Prostate Cancer Treatments

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Medical oncologist Dana Rathkopf (

Medical oncologist Dana Rathkopf (left) considers treatment options for a man with an aggressive form of prostate cancer.

NBC’s Al Roker Shares Important Message About Prostate Cancer Screening
Al Roker, anchor of NBC’s TODAY, shared an update on his successful treatment for prostate cancer at MSK in a recent segment on the broadcast. 
Learn more

MSK can help you choose treatments that give the best chance to control or cure prostate cancer. There are treatments for newly diagnosed early-stage prostate cancer, for cancer that returned after treatment, and for advanced disease.

We have made many advances in prostate cancer screening and treatment over the past 20 years. We can find prostate cancer earlier, when it is easier to treat. That means more people beat the disease for longer periods of time. Years ago, nearly 7 out of every 10 people with prostate cancer survived 10 years after their diagnosis. Now, that 10-year survival rate has jumped to more than 9 out of 10.

Surgery: Our prostate surgeons are among the most experienced in the U.S. Research studies have examined the track records of surgeons who regularly perform radical prostatectomies (removal of the prostate). This research shows these surgeons have fewer complications on average than surgeons who do these surgeries less often. Many of our prostate cancer surgeons focus only on prostate cancer. Their deep knowledge and experience means they can give you care with the best outcomes.

Radiation Therapy: Our radiation oncologists, medical physics experts, and radiologists work closely as a team to provide a comprehensive treatment plan. Recent research studies show patients have better outcomes when treated by an experienced radiation oncology team that specializes in prostate cancer.

In recent years, we have learned much about the biology of prostate cancer. We know more about why and how it happens, and better understand its many forms. There have also been many advances in surgery, radiation therapy, and medical therapies. These trends have made it possible to successfully treat most prostate cancers that have not spread. We can often lengthen life spans for people who have metastatic disease.

Many prostate cancers diagnosed today are indolent (grow slowly). They grow so slowly that they probably will not cause symptoms, spread, or shorten your life in any way. MSK experts will learn what kind of cancer you have and talk with you about the options best for you. Sometimes we may recommend that you do not have surgery or radiation therapy right away. Instead, we will carefully monitor the cancer’s growth.

Each case of prostate cancer is different. The cancer you have may change over time. Our experts will keep assessing changes in the cancer and its response to treatment.

Many of our doctors are lead investigators in clinical trials that test new therapies and diagnostic methods in patients. If you choose Memorial Sloan Kettering for your cancer care, you may be able to join our research. You could have access to new approaches that usually are not as available at other hospitals.

Choosing Your Treatment Options

Once your diagnostic tests are complete, we will know more about your condition. You may have:

  • No cancer
  • Clinically localized disease (cancer that has not spread from prostate)
  • Rising PSA after treatment, such as surgery or radiation
  • Metastatic disease (the cancer has spread)

Each has different treatment goals and treatment options for best managing the disease.

No Cancer Diagnosis

We have deep experience in finding prostate cancer and helping our patients understand their options. Some risk factors mean you have a higher chance of developing prostate cancer. If you’re worried about prostate cancer, contact our Bendheim Prostate Cancer Diagnostic Center. Through testing, they can tell you if you have the disease and your level of risk. MSK offers the following diagnostic tests:

  • Blood tests for prostate-specific antigen (PSA) levels
  • Digital rectal examination (DRE)
  • Family history analysis
  • Diagnostic imaging studies

If tests show you may have prostate cancer, our doctors can talk with you about your treatment options.

Screening
Please see our recommendations for who should think about getting screened for prostate cancer.

Diagnosis
A PSA test or DRE may suggest you have prostate cancer. If so, a biopsy and diagnostic imaging can confirm there is cancer and whether it has spread outside the prostate.

Clinically Localized Disease

When we say the disease is clinically localized, we mean it has not spread outside the prostate gland. Often, localized tumors are indolent (grow very slowly). They probably will not cause symptoms or become life threatening. Aggressive treatment may not be the best approach. For this reason, we will do a thorough evaluation of your risk before we recommend your best options.

