incidence of prostate cancer increases with age. Most cancers are diagnosed between the ages of 60 and 75.