Prostate Cancer: How We Plan Your Treatment

In some cases prostate cancer can be very aggressive and require intensive treatment. In others, men live with prostate cancer as a chronic disease that can be managed successfully over many years.

Because each man’s case of prostate cancer evolves differently over time, our experts approach your treatment in a dynamic way. Which treatment approach we recommend depends not only on your latest diagnostic tests, but also on the entire history of your disease and any treatments that you have received.

Determining Your Treatment Options

After your diagnostic tests are complete, your doctor will explain which clinical state best describes your condition. There are four clinical states, shown below, each of which has different treatment goals as well as a set of treatment options that have been shown to be most effective at managing disease.

Click on your clinical state in the tabs below to find a summary of which treatment options may be recommended for you. You can learn more about specific treatment approaches by following the links underneath each tab.

No Cancer
Diagnosis

At Memorial Sloan Kettering we have vast experience in detecting prostate cancer and helping patients evaluate their options. A number of factors place some men at a higher risk of developing prostate cancer than others. Risk factors include:

  • Your age (older men are at higher risk of developing prostate cancer)
  • A family history of the disease
  • Your race and nationality (African American men, for example, are more likely than Caucasian men to develop prostate cancer)
  • Hormone (testosterone) levels
  • Symptoms that might indicate the presence of the disease

If you are concerned about prostate cancer, you can contact our Bendheim Prostate Cancer Diagnostic Center to determine whether you have the disease, or assess your risk. We offer tests that can reveal evidence of disease, including blood tests for PSA levels, digital rectal examination, family history analysis, and diagnostic imaging studies. If tests indicate that you might have prostate cancer, our doctors can advise you on your treatment options.

Screening and diagnosis
If a PSA test or digital rectal examination suggests that you might have prostate cancer, a biopsy and diagnostic imaging can confirm the presence of cancer and whether it has spread from the prostate.

Prostate cancer screening guidelines
See Memorial Sloan Kettering’s recommendations on who should consider screening for prostate cancer.

Prostate cancer and heredity
Get answers to some frequently asked questions about inherited forms of prostate cancer.

Clinically Localized
Disease

Clinically localized disease means that the entire cancer is located inside the prostate gland and has not spread to the pelvic lymph nodes or distant organs. In many cases localized tumors are indolent, meaning that they are not likely to cause symptoms or become life threatening. For this reason, they may not require aggressive treatment. In others, the results of diagnostic tests determine that small tumors are likely to grow and spread quickly. Many highly effective approaches are now available to remove or destroy aggressive localized tumors.

Memorial Sloan Kettering takes care to avoid overtreatment for men with localized tumors that are indolent, particularly if tests suggest that the risk posed by possible side effects of treatment is higher than the risk posed by the cancer. For this reason, our doctors will perform a comprehensive evaluation to determine your risk before recommending treatment options to you.

Memorial Sloan Kettering physicians have expertise in the following treatment approaches for men with localized disease.

Active surveillance
A dynamic disease-management treatment option in which more aggressive treatment is deferred while your doctor monitors the tumor closely for any signs that it might be growing or is becoming more aggressive.

Radical prostatectomy
Surgery to remove the prostate gland. Prostatectomy may offer a cure if the cancer has not spread beyond the gland.

Radiation therapy
Highly precise doses of radiation delivered by radioactive seed implantation and external beam techniques, including stereotactic radiosurgery. Radiation therapy may be used in the treatment of both early-stage and more-advanced localized tumors.

Focal therapies
Minimally invasive techniques for eliminating small tumors that are confined to the prostate and show no signs of being aggressive. Focal therapies minimize injury to the prostate gland and surrounding tissue.

Systemic therapies
Drugs that attack cancer cells that may have escaped from the prostate and spread to other parts of the body (metastasized). Systemic therapies are often used in conjunction with radical prostatectomy or radiation therapy as a precaution against the spread of a clinically localized prostate cancer. Your doctor may recommend these drugs if there is evidence that the tumor is aggressive, even if metastatic tumor cells cannot be detected by imaging.

Rising PSA after Surgery
or Radiation Therapy

In some men, PSA levels start to rise after surgery or radiation therapy, even when no disease is visible on a scan. Rising PSA levels in this situation can indicate that:

  • there has been a local recurrence in the prostate “bed” (if the gland itself has been surgically removed)
  • there has been a local recurrence in the prostate itself after radiation therapy (if the gland has not been surgically removed)
  • the cancer has spread to the lymph nodes, bones, or other parts of the body (whether or not the gland has been removed)

Doctors at Memorial Sloan Kettering are highly experienced in making these subtle but important distinctions.

If your doctor determines that your PSA is rising because there is still cancer in the area of the pelvis that was removed or received radiation therapy, additional local treatment may be advised. Your treatment may include one or a combination of the following approaches or methods.

Radiation therapy
If you have already had a radical prostatectomy, highly precise doses of radiation can eliminate cancer that remains in the prostate bed after surgery.

Radical prostatectomy
If you have not yet undergone surgery, your doctor may recommend an operation to remove the prostate gland. Surgery following radiation therapy is sometimes called salvage radical prostatectomy.

Focal therapies
Focal therapies — noninvasive techniques for eliminating small tumors — minimize injury to the prostate gland and surrounding tissue.

Systemic therapies
If there is evidence that the cancer is aggressive, your doctor may recommend that you also receive one or a combination of drugs, also called systemic therapies. Systemic therapies including hormone therapy, chemotherapy, immune therapy, and bone-protecting treatments circulate throughout the body and attack cancer cells in the environment in which they thrive. They can prevent the development of new tumors.

Active monitoring
If your prior medical history, current PSA, or rate of PSA rise (doubling time) suggest that the cancer is unlikely to become detectable, cause symptoms, or shorten your life expectancy, your doctor may recommend monitoring you closely while deferring more aggressive treatment.

Metastatic
Disease

In some cases, findings during surgery or imaging scans clearly indicate that cancer has spread from the prostate to the lymph nodes, bones, or other parts of your body. Even at this advanced stage, there are many effective treatments for your illness that have been proven to prolong life.

Doctors at Memorial Sloan Kettering often combine several approaches to treat more-advanced localized and metastatic prostate cancers. We will integrate whatever therapies are needed to best control your disease.

Which treatments your doctor recommends will depend on many factors, including the specific parts of the body to which the cancer has spread, and whether you are experiencing symptoms such as discomfort or pain. If you don’t have symptoms, your doctor will consider treatment options that can prevent or delay symptoms from occurring in the future.

Click the links to learn more about treatment options for metastatic prostate cancer.

Systemic therapies
Drugs that circulate throughout the body can attack cancer cells wherever they are located. Systemic therapies include hormone therapy, chemotherapy, biologic approaches, immunotherapy, and bone-targeting approaches.

Radiation therapy
Highly precise doses of external-beam radiation can be used to eliminate painful metastases in bone and at other tumor sites in the body.

Investigational therapies
At Memorial Sloan Kettering, eligible patients can take part in clinical trials of new treatments and diagnostic approaches that are not widely available at other hospitals.

Need More Information?

Not sure which treatment approach is right for you? Call 800-525-2225 to make an appointment with one of our doctors. We will provide a personalized assessment that considers both your diagnosis and your preferences. Learn more about Making an Appointment.