Prostate Cancer Treatment

There are a number of ways to treat prostate cancer. 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 and tools. 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:

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

What is 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. This allows them to forgo side effects from treatment while not reducing their life span.

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

If you and your physician choose active surveillance, you’ll meet with your medical team regularly to ensure the cancer hasn’t changed. Tests and procedures may 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 as an extra safeguard against rapid or sudden cancer growth. Ask your physician if this could be an option for you.

What is 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.

The goal of watchful waiting is to simply monitor the cancer. The patient is kept comfortable without having to deal with 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. 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.

What is focal therapy?

This novel approach to treating prostate cancer destroys the tumor within the prostate. 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 visualize tumors precisely on MRI scans or other imaging tests, using 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.

What surgical procedures are used to treat prostate cancer?

Two main procedures are used in the treatment of prostate cancer:

  • Removal of the prostate gland (radical prostatectomy)
  • Removal of a portion of prostate tissue (transurethral resection of the prostate). Patients might undergo this procedure as part of a broader treatment program.

Read more about prostate cancer surgery at Siteman.

What is radiation therapy for prostate cancer?

Radiation to the prostate is given 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. Radiation 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.

What is systemic therapy for prostate cancer?

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.