The outlook for people with prostate cancer has greatly improved in recent years. The 10-year survival rate for all stages combined is 98%, according to the American Cancer Society, because new treatments and better screening are helping patients live longer.
Memorial Sloan Kettering Cancer Center (MSK) has led clinical development of some of the latest improvements in prostate cancer treatment, including high-intensity focused ultrasound for intermediate risk tumors, genetic sequencing to guide checkpoint inhibitor immunotherapy, and a radiopharmaceutical therapy for metastatic prostate cancer (Pluvicto®) that was recently approved by the U.S. Food and Drug Administration (FDA).
“At MSK, we’ve made many advances in prostate cancer treatment — but just as important, we developed more personalized evaluations to better understand each person’s disease,” says urologic surgeon Massimiliano Spaliviero, MD, FACS. “This helps us determine the true level of risk and whether treatment is needed, so we can recommend the most appropriate care for each patient.”
“Many men with prostate cancer don’t need treatment right away because this type of cancer grows slowly,” he explains. “At MSK, we have the expertise to carefully identify who can safely monitor their condition over time or delay treatment without added risk. For people with higher-risk cancer, we provide access to the latest treatments as well as clinical trials that offer therapies not available elsewhere.”
MSK’s prostate cancer specialists are part of a team that was ranked #1 in the nation for urology care by U.S. News & World Report in 2025 for the third consecutive year.
Dr. Spaliviero discusses how MSK experts treat prostate cancer to give each patient the best outcome with the fewest side effects.
When should active surveillance be used for prostate cancer?
For men whose prostate cancer is considered low-risk, we offer active surveillance, which involves very close monitoring and helps people avoid the possible side effects of surgery and radiation therapy.
People should know that active surveillance does not mean doing nothing. It’s called active surveillance because it is active — with regular scans, bloodwork, and other tests. The schedules for these tests are based on scientific studies of how these low-risk cancers are most likely to behave. We only intervene with treatment if the cancer begins to grow.
For many people, it’s difficult to accept that there is cancer in their body that is not being treated. MSK offers many resources to help patients manage their feelings, including therapy and support groups specifically for people in active surveillance.
How is prostate cancer treatment changing?
For those with advanced, high-risk prostate cancer, MSK offers the latest forms of diagnosis and treatment. This includes new surgical approaches, more powerful and precise radiation treatments, and more effective drugs for disease that has spread. Prostate cancer patients who come to MSK also have access to clinical trials testing new treatments not available elsewhere.
When is prostate cancer surgery necessary?
Surgery for prostate cancer is very effective at controlling or curing the disease when it has not yet spread to organs or tissues outside of the prostate gland. The prostate surgeons at MSK are among the most experienced in the world.
The most common type of surgery is called radical prostatectomy, which involves removing the prostate gland and some of the surrounding tissue. In some cases, nearby lymph nodes are removed as well.
What are the types of prostate cancer surgery?
There are different surgical approaches for radical prostatectomy:
- Open surgery involves a traditional incision and remains an effective treatment option for prostate cancers that have spread locally, are considered high-risk, or are more complex to remove.
- Minimally invasive surgery uses smaller incisions and is associated with less postoperative pain and a shorter hospital stay, often just one night. At MSK, robot-assisted laparoscopic surgery is the most common way to perform a radical prostatectomy.
Are there new techniques to minimize side effects of prostate cancer surgery?
At MSK, we are working to develop advanced imaging tests that help us plan prostate cancer surgery with greater precision. This could allow us to better protect important nerves and surrounding structures, which can reduce the risk of incontinence and improve the chances of preserving sexual function.
We continue to look for ways to further reduce the risk of side effects from prostate cancer surgery. MSK clinical trials are investigating:
- A new method for lighting up nerves during the operation so our surgeons can avoid damaging them.
- Whether exercising pelvic muscles before and after radical prostatectomy can minimize loss of urinary control after the surgery.
What’s the latest radiation therapy used to treat prostate cancer?
Our experts deliver radiation therapy for prostate cancer using advanced tools to target tumors with precision while minimizing side effects. Radiation therapy is broadly divided into two categories, external radiation therapy and internal radiation therapy, also called brachytherapy.
What is external radiation therapy?
External radiation therapy delivers radiation from outside the body, most often in the form of X-rays. At MSK, we use multiple approaches to deliver external radiation therapy:
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Stereotactic body radiation therapy (SBRT) SBRT delivers higher, more precise doses of radiation than older forms of radiation therapy. MSK’s SBRT treatment is called MSK Precise®. MSK is using SBRT for more patients. Benefits of SBRT include:
- Fewer sessions: SBRT can be given in just five short visits over about 10 days.
- Excellent outcomes: Multiple randomized clinical trials have shown that SBRT is very effective at controlling cancer.
- Few side effects: SBRT has low rates of urinary and bowel problems.
- Extremely precise: SBRT pinpoints the exact location of a tumor, by using advanced imaging such as magnetic resonance imaging (MRI) and PSMA PET imaging.
- Intensity-Modulated Radiation Therapy (IMRT): IMRT uses advanced computer programs to calculate and deliver radiation directly to cancer cells from different angles. IMRT lets doctors change the radiation beams’ power during treatment using a special computer program. IMRT is so accurate that it can mean fewer prostate cancer radiation side effects than older radiation methods.
- Proton Therapy: MSK offers the most advanced proton therapy in New York City. Proton therapy uses charged particles called protons to kill cancer cells.
What is MRI-guided radiation therapy and CT-based adaptive radiation therapy?
At MSK, some patients now have access to real-time, MRI-guided radiation therapy, which allows doctors to see the prostate and surrounding organs as they deliver radiation. With clear MRI tumor images, doctors can tell if they should use higher radiation doses on certain areas.
