Medical oncologist Dana Rathkopf (left) considers treatment options for a man with an aggressive form of prostate cancer.
More options exist for men with prostate cancer than ever before, whether you’ve just been diagnosed with early-stage prostate cancer, your cancer has returned after treatment, or you have more advanced disease. We can help you decide what treatment or treatments offer you the best chance to control or cure your cancer.
The good news is that over the past two decades, earlier detection of prostate cancer has boosted the number of men who beat the disease for long periods of time; ten-year survival rates have jumped from 67 percent to more than 90 percent.
For men who choose to undergo surgery, our prostate surgeons are among the most experienced in the country. Studies have shown that surgeons who regularly perform radical prostatectomies (removal of the prostate) have fewer complications on average than those who perform these surgeries less often. Many of our prostate cancer surgeons focus solely on prostate cancer, meaning more experience gained over a shorter period of time. By focusing on one disease process, our surgeons have gained the knowledge and experience to optimize outcomes for their patients.
For men who opt for radiation therapy, our renowned radiation oncologists work closely with our highly experienced medical physics team and radiologists to provide the most comprehensive and personalized treatment possible. Recent studies have demonstrated that when men are treated by an experienced radiation oncology team that specializes in prostate cancer, outcomes are improved.
In the past few years we’ve learned so much about the biology of prostate cancer — why it happens, how it happens, and what forms it takes. These findings, along with advances in surgery, radiation therapy, and medical therapies, have made it possible to eliminate most localized prostate cancers and to lengthen life for men with metastatic disease.
Many prostate cancers diagnosed today are indolent, meaning that they’re unlikely to cause symptoms, spread, or shorten your life in any way. By learning about and characterizing your cancer accurately, we can give you appropriate options that make sense for you. Sometimes this means we may recommend deferring surgery or radiation therapy and carefully monitoring your disease.
Because each man’s situation evolves differently over time, our experts approach your treatment in a dynamic way, continually reassessing your disease as it changes and responds to treatment.
Many of our doctors are lead investigators in clinical trials that test new therapies and diagnostic methods in patients. This means that choosing Memorial Sloan Kettering for your cancer care may offer you the opportunity to participate in trials of innovative approaches that are not widely available at other hospitals.
Determining Your Treatment Options
Once your diagnostic tests are complete, we’ll determine which of the following four clinical states best fits your condition. Each has different treatment goals as well as a set of treatment options that have been shown to be most effective at managing the disease.
No Cancer Diagnosis
We have vast experience in detecting prostate cancer and helping patients evaluate their options. Some risk factors place certain men at a higher risk of developing prostate cancer than others. If you’re concerned about prostate cancer, contact our Bendheim Prostate Cancer Diagnostic Center to determine whether you have the disease or to get a better sense of your level of risk. At MSK, we offer diagnostic tests that can reveal evidence of the disease, including:
- blood tests for prostate-specific antigen (PSA) levels
- digital rectal examination (DRE)
- family history analysis
- diagnostic imaging studies
If tests indicate that you might have prostate cancer, our doctors can advise you on your treatment options.
See our recommendations on who should consider screening for prostate cancer.
If a PSA test or DRE suggests that you might have prostate cancer, a biopsy and diagnostic imaging can confirm the presence of cancer and whether it has spread outside the prostate.
Clinically Localized Disease
With clinically localized disease, the tumor is still inside your prostate gland and hasn’t spread anywhere else. Often, localized tumors are indolent, meaning they aren’t likely to cause symptoms or become life threatening, and the best approach may not involve aggressive treatment. For this reason, we’ll perform a comprehensive evaluation to determine your risk before recommending and discussing your next options.
When the results of diagnostic tests determine that a small tumor is likely to grow and spread quickly, we offer a number of highly effective approaches to remove or destroy it. We have years of experience and perspective in the following treatment approaches for men with localized disease.
With this approach, we’ll work with you to watch for any changes and hold off on more direct treatment as we monitor the tumor closely for signs that it might be growing or becoming more aggressive.
This is surgery to remove your prostate gland. A prostatectomy may offer you a cure if the cancer hasn’t spread beyond the gland.
With this approach, we deliver highly precise doses of radiation by implanting a radioactive seed in the prostate or by applying highly targeted external-beam radiation treatments delivered over a period of several days or weeks. These approaches also may offer you a cure if the cancer hasn’t spread beyond the pelvis.
This includes minimally invasive techniques for eliminating small tumors that are confined to the prostate and show no signs of being aggressive. Focal therapy minimizes injury to the prostate gland and surrounding tissue.
If there’s evidence that your tumor is aggressive, we sometimes recommend drugs after surgery or radiation therapy as a precaution against the spread of cancer cells that may have escaped the prostate.
Rising PSA after Surgery or Radiation
In some men, PSA levels start to rise after surgery or radiation therapy — even when we can’t see evidence of the disease on a scan. Rising PSA levels in this situation can indicate one of several things:
- There’s been a local recurrence in the prostate “bed,” 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 (if the gland was not surgically removed).
- The cancer has spread to the lymph nodes, bones, or other parts of the body (whether or not the prostate gland was removed).
We’re experienced in making these subtle but important distinctions. If your doctor determines that your PSA level is rising because there’s still cancer in the area where the prostate is or was located, we may recommend additional local treatment, including one or more of the following approaches.
If you’ve already had a radical prostatectomy, highly precise doses of radiation may be able to eliminate cancer that remains in the prostate bed or lymph nodes after surgery. Even after radiation treatments are delivered to the prostate, if the disease comes back in the prostate, highly targeted seed implants, known as salvage brachytherapy, can be used to treat the recurrent cancer.
If you haven’t undergone surgery, we may recommend that you have an operation to remove your prostate gland. Surgery following radiation therapy is sometimes called salvage radical prostatectomy.
Focal therapies are noninvasive techniques for eliminating small tumors and are designed to minimize injury to the prostate gland and surrounding tissue.
If there’s evidence that the cancer is aggressive, your doctor may recommend that you also receive one or a combination of drugs. These systemic (whole body) therapies — including hormone therapy, chemotherapy, bone-targeted therapy and immune therapy — circulate throughout the body and attack cancer cells wherever they are. They can also prevent the development of new tumors.
If your prior medical history, current PSA level, or the rate at which your PSA level is rising suggest that your cancer is unlikely to cause symptoms or shorten your life expectancy, we may recommend monitoring you closely over time and deferring more aggressive treatment.
If findings during surgery or imaging scans indicate that your cancer has spread (metastasized) from the prostate to the lymph nodes, bones, or other parts of your body, we can offer you treatments that address the illness and prolong your life.
For many men with metastatic disease, we’re able to offer combinations of approaches. The selection of treatments we recommend will depend on many factors, including the specific parts of your body to which the cancer has spread and whether you’re experiencing such symptoms as discomfort or pain.
If you don’t have symptoms, we may offer treatment options that can often prevent or delay them from occurring. Treatment approaches we often offer for men with metastatic prostate cancer include the following:
These drugs circulate throughout the body and attack cancer cells wherever they are. Systemic therapies include hormone therapy, chemotherapy, biologic approaches, and bone-targeted therapy.
We can aim highly precise doses of external-beam radiation at tumors that have spread to the bones and other sites in your body. In cases where cancer in the bone is limited to a few locations, stereotactic radiosurgery that delivers pinpoint, high radiation doses can in many cases effectively eliminate the disease in the treated sites.
Clinical Trials and Other Investigational Therapies
At MSK, we’re often able to offer men the option to participate in clinical trials of new treatments and diagnostic approaches that are not widely available at other hospitals.