Medical oncologist Dana Rathkopf (left) considers treatment options for a man with an aggressive form of prostate cancer.
Whether you’ve just been diagnosed with early-stage prostate cancer, your cancer has returned (recurred) after treatment, or you have more advanced disease, more options exist for you and other men than ever before. We can help you decide what treatment or treatments offer you the best chance to control or cure your cancer.
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.
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.
Although results for individual patients vary, 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. Our prostate surgeons are among the most experienced in the country. Learn more.
We’ve also learned so much more about the biology of prostate cancer — why it happens, how it happens, and what forms it takes — which, along with advances in surgery, radiation therapy, and medical therapies, has made it possible to eliminate most localized prostate cancers and to lengthen life for men with metastatic disease.
Because prostate cancer is a disease that may evolve over time — often many years — there’s no one perfect approach to treatment. In some cases, men live with prostate cancer as a chronic disease that is managed successfully over many years. In others, prostate cancer can be very aggressive and require intensive treatment. Because each man’s situation evolves differently over time, our experts approach your treatment in a dynamic way, continually reassessing your disease as it evolves and responds to treatment.
Many prostate cancers diagnosed today are indolent, meaning that they’re unlikely to cause symptoms, spread, or shorten your life in any way. At MSK, we don’t want to subject anyone to overtreatment for an indolent prostate cancer. Overtreatment offers no benefit and may even cause harm.
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.
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.
Get answers to some frequently asked questions about inherited forms of prostate cancer.
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 disease, including:
- blood tests for 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.
With clinically localized disease, the entire cancer is still inside your prostate gland and hasn’t spread anywhere else. Often, these localized tumors are indolent, meaning they aren’t likely to cause symptoms or become life threatening. For this reason, the best approach may not involve aggressive treatment. We take care to avoid overtreatment for men with localized tumors that are indolent, particularly if tests suggest that the risks posed by possible treatment side effects could potentially put you at even higher risk than the cancer itself. For this reason, we’ll perform a comprehensive evaluation to determine your risk before recommending and discussing your next options. For other situations, when the results of diagnostic tests determine that small, localized tumors are likely to grow and spread quickly, we now have a number of highly effective approaches that remove or destroy them. 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. 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 and then applying external-beam radiation.
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.
We often recommend taking drugs that attack cancer cells that may have escaped the prostate and spread to other parts of the body (systemic therapy) along with radical prostatectomy or radiation therapy as a precaution against the spread of a clinically localized prostate cancer. We may recommend systemic therapy if there’s evidence that the tumor is aggressive but no metastatic disease is found.
In some men, PSA levels start to rise after surgery or radiation therapy — even when we can’t see evidence of 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 of the pelvis that was removed or that received radiation therapy, 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 can eliminate cancer that remains in the prostate bed after surgery.
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, immune therapy, and bone-protecting treatments — 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 (doubling time) suggest that your cancer is unlikely to become detectable, cause symptoms, or shorten your life expectancy, we may recommend monitoring you closely over time and deferring more aggressive treatment.
Even if findings during surgery or imaging scans clearly indicate that your cancer has spread from the prostate to the lymph nodes, bones, or other parts of your body, we may be able to 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 that address more advanced localized and metastatic prostate cancers. We’ll combine whatever therapies are needed to best control your disease. 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’ll offer treatment options that can often prevent or delay them from occurring in the future. 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 immunotherapy.
We can aim highly precise doses of external-beam radiation at painful metastases in bone and at other tumor sites in your body.
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.