Treatment

Our Approach

Prostate cancer is the most common type of cancer in American men. 1 in 5 men will develop it during their lifetimes. Owing to advances in early diagnosis and effective treatments, the majority of men with prostate cancer will not die from it.

Most men begin to suspect they have prostate cancer after obtaining an elevated PSA level or abnormal digital rectal examination. The PSA blood test measures the level of prostate-specific antigen in the blood.

The challenge for physicians is determining which patients with high PSA levels need invasive tests such as biopsies, and which patients diagnosed with prostate cancer need localized treatment to the prostate and surrounding tissues, such as surgery or radiation.

The Siteman difference

The Siteman Cancer Center is the only National Cancer Institute-designated Comprehensive Cancer Center in Missouri and is ranked among the top cancer facilities in the nation by U.S. News & World Report.

At Siteman, we diagnose and treat prostate cancer with the most sophisticated imaging techniques, diagnostics, and therapies available. Our multidisciplinary team sees approximately 1,000 new prostate cancer patients a year. Each patient receives an individualized treatment plan for his prostate cancer.

Siteman has led the field in the development of genomic testing for personalized, targeted treatment. We were the first institution to sequence the DNA of a cancer patient. Today, we routinely evaluate our patients’ genetic information for additional insights into their cancer. This helps us to better meet every patient’s unique treatment needs. Our research into DNA-based cancer treatments led to the first clinical trial of a “neoantigen” DNA vaccine for metastatic prostate cancer, which targets the specific mutations found in each patient’s tumor in order to stimulate the immune system to fight them.

Expert physicians

Our physicians at Siteman Cancer Center pioneered the prostate-specific antigen (PSA) blood test as a tool for early prostate cancer detection. As laboratory technology has improved, they continue to examine newer blood tests to more accurately determine which patients with an elevated PSA are likely to have an aggressive prostate cancer. They also conducted the world’s largest single-institution prostate cancer screening study with more than 32,000 men and led the NCI-funded PLCO cancer screening trial, which evaluated genetic data from 80,000 men.

Accurate, customized diagnostic techniques

Washington University Physicians at Siteman use cutting-edge tests to evaluate each patient’s level of risk and ensure that he gets the right diagnosis.

We pride ourselves on our advanced use of imaging to assess patient risk, and often pair MRI scans with biopsies to ensure that we are finding the worst part of the cancer. In fact, we are one of the few centers in the U.S. who have published a number of studies demonstrating the benefit of prostate MRIs as a diagnostic tool. We also have trials for leading-edge imaging methods, such as PSMA and other PET/CT scanning techniques.

In addition, our urologists are working to pair imaging with biomarker tests for maximum accuracy.  Biomarkers are traces of disease than can be present in the blood or urine. They help physicians gauge the severity of your prostate cancer, and can potentially be used to predict how different therapies will work for you. Investigators at Siteman are developing novel “liquid biopsy” tests to determine which patients will respond best to certain prostate cancer drugs.

Low-intervention treatment options

The Washington University urologists at Siteman know that not every patient with prostate cancer needs to be treated. Instead, some patients with lower-risk prostate cancer can be monitored carefully. This type of close monitoring is called active surveillance. Some patients on active surveillance at Siteman may be eligible to join a clinical trial for immunotherapy, which offers an additional level of treatment.

In other patients with prostate cancer, it isn’t necessary to remove the entire prostate. The newest advance in prostate cancer care is focal therapy, methods of treating the prostate cancer tumor without major surgery. Focal therapy may involve removing only the cancerous part of the prostate, freezing the tumor, or shrinking the tumor with high-intensity ultrasounds. Radiation therapy can also cure prostate cancer in place of surgery. Washington University Physicians at Siteman excel at these techniques.

Innovative surgeries

For patients who do need to have their prostates removed, our surgeons and urologists are experts at conducting the operation without damaging the surrounding nerves (a procedure called a nerve-sparing radical prostatectomy). This procedure helps preserve normal urination and sexual function.

Washington University surgeons are also experts at robotic prostate removal, laparoscopic prostate removal, and open, or conventional, prostate removal. They have completed thousands of prostate operations, which makes our team one of the most experienced in the United States. Patients who come to Siteman generally have higher rates of cure and improved physical well-being.

Immunotherapy

Prostate cancer patients may also have the opportunity to be treated with immunotherapy, a ground-breaking technique that teaches the immune system to recognize and destroy cancerous cells. At this time, only one immunotherapy is FDA-approved to treat prostate cancer, and it is only used for patients with advanced, metastatic disease. Urologists at Siteman, however, have teamed up with other researchers and clinicians to explore the use of immunotherapy earlier in prostate cancer treatment. Ongoing clinical trials are also investigating the use of immunotherapy and other therapies before surgery.

Clinical trials

Washington University Physicians at Siteman are actively involved in clinical trials that investigate new technology in the accurate diagnosis and successful treatment of prostate cancer. Having your prostate cancer treated at Siteman gives you access to new diagnostic and treatment approaches that are as good as – or potentially better than – current standard therapies available elsewhere.

As prostate cancer treatment continues to evolve, it is important that you are treated at a cancer center that has all treatment options available. Siteman will provide the FDA-approved medications and treatments as well as access to the newest therapies for prostate cancer.

Personal support

At Siteman, we understand that excellent cancer care takes a personal touch. Our experienced nurses are specially trained to support cancer patients and will help you cope with your symptoms, treatments, and side effects. We have registered dieticians on staff who can provide guidance about nutrition and suggest ideas for meals and snacks that will taste good as you move through your treatment plan. In addition, patients and family members who desire mental health care can receive free treatment from our team of skilled cancer psychologists. Social workers are also available to meet with patients.