Prostate Cancer Treatment

Active surveillance (sometimes called “watchful waiting”) may be an option if you have early-stage prostate cancer that is growing slowly, if you are older or if you have other health problems. By closely monitoring prostate cancer development through testing, active surveillance of prostate cancer provides the option to postpone or possibly avoid treatment (and potential treatment-related side effects). 

Active surveillance may include:

• A prostate-specific antigen (PSA) test and/or digital rectal exam (DRE) every three to six months
• Regularly scheduled imaging tests of the prostate
• A yearly prostate biopsy, or biopsies at shorter intervals

If active surveillance is an option for you, discuss the pros and cons with your cancer care team. Some men report an increased quality of life with active surveillance because it doesn’t expose them to potential treatment risks and side effects, such as decreased sexual function or incontinence associated with radiation therapy and surgical removal of the prostate (radical prostatectomy). But others can experience anxiety and a perception that active surveillance means “doing nothing” and ultimately prefer a more proactive approach.

Studies have shown that about 70% of men with early-stage, slow-growing prostate cancer can maintain active surveillance for up to 10 years without needing treatment. Should prostate cancer progress to the point where treatment is recommended, your physician will discuss the appropriate treatment options with you.

If prostate cancer is restricted only to the prostate gland and has not spread, your oncologist may recommend a radical prostatectomy to remove the tumor. Depending on each patient’s individual needs, Scripps surgeons may perform prostate cancer surgery using one of three techniques:

Laparoscopic radical prostatectomy

Laparoscopic radical prostatectomy is a minimally invasive surgical procedure that involves small incisions through which the surgeon uses special tools aided by a small video camera (laparoscope).

Robotic radical prostatectomy

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, highly maneuverable instruments that provide surgeons greater range of mobility and dexterity than their own human hands and wrists. The robot’s movements are completely controlled by the urologic surgeon.

Radical retropubic prostatectomy

Radical retropubic prostatectomy is an “open” surgery in which a single incision is made to access the prostate gland. This surgical approach has been largely replaced by minimally invasive surgical procedures.

All prostatectomies are performed under general anesthesia. If surgery is part of your treatment plan, your physician will review potential benefits, risks and what to expect.

Scripps’ renowned radiation oncology experts offer state-of-the-art radiation therapy treatments for prostate cancer that target cancer while minimizing radiation exposure to nearby areas. Because the prostate gland is very close to the bladder, rectum and other critical genitourinary structures, your physician will design a treatment plan that targets the tumor while minimizing radiation exposure 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. Radiation therapy for prostate cancer may include intensity-modulated radiation therapy (IMRT), image-guided radiation therapy (IGRT) and stereotactic body radiotherapy (SBRT).

Intensity-modulated radiation therapy (IMRT)

An advanced form of radiation therapy, intensity-modulated radiation therapy (IMRT) 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)

Image-guided radiation therapy 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), SBRT treats prostate cancer tumors with multiple high-dose radiation treatments (typically two to five).

High-risk, advanced or recurrent prostate cancer may be treated with systemic approaches that kill cancer cells throughout the body. Your Scripps medical oncologist may refer you to our infusion center locations throughout San Diego for systemic treatments for prostate cancer. Your treatment plan may include one or more of the following: hormone therapy, immunotherapy, chemotherapy or bone-directed therapy.

Hormone therapy for prostate cancer, commonly referred to as androgen deprivation therapy (ADT) or androgen suppression therapy, works by lowering androgen levels in the body. Androgens, mainly testosterone, stimulate prostate cancer cells to grow; lowering androgen levels can make prostate cancers shrink or grow more slowly for a period of time.

Several types of hormone therapy can be used. Some lower the levels of testosterone or other androgens, while others block the action of these hormones.

Hormone therapy may be recommended:

• 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
• Prior to radiation therapy with the aim to shrink the prostate cancer to make the radiation treatment more effective

Hormone therapy by itself does not cure prostate cancer, and ultimately, other options may need to be considered. Your Scripps cancer care team will provide you with information and recommendations to help you 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 cancer of the prostate. Biologic agents that naturally occur in the body can now be produced in the lab. These agents can then be given to patients to imitate or influence the natural response from the immune system, 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 treatments for prostate cancer that may be available to you.

Chemotherapy treatment uses drugs to attack cancerous cells directly or indirectly, with the aim of destroying cancer cells or slowing their growth. Chemotherapy for prostate cancer may 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 provides chemotherapy services in several locations throughout San Diego County, including Scripps hospitals, outpatient infusion centers and in Scripps-affiliated physicians’ offices.

Advanced-stage prostate cancer causes reduced bone mass in patients. This condition may be further impacted by long-term hormonal therapy, due to reduced androgen levels 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.

Some treatment plans may include clinical trials. Talk to your physician about current clinical trial opportunities and potentially appropriate matches.

Your Scripps cancer team will develop a customized treatment plan outlining the treatments and therapies we recommend for your care. Before you begin treatment, you and your physician will review your plan together and discuss any questions or concerns you may have.

Your prostate cancer treatment plan generally includes:

• Family and medical history
• A summary of your cancer diagnosis and staging information
• Diagnostic testing completed (e.g., imaging, biopsy, lab tests)
• Plans for surgery, radiation, chemotherapy and/or other treatments
• Potential side effects of treatments
• Contact information for your cancer care team members

Along with helping you understand your course of treatment and encouraging discussion between you and your physician, your plan helps your team coordinate your care. You also can share your treatment plan with other providers who may be involved in your medical care.

Your prostate cancer care team includes health and medical professionals from a wide range of specialties. Scripps will customize your team to ensure you have the expertise and support you need. Your team may include:

• Physicians
• Nurse navigators
• Surgeons
• Radiation oncologists
• Medical oncologists
• Registered nurses
• Dietitians
• Social workers

For details, refer to our section covering your cancer care team.

In support of our prostate cancer patients, survivors, their family members and the community, we host a range of health and wellness events and classes throughout San Diego County.