The results of diagnostic tests may show a small tumor will probably grow and spread quickly. If so, we offer many very good approaches to remove or destroy it. Treatments for localized disease include:

Active Surveillance
We work with you to watch for changes as we closely monitor the tumor. We will hold off on more direct treatment until there are signs it may be growing or becoming more aggressive.

Radical Prostatectomy
This is surgery to remove your prostate gland. A prostatectomy may cure cancer that has not spread outside the gland.

Radiation Therapy
Radiation therapy uses high-energy beams to treat cancer. It works by damaging the cancer cells using very precise doses of radiation. We implant a radioactive seed in the prostate, or use highly targeted external beam radiation treatments. This spreads the radiation out over a period of several days or weeks. These approaches may cure cancer that has not spread beyond the pelvis.

Focal Therapy
We use minimally invasive methods to remove small tumors that are only in the prostate and are not aggressive. An invasive procedure is where we need to put something inside the body. Focal therapy is minimally invasive, so there is less chance of injuring the prostate gland and nearby tissue.

Systemic Therapy
There may be evidence that the tumor is aggressive. We sometimes recommend drugs combined with surgery or radiation therapy. This approach can help prevent the spread of cancer cells that may have escaped the prostate.

Rising PSA after Surgery or Radiation

PSA levels may start to rise after surgery or radiation therapy. This can happen even if we cannot see evidence of the disease on a scan. Rising PSA levels can mean one of these things has happened:

  • There’s been a local recurrence (the cancer returned) in the prostate bed. This is the area where the prostate gland was before it was surgically removed.
  • There’s been a local recurrence in the prostate itself after radiation therapy. The prostate gland was not surgically removed.
  • The cancer spread to lymph nodes, bones, or other areas, whether or not the prostate gland was removed.

The differences are slight, but through experience we understand their importance. PSMA PET imaging can accurately find the location of the disease. Your doctor may decide your PSA level is rising because there still is cancer near where the prostate is or was located. We may recommend more local treatment, including:

Radiation Therapy
If you’ve already had a radical prostatectomy, radiation therapy may be the next step after surgery. Very precise doses of radiation may be able to remove cancer that’s still in the prostate bed or lymph nodes. After radiation therapy, we offer other treatments if the cancer returns to the prostate. We can treat it by implanting a highly targeted seed, a procedure called salvage brachytherapy.

Radical Prostatectomy
We may recommend that you have an operation called a radical prostatectomy to remove your prostate gland. If you have surgery after radiation therapy, that sometimes is called a salvage radical prostatectomy.

Focal Therapy
Focal therapies are minimally invasive methods to remove small tumors that only are in the prostate. An invasive procedure is where we need to put something inside the body. Focal therapy is minimally invasive, so there is less chance of injury to the prostate gland and nearby tissue.

Systemic Therapies
If there’s evidence the cancer is aggressive, your doctor may recommend that you also get one or more systemic (whole body) therapies. These include hormone therapy, chemotherapy, bone-targeted therapy, and immune therapy. Such therapies move throughout the body and attack cancer cells wherever they are. They can also prevent new tumors from forming.

Active Surveillance
Your medical history, current PSA level, and rate at which your PSA level is rising gives us important information. It can suggest whether the kind of prostate cancer you have will likely cause symptoms or shorten your life. We may recommend monitoring you closely over time before starting more aggressive treatment.

Metastatic Disease

Metastatic disease is when cancer has metastasized (spread) from the prostate to the lymph nodes, bones, or other parts of your body. Treatment can help you live a longer life.

For many people with metastatic disease, we offer a combination of approaches, based on your situation. We look closely at where the cancer has spread, for example, and whether you have symptoms such as discomfort or pain.

If you don’t have symptoms, treatment options often can prevent or delay them. Treatment approaches include:

Systemic Therapies
These drugs move throughout the body and attack cancer cells wherever they are. Systemic therapies include hormone therapy, chemotherapy, biologic approaches, and bone-targeted therapy.

Radiation Therapy
We aim very precise doses of external beam radiation at tumors that have spread to the bones and other areas. When cancer in the bone is only in a few locations, stereotactic radiosurgery may be an option. Precise, high radiation doses often can kill off cancer cells in the treated areas.

Clinical Trials and New Therapies
At MSK, you may be able to join research studies (clinical trials) of new treatments and diagnostic approaches. They are not widely available at other hospitals.