The recommended course of treatment and management for prostate cancer depends on a patient’s health profile, tumor characteristics and the patient’s ultimate goals. Not all prostate cancers are immediately treated with surgery or radiation therapy. Potential prostate cancer treatment and management methods for patients include:
- Active surveillance
- Radiation therapy
- Systemic therapy
- Hormonal therapy
- Infusion services
- Bone directed therapies
- Clinical trials
- Genetics counseling
- Patient support
This may be an option for some men with prostate cancer that is low-volume, slow-growing and early-stage. Active surveillance provides men an alternative to postpone or possibly avoid treatments and potential treatment-related side effects. Active surveillance may include:
- A PSA test and/or DRE exam every three to six months.
- Regularly scheduled imaging tests of the prostate.
- A yearly prostate biopsy, or biopsies at shorter intervals.
Weighing risks and benefits of active surveillance
Some men report an increased quality of life with active surveillance because it doesn’t expose them to potential risks such as decreased sexual function or incontinence associated with radiation therapy and surgical removal of the prostate (radical prostatectomy). But other men can experience anxiety and a perception that active surveillance means “doing nothing” and ultimately prefer a more proactive approach.
Patients should fully discuss the active surveillance option with their care team. Patients’ personal goals, expectations, and concerns must be factored into their specific diagnoses and best approaches to manage and treat prostate cancer.
Surgery for prostate cancer
If the prostate cancer is restricted only to the prostate gland and has not spread, your oncologist may recommend a radical prostatectomy to remove the tumor. This surgery can be performed three different ways:
- Laparoscopic radical prostatectomy is a minimally invasive surgical procedure that involves small incisions through which a surgeon uses special tools aided by small video camera (laparoscope).
- Robotic radical prostatectomy is a minimally invasive surgical procedure performed with a robotic tool through small incisions, the use of a magnified 3-D high-definition vision system and tiny wristed instruments that provide the surgeon greater range of mobility and dexterity than their own human hands and wrists. The advanced robotic tool does not act on its own and its movements are controlled by the surgeon.
- Radical retropubic prostatectomy is an “open” surgery where a larger single incision is made to access the prostate gland. This surgical approach has been largely replaced by minimally invasive surgical procedures.
All prostatectomies require general anesthesia. Your physician will review potential benefits, risks and what to expect, if surgery is part of your treatment plan.
Radiation therapy for prostate cancer
Because the prostate gland is very close to the bladder, rectum and other critical genitourinary structures, your physician will design a treatment plan that minimizes side effects and tissue damage to these sensitive areas. With the most advanced radiation therapy facilities in San Diego County, Scripps offers several options that allow previously unprecedented targeting of tumors.
Scripps renowned radiation oncology experts offer state-of-the-art approaches to treat all types of cancer, including cancer of the prostate. Radiation therapy for prostate cancer may include:
- Intensity-modulated radiation therapy (IMRT) is an advanced form of radiation therapy that allows the radiation oncologist to specify the radiation dose for the tumor while restricting the dose to surrounding healthy tissues.
- Image-guided radiation therapy (IGRT) takes patient motion and tumor movement into account during radiation treatments through repeated imaging. This allows the delivery of a more effective “real-time” radiation beam to the tumor.
- Stereotactic body radiotherapy (SBRT), also known as stereotactic ablative radiotherapy (SABR), can be used to treat tumors in almost any part of the body, including the prostate. Multiple radiation treatments (typically two to five) are delivered to a precise volume.
- Proton therapy uses a controlled beam of protons to target tumors with unprecedented accuracy. Scripps Proton Therapy Center is the only facility of its kind in San Diego, California.
