Treatment

Therapy is based on the stage of the cancer, age and expected life span, prognosis, other health problems, and the patient's wishes. It's critical to know the stage of cancer and Gleason score, which is a grading system used for prostate tumors. Most prostate cancer biopsies have a grade between 6 and 10, with 10 being the most serious. Staging ranges from early-stage disease to stage IV prostate cancer, which means the cancer cells have already spread to distant sites in the body. The stage of disease impacts prostate cancer survival rates.

Some patients' cases are discussed at Wilmot's multidisciplinary tumor board — a conference that is attended by all different specialties required for your care.

Seven types of treatment are commonly used for prostate cancer: active surveillance, surgery, radiation, hormone therapy, chemotherapy, biologic therapy, bone-directed treatment.

Active Surveillance

Some men may never need treatment for prostate cancer. Doctors will monitor the cancer closely using the PSA and the DRE tests every three to six months. Surveillance usually includes repeat prostate biopsies at varying times as well. An MRI might also help to make sure a more aggressive cancer doesn’t exist. Treatment can be started if the tests indicate the cancer has started to grow. This approach is reasonable for men with slow-growing, low-risk cancer because it’s not clear if treating these cases with surgery or radiation, for example, would extend survival. Older men or those who have other health problems and don’t want to risk the side effects of therapy might also choose this option. 

Surgery

PRECISION SURGERY

With UroNav and robotics, we are making surgery more precise. UroNav can help reveal the exact location of cancer cells. For some patients, that allows us to spare important nerves in the prostate through precision robotic surgery procedures.

Hani Rashid, M.D.
Associate Professor of Urology

The main surgery for prostate cancer is a radical prostatectomy to remove the entire prostate gland, surrounding tissue, and seminal vesicles, through an incision in the abdomen or the perineum. Nearby lymph nodes are also removed. Open surgery is still done, but Wilmot also uses minimally invasive approaches. They include:

Laparoscopic radical prostatectomy: The surgeon makes small incisions and removes the prostate with the help of a long instrument with a small video camera on the end. Patients usually recover faster and have shorter hospital stays. Wilmot uses the daVinci robot surgical system with high-definition 3D imaging for this procedure. It's important to know the skill and experience of your surgeon when considering this option — and UR Medicine was the first to introduce the daVinci system to upstate New York in 2003. Since then, our urologists have performed thousands of prostate cancer surgeries, the most in upstate New York, and have been leaders in training others and advancing the use of robotic prostatectomy nationally.

Transurethral resection of the prostate (TURP): The surgeon uses an instrument called a resectoscope, which is passed through the tip of the penis to the prostate gland, where electricity or a laser vaporizes the abnormal tissue. TURP is primarily done for men with non-cancerous enlargement of the prostate or to relieve symptoms in men with cancer who are not undergoing radical prostatectomy.

Cryosurgery: This involves using an instrument to freeze and destroy cancer cells.

Surgery for prostate cancer often comes with side effects, some of which are temporary. They include problems controlling urine and impotence. Urinary incontinence ranges from leakage or dribbling while laughing, sneezing, or exercising, to having the sudden urge to urinate or taking a long time to urinate because of little force or flow. Normal bladder control almost always returns after several weeks or months. Prostate cancer treatments can also damage the nerves that enable an erection. Wilmot offers many treatments to help this problem and also is conducting a clinical trial to find out if a newer drug might protect the prostate nerves from injury.

High Intensity Focused Ultrasound (HIFU)

HIFU is a personalized treatment of prostate cancer that uses ultrasound energy, or sound waves that rapidly destroy the targeted tissue while surrounding tissue remains unharmed. The outpatient procedure lasts about 2-4 hours and is usually performed under general anesthesia. HIFU has similar rates of efficacy as other treatment options for prostate cancer, with a lower risk of erectile dysfunction and incontinence.

Hormone Therapy

This is also called androgen deprivation therapy (ADT). The goal is to lower the amount of male sex hormones (androgens) made by the body to stop the growth of prostate cancer. ADT can be achieved with medicines or through surgery to remove the testicles. Side effects can be difficult. Hormone therapy is used before or after prostate cancer surgery or radiation, or alone as the primary treatment. This approach is also used for men who have castration-resistant prostate cancer, an aggressive subtype that keeps growing despite treatment. This type of prostate cancer is often dependent on the receptor for testosterone being continually activated, and will respond to therapies that de-activate the hormone.

Radiation Therapy

PRECISION RADIATION

Wilmot Cancer Institute is the only cancer center in Upstate New York offering HDR Brachytherapy – a unique type of internal radiation therapy. During brachytherapy, a radiation source is placed directly into or next to a tumor. Your healthcare provider will place hollow needles inside your prostate gland. These needles will be attached to cables that will deliver the radiation source into your prostate. After your treatment, the cables and needles will be removed. You will not be radioactive after this treatment, unlike being treated with Low Dose Rate (LDR) Brachytherapy where radioactive seeds are left in the prostate.

HDR prostate brachytherapy can be administered alone or in combination with external radiation therapy.

Benefits of HDR Prostate Brachytherapy

• Convenient: Significantly fewer treatment sessions than external radiation therapy

• Minimally invasive: Shorter recovery time to get you back into your routine

• Precise targeted treatment: Decreased radiation exposure to surrounding organs and soft tissue

• Non-radioactive after procedure: Can be around family and friends

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Chemotherapy

Chemotherapy uses drugs or combinations of drugs — given intravenously or as pills — to destroy cancer cells.

Targeted Therapy

These are newer drugs designed to target specific gene changes that result in prostate cancer. They single out cancer cells without harming normal cells and usually have less severe side effects compared to chemotherapy.

Biologic or Immunotherapy

These drugs boost a person’s own immune system to fight cancer. Sipuleucel-T is an example of a biologic used to treat prostate cancer that has spread to other parts of the body.

Bone-directed Therapy

Drugs that strengthen the bone are prescribed for men who have also received hormone therapy because they are at increased risk for bone loss or fractures. Researchers are also studying whether these drugs can prevent or slow the growth of tumors that have spread to the bone.