Prostate Cancer Treatment

There are a number of approaches to prostate cancer treatment. At Siteman Cancer Center, our Washington University Physicians build a custom treatment plan for each patient. These plans draw upon the latest research and the most advanced therapies available. Sometimes, our experts even decide that the best course of treatment is no treatment at all.

How is prostate cancer treated at Siteman?

The standard treatments for prostate cancer at Siteman Cancer Center are:

  • Active surveillance
  • Watchful waiting
  • Focal therapy
  • Surgery
  • Radiation therapy
  • Systemic therapy

Active surveillance for prostate cancer

Active surveillance means watching a low-grade and non-aggressive prostate cancer instead of pursuing treatment right away. Many prostate cancers that are caught early with PSA screening can be watched safely. With careful monitoring, they will not cause the patient any pain or impact his quality of life. What this means is that the patient has prostate cancer but is not treated for it, sparing the patient the harsh side effects from treatment while not reducing his life span.

Before choosing active surveillance, it’s crucial that you undergo testing to ensure that your cancer is safe to track. Research led by Washington University urologists at Siteman has shown that active surveillance is safe for many patients with low-risk prostate cancers.

If you and your physician decide that active surveillance is right for you, you’ll meet with your care team regularly to ensure your cancer hasn’t changed. Tests and procedures you may need to have done include a digital rectal exam, PSA blood test, ultrasound or MRI, or prostate biopsy.

Some active surveillance patients at Siteman are eligible to join clinical trials for immunotherapies. These trials can act an extra safeguard against rapid or sudden cancer growth. Ask your physician if this could be an option for you.

Watchful waiting for prostate cancer

Like active surveillance, watchful waiting involves watching low-grade and non-aggressive prostate cancers. However, watchful waiting is a less intensive way of keeping an eye on the cancer without actually treating it. This type of observation may mean fewer tests. It also relies more on changes in a man’s symptoms to determine if treatment is needed.

Watchful waiting may be a good option for prostate cancers that are slow growing, aren’t causing symptoms and are contained to the prostate. It may also be good for older men who aren’t candidates for harsh treatments like surgery, chemotherapy and radiation.

This approach involves simply monitoring the cancer. The goal is to keep the patient comfortable while sparing him the taxing side effects of treatment. If the cancer spreads or starts to cause symptoms down the road, the patient may then decide to pursue treatment.

When it comes to weighing options for prostate cancer monitoring and treatment, there are many factors to think about. For example, the risks and side effects of prostate cancer treatment can sometimes outweigh the possible benefits. And, because prostate cancer is often slow growing, some men may never even need treatment. Speak with your doctor to see if watchful waiting might be right for you.

Focal therapy

This novel approach to treating prostate cancer destroys the tumor within the prostate. However, not all prostate cancers can be treated safely with focal therapy, and this is an ongoing area of research. We do know that high-quality imaging is key. Surgeons employ MRI scans or other imaging tests to first visualize tumors, then use various forms of energy to destroy them. These include cryoablation (freezing), laser ablation or high-intensity frequency ultrasound (HIFU). HIFU uses high-intensity sound waves to destroy cancer cells without harming the prostate.

Focal therapy can carefully remove the prostate cancer without harming the rest of the prostate gland. This reduces the risk of urinary or sexual side effects.


There are two main procedures that treat prostate cancer:

  • Radical prostatectomy: removal of the prostate gland
  • Transurethral resection of the prostate: removal of a portion of prostate tissue. Patients might undergo this procedure as part of a broader treatment program.

Read more about prostate cancer surgery at Siteman.

Radiation therapy

Radiation may be delivered to the prostate with the intent of curing the cancer. It can sometimes be used instead of surgery. Patients with low-grade disease can be treated with radiation alone, often with shorter courses to reduce the number of appointments. It can also be given to relieve cancer symptoms.

The radiation therapy options available to patients at Siteman include:

  • Intensity-modulated radiation therapy (IMRT)
  • Brachytherapy, given as low-dose-rate (LDR) or high-dose-rate (HDR)
  • Proton beam therapy
  • Radium-223

If you receive radiation at Siteman, your doctors will strive to ensure that your treatment is safe and effective. Siteman’s radiation oncology team has developed new methods to target prostate cancer without harming nearby healthy tissue.

Learn about Siteman’s advanced radiation therapies.

Systemic therapy

Systemic therapies for prostate cancer kill cancer cells in the prostate. They also kill cancer cells that have spread to other areas of the body, like the bones or lymph nodes. The patient can ingest systemic therapies as pills or receive them through an IV or an injection.

Hormone therapy is the main systemic therapy used in the treatment of prostate cancer. It prevents prostate cancer cells from getting the hormones they need to grow. Patients may receive chemo in certain cases.

Washington University Physicians at Siteman use newer drugs, such as new hormonal and immunotherapies, to fight prostate cancer. Some of these therapies stop cancer cells from spreading through new tissues or forming new blood vessels. They also have pioneered studies of effective systemic therapy for patients with advanced prostate cancer.

Learn more to learn more about systemic therapies at Siteman.