Another advanced technique used at MSK is CT-based adaptive radiation therapy, which allows doctors to adjust the treatment plan every day, based on daily changes in your anatomy. Using sophisticated software, a special CT scan is given right before each treatment.
What is brachytherapy for prostate cancer?
Brachytherapy uses sealed radioactive material placed close to or inside the tumor. The radiation does not travel far from the radioactive material. MSK doctors were among the first to offer this form of treatment, and MSK has the country’s busiest brachytherapy program, with a dedicated suite just for this procedure. The two main forms are low-dose rate (LDR) brachytherapy and high-dose rate (HDR) brachytherapy.
What is prostate cancer focal therapy?
Focal therapy is a prostate cancer treatment for small tumors that are limited to one area of the prostate. Focal therapy is also called partial gland ablation. Focal therapy is less invasive, meaning it does less harm to healthy issue.
We carefully evaluate patients for receiving focal therapy. We use it to treat the area of the prostate gland that has higher-grade cancer. For the parts of the prostate that have low-grade tumors, we use active surveillance.
There are a few ways to do focal therapy (ablation):
- Freezing: Prostate cancer cryoablation uses a needle to kill cancer cells by freezing them. This treatment is also called cryotherapy.
- Heat: Prostate cancer high-intensity focused ultrasound (HIFU) uses focused ultrasound waves to kill tumor cells with high heat. At MSK, we have been using HIFU increasingly for prostate cancers considered “intermediate risk.” A phase 2 clinical trial led by MSK urological cancer surgeon Behfar Ehdaie, MD, MPH, and reported in Lancet Oncology in 2022 demonstrated this less-invasive method works well for controlling prostate cancer in many people.
- Electric currents (irreversible electroporation): Prostate cancer irreversible electroporation uses a tool called NanoKnife® to generate short electrical pulses. The electricity makes very tiny openings (pores) in the tumor’s cells which kill the cells.
MSK is also researching light-based therapy in a clinical trial exploring a new photodynamic therapy (PDT) for prostate cancer.
Treatments for prostate cancer that has spread
For men whose prostate cancer has metastasized (spread) to other parts of the body, we offer systemic treatments that include:
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Hormone therapy
Hormone therapy works by slowing or blocking prostate cancer cells from growing. MSK led clinical trials testing more effective hormone therapies that are now commonly used for metastatic prostate cancer, including abiraterone acetate (Zytiga™) and enzalutamide (Xtandi®). -
Theranostics
Theranostics uses targeted imaging molecules to find cancer cells. Then the same molecules deliver radiation right to those cells. Some men with metastatic prostate cancer can now receive radioactive substances to zero in on prostate cancer cells to destroy them. The therapy, which is called Pluvicto®, selectively seeks out and attaches to a specific protein on the cancer cell surface called PSMA (prostate-specific membrane antigen). MSK medical oncologist and Prostate Cancer Section Head Michael Morris, MD, led clinical trials that resulted in FDA approval of this therapy to treat patients after chemotherapy had failed. -
Targeted therapy
Prostate cancer targeted therapies target either genetic changes or a protein on cancer cells. Poly (ADP-ribose) polymerase inhibitors are a type of targeted therapy called PARP inhibitors. They block the PARP protein inside cells that helps repair cell DNA. PARP inhibitors treat prostate cancer that has a mutation (change) in the BRCA gene. PARP inhibitors for prostate cancer include the drugs olaparib (Lynparza®) and rucaparib (Rubraca®). -
Chemotherapy
Chemotherapy can lengthen life and reduce pain for people who have prostate cancer that has spread to the bones. Docetaxel (Taxotere®) is the standard chemotherapy for prostate cancer that is resistant to hormone therapy. It works by damaging the structure of prostate cancer cells. In addition, cabazitaxel (Jevtana®) is given for people with metastatic prostate cancer that has grown while they are taking docetaxel. -
Immunotherapy
Immunotherapy harnesses the power of the immune system to selectively target cancer cells. While immunotherapy is rarely used as a treatment for prostate cancer, it may help some people with a certain genetic mutation. A class of immunotherapy drugs called immune checkpoint inhibitors help the body’s immune cells kill cancer cells.
What is neuroendocrine prostate cancer (NEPC)?
Neuroendocrine prostate cancer (NEPC) is deadlier form of prostate cancer that usually arises when common prostate adenocarcinoma develops resistance to certain hormonal therapies. NEPC is becoming more common. This urgent need spurred MSK to create a new program focused on NEPC. We have multiple research projects and clinical trials investigating new NEPC treatments.
Our researchers identified a new target: a ligand (molecule) called DLL3 that is especially prominent in NEPC. They have developed radioactive agents that selectively target DLL3-expressing cancer cells while sparing normal tissue, and they’re working toward translating the technology into a clinical trial.
What research is MSK conducting to improve prostate cancer treatment?
We are continually conducting research to better understand and treat prostate cancer. MSK scientists and clinicians are investigating ways to treat primary disease (cancer that has not spread) with fewer side effects, as well as novel therapies for more advanced cases of prostate cancer.
One intriguing recent finding is that exercise before surgery might reduce the chance of prostate cancer progressing. A clinical trial showed that exercise had a beneficial effect on two biomarkers linked to prostate cancer growth. While this looks promising, determining if exercise leads to better outcomes and survival rates will require longer and larger clinical trials.
Many other new treatment options are being explored in our wide range of prostate cancer clinical trials.
Key Takeaways
- New treatments and better screening tools are helping people with prostate cancer live longer, with a 10-year survival rate of 98% for all stages combined.
- Some prostate cancer patients don’t need treatment but can be monitored closely with an approach called active surveillance.
- MSK offers the latest treatments, including new surgical approaches, more powerful and precise radiation treatments, and more effective drugs for disease that has spread.