Systemic therapy for prostate cancer
High-risk, advanced or recurrent prostate cancer may be treated through a range of approaches, from new hormonal therapies, to advanced targeted therapies, to immunotherapy. Scripps medical oncologists have several infusion center locations and private offices throughout San Diego. Your care team may often recommend a combination of therapies that may include:
Hormonal therapy is commonly, referred to as androgen deprivation therapy (ADT) or androgen suppression therapy, works by lowering androgen levels in the body. Androgens, primarily testosterone, stimulate prostate cancer cells to grow; lowering androgen levels can make prostate cancers shrink or grow more slowly for a period of time. Hormone therapy by itself does not cure prostate cancer, and ultimately, other options need to be considered:
- If a patient isn’t a candidate for surgery or radiation because the cancer has already spread beyond the prostate gland.
- If the cancer remains or returns following prostate cancer surgery or radiation therapy.
- In combination with radiation therapy as initial treatment if a patient is considered at higher risk of cancer returning, based on a high PSA level, high Gleason score and/or spread of the cancer outside the prostate.
- Prior to radiation therapy with the aim to shrink the prostate cancer to make the radiation treatment more effective.
Several types of hormone therapy can be used. Some types lower the levels of testosterone or other androgens, while others block the action of these hormones. Your Scripps multidisciplinary team can provide you with the latest information and recommendations to understand your options and make informed decisions.
Clinical trials have shown that immunotherapy, also called biological response modifier (BRM) therapy, biologic therapy or biotherapy, can be effective for many types of cancer, including cancer of the prostate. Biologic agents that naturally occur in the body now can be produced in the lab. These agents can then be given to patients to imitate or influence natural immune response with the goal of slowing cancer cell growth or helping the body’s healthy cells control the cancer. Be sure to speak with your care team to learn about alternative forms of treatment.
Chemotherapy treatment uses drugs to attack cancerous cells directly or indirectly, with the aim of destroying cancer cells or slow their growth. Chemotherapy for prostate cancer can be recommended if a patient is not responding to hormonal therapy and the cancer has spread outside the prostate. Chemotherapy is not standard protocol for early-stage prostate cancer, but studies are being conducted to learn if this approach can be an option.
Scripps Health provides chemotherapy services in several locations throughout San Diego County, including Scripps hospitals, outpatient infusion centers, or in Scripps affiliated physicians’ offices. Physicians and nurses specially trained in oncology manage the infusion treatments. Scripps nurses administering chemotherapy have completed extensive training and education through the Oncology Nursing Society, and many of Scripps clinical pharmacists have advanced training in chemotherapy preparation and treatment.
Infusion services and locations
New medications and advancements in chemotherapy allow most patients to receive their infusion therapy in an outpatient setting. Each visit to a Scripps Health infusion center includes a nurse assessment to determine how a patient is tolerating treatment. The assessment includes recommendations, educational materials, and consultation with a pharmacist, if needed.
Chemotherapy and other infusion treatments can produce physical symptoms that may be controlled through medication, nutrition and relaxation techniques. Nurses and pharmacists at all Scripps infusion centers work with patients to help manage any side effects.
Advanced-stage prostate cancer causes reduced bone mass in patients. This condition may be further impacted by long-term hormonal therapy, due to reduced androgens or no androgens in the body. Bone-directed therapies aim to provide palliative and therapeutic benefits for patients with later-stage prostate cancers that have metastasized to the bones.
Scripps Health physicians and scientists are actively involved in research and studies to provide greater understanding of cancer biology and enable faster availability of new treatments to patients.
If you are interested in participating in clinical trials, please discuss with your physician the various clinical trials options and potentially appropriate matches.
Scripps offers genetics counseling services for patients and families. Although most cancers are not clearly linked through genes passed from one generation to the next, a small portion of cancers are inherited, according to the American Cancer Society.
Prostate cancer patient support
As part of Scripps Health’s full spectrum of prostate cancer care, we offer a range of support services and programs. These include patient care coordinators, social workers, support groups, nurse navigators, and the Scripps Center for Integrative Medicine, which offers the best of conventional and complementary medicine. We believe there are many paths to healing and that holistic health is a cohesive balance of mind, body and soul. Through research, education and the design of healing medicine programs, we value and recognize the wisdom of all healing traditions through complementary therapies.