No two prostate cancers are alike. At Columbia Cancer, you will be seen by an entire team of specialists, including urologic oncologists, radiation oncologists, and medical oncologists. Your team will work with you to develop a personalized treatment plan unique to you. When you are diagnosed, your care team will take into account your age and physical condition plus how aggressive the disease is (your Gleason Score) to determine the best treatment for you.
The good news is that most men with prostate cancer have an excellent prognosis, with a 10-year prostate cancer survival rate of more than 90%.
Many prostate cancers are indolent, or slow-growing, and unlikely to cause symptoms or to spread to other parts of your body. Because there are risks to overtreating indolent prostate cancer, such as loss of sexual function and incontinence, our goal is to avoid aggressive treatment when it is not absolutely needed. Sometimes this means watching and waiting is the best move.
Other tumors are more aggressive and need aggressive treatment.
Active surveillance is now the preferred treatment option for most men with slow-growing prostate cancer. Men who are the best candidates for active surveillance have low-grade cancers that are confined to the prostate or men who are older or sicker. If we recommend active surveillance for you, we will monitor your PSA and digital rectal exam periodically and perform an MRI and biopsy every one to three years to determine if there are any signs of the cancer becoming more aggressive. If your cancer becomes more aggressive over time, your doctor may recommend a different treatment.
If your prostate cancer is more advanced, you may need to have your entire prostate gland, the seminal vesicles, and lymph nodes removed. This surgery is called a radical prostatectomy. As long as the cancer is contained in your prostate, this procedure can cure your cancer.
This surgery can either be done through a small open incision or minimally invasively using a surgical robot. Most radical prostatectomies in this country and here at Columbia Cancer are performed using the da Vinci robot. The robotic approach gives us a better view of the surgical field and greater precision and control of our instruments. This can lead to less blood loss, a shorter hospital stay, and faster recovery.
Our surgeons are experts at radical prostatectomy using anatomic and nerve sparing techniques, which help preserve urinary and sexual function.
Radiation therapy causes cancer cells to break or die by targeting the DNA with high-energy particles, such as X-rays, gamma rays, electron beams, or protons. Radiation oncologists direct these particles to the tumor site from outside of your body to precisely target cancer cells, often sparing nearby tissue.
Radiation therapy can be as effective as surgery for early-stage prostate cancer, often giving a lasting cure. It can also improve your quality of life if cancer has spread to bones, which is painful.
Your radiation oncologist will design the optimal treatment plan with you to ensure you achieve the best outcomes. You could have radiation therapy daily, weekly, every other day, or a single dose.
3-D Conformal External Beam Radiation Therapy
Your radiation oncologist directs a beam of high-energy radiation from outside your body to the site of your prostate cancer, using sophisticated computer technology that can spare normal surrounding tissue.
Intensity Modulated Radiation Therapy (IMRT)
IMRT uses an ultrasound system to make sure your body is correctly positioned so that your doctor can more precisely direct higher doses of radiation to the prostate gland.
3-D Conformal Brachytherapy
Your radiation oncologist uses a sophisticated computer-generated plan to implant radioactive pellets or seeds directly into the affected parts of your prostate gland. Over time, the seeds bombard malignant tissue with low-level radiation while sparing normal surrounding tissues. This treatment is customized to your exact anatomy. It doesn’t require a surgical incision. Your doctor will plan and perform seeding during one procedure.
Focal therapy is usually your first surgical option if you have early prostate cancer. It’s typically an outpatient procedure. It destroys small tumors while leaving the prostate essentially intact. This can reduce and lessen the time of side effects such as incontinence and erectile dysfunction.
Your surgeon uses an MRI to find the precise location of your tumor. They then eliminate the tumor using one of these methods:
- High-intensity focused ultrasound: uses sound waves to destroy the tumor by overheating it.
- Focal cryoablation: uses an injected solution to freeze the tumor and destroy it.
For men with aggressive or metastatic prostate cancer, medications are often required. Medications can be given through a pill or injection depending on the type.
Prostate cancer is highly sensitive to testosterone levels. Hormone therapy controls the production of the testosterone that cause prostate tumors to grow. This therapy can also block the effects of testosterone within cancer cells.
You’ll take hormone therapy through a pill or injection. We sometimes give hormone therapy with radiation therapy to help increase cure rates if you have more advanced or higher-risk prostate cancer.
Once cancer has spread beyond the prostate, hormone therapy becomes the cornerstone therapy to control the disease.
Sometimes your body’s defenses—your immune system—don’t recognize prostate cancer cells as foreign. If you have prostate cancer that has spread beyond the prostate, we can use a new immunotherapy called sipileucel-T to train your own white blood cells to target the cancer. After training the cells, we infuse them back into your body through an IV. This treatment has been shown to improve survival.
Chemotherapy is the most commonly known cancer treatment. Chemotherapy uses chemicals (medicines) to stop cancer growth and spread by causing rapidly dividing cancer cells to become damaged and die. You can receive chemo through an IV in our comfortable infusion center.
Chemotherapy is “systemic” medicine (it acts on your entire body) that targets fast-growing cells. This leads to side effects such as hair loss, fatigue, and vomiting. If you receive chemotherapy, you’ll likely take it once every three weeks so your body has time to recover.
Bone Targeted Therapy
Sometimes prostate cancer spreads to your bones, which can cause them to become fragile. We use two medications to strengthen your bones. You might also get one of these medications if you’re taking hormone therapy. They can prevent osteoporosis, or bone degeneration.
Radium 223 is the newest FDA-approved agent for prostate cancer treatment. It specifically targets prostate cancer that has spread to bone and has been shown in a pivotal clinical trial to improve survival.
We inject this radium medication into your blood. Then it travels to bone and areas of high bone turnover. The radioactive particles kill cells in the immediate surrounding area.