The prostate is a walnut-size gland that makes and stores semen, a milky liquid that nourishes sperm. It’s located below the bladder in front of the rectum and surrounds the upper part of the urethra, the tube that empties urine from the bladder. Because of the location of the prostate gland in the body, diseases of the prostate (both cancerous and noncancerous) may affect bladder and sexual function. Nerves and blood vessels that control erectile function are near the prostate and can be affected by prostate cancer or treatment for prostate cancer.
After skin cancer, prostate cancer is the most common cancer among men in the United States. Prostate cancer is more common in older men (greater than age 50). However, most prostate cancers will not affect the length of one’s life. In other words, most men die with prostate cancer but not from it.
More than 90 percent of prostate cancers are found when they’re still within the prostate gland. Prostate cancer can spread by extending outside of the prostate capsule (a thick covering of the prostate) or up into the seminal vesicles (two small tubelike glands that sit on top of the prostate). Sometimes prostate cancer can spread into lymph nodes in the pelvis or into bones.
Treatment Options for Prostate Cancer
For men with slow-growing prostate cancer that may have been detected during screening but is not aggressive in behavior, we offer active surveillance. During active surveillance, your doctors regularly monitor your tumor’s characteristics for any signs that it is changing.
For patients who are interested in or who are advised to undergo surgery, our surgeons are among the world’s most experienced in performing prostate operations, and we’re continually working to improve the safety and effectiveness of radical prostatectomy. We offer robotic as well as laparoscopic and open surgery. Our surgeons are also highly experienced in performing a procedure called salvage radical prostatectomy, which is sometimes done for men who experience prostate cancer recurrence after radiation therapy.
Our radiation oncology team is one of the most experienced in the world and has an established track record of treating prostate cancer with various types of radiotherapy. Our physicians have broad experience using image-guided, intensity-modulated radiation therapy (IG-IMRT), stereotactic high-precision radiosurgery (similar to CyberKnife), stereotactic hypofractionated accelerated radiation therapy (SHARP), and low-dose-rate permanent seed implants and high-dose-rate temporary seed implants (both forms of brachytherapy).
Our doctors not only pioneered these approaches but we continue to improve and enhance these therapies. Because of our expertise with a variety of radiation therapy techniques, we are able to personalize your treatment. Furthermore, we’ve developed and refined the use of sophisticated tools — including state-of-the-art linear accelerators, advanced imaging approaches, and high-speed computer-based systems — to deliver powerful doses of radiation directly to your tumor with incredible precision.
For men with small, localized prostate tumors, we offer a treatment approach called focal therapy, or partial gland ablation. Focal therapy is a general term for a variety of noninvasive techniques that use such techniques as freezing, heat, electricity, or highly targeted seed implants that destroy only the portion of the prostate where the cancer is located. This approach may be particularly beneficial for men with recurrent prostate cancer in the prostate itself who have already received radiation therapy. Our brachytherapy experts are among the most experienced in performing these complex implants.
For men with aggressive cancers that are at risk of spreading into tissues next to the prostate or to the lymph nodes, we use combined treatment approaches, including hormone therapy, brachytherapy, and external-beam radiation therapy, which can comprehensively treat at the risk areas while reducing the radiation exposure of normal healthy tissue.
This approach allows us to give high radiation doses to the prostate and reduced doses to the surrounding tissue in order to give you the best chance of a cure and to reduce the long-term side effects of treatment. For men with very high risk prostate cancer, we have novel clinical trials that combine stereotactic radiosurgery with next generation antiandrogens in an attempt to improve cure rates.
For men with a rising prostate-specific antigen (PSA) level after a radical prostatectomy, external-beam radiation therapy with or without hormone therapy may be the only chance for a cure. Our radiation oncologists use highly targeted IG-IMRT to give patients the lowest risk of long-term side effects from radiation therapy.
For men with prostate cancer that has spread outside the prostate, we offer a number of systemic therapies, including hormonal therapy, chemotherapy, bone-targeted therapy, biologics, and clinical trials. Our medical oncologists are experts at determining which treatment or combination of treatments will be most effective for you, considering the specific features of your disease. For men with advanced prostate cancer, our team offers a number of clinical trials testing targeted therapies and new approaches to treatment.
Our doctors have led the field in the development and conduct of practice-changing studies targeting advanced prostate cancer with such drugs as abiraterone acetate and enzalutamide. We are also the coordinating center for the Prostate Cancer Clinical Trials Consortium, a collaboration between 13 leading centers focused on early drug development and clinical trial design.
In certain men with oligometastatic prostate cancer (prostate cancer that has spread to a limited number of locations in the bones), we offer stereotactic radiosurgery for both the prostate and the sites of metastatic disease and combine that with other treatments such as surgery or systemic therapy, in order to further improve outcomes.
Many men treated for prostate cancer experience significant side effects. Our follow-up care experts can offer a number of programs to help you cope with or overcome those problems and maintain a good quality of life. For men who experience changes in sexual and reproductive health, our Male Sexual and Reproductive Medicine Program can help you adjust to life during and after cancer treatment.