An individual's treatment path for prostate cancer is determined after assessing the risk level of your disease. Treatment paths are also greatly influenced by age and lifestyle of an individual with prostate cancer. For example, a 40 year old man diagnosed with early stage & low-risk prostate cancer may still decide to opt for a robotic prostatectomy to eliminate lifelong surveillance / watchful waiting. Then again, another 40 year old man may choose to forgo active treatment, and regularly monitor to check for progression of the disease.
For men with high risk disease, multi-modal therapy is usually needed, as surgery or radiation therapy alone may not be curative.
It is best to speak with your urologist to determine the treatment path that is best for you.
- Involves serial monitoring of prostate cancer through prostate needle biopsies, PSA testing, and imaging with the intent of intervening to prevent the spread of prostate cancer
- The frequency of prostate biopsy, PSA testing, and imaging depends on patient and physician discussion.
- Active surveillance is typically not an option for men with high risk prostate cancer.
The decision to pursue definitive therapy is influenced by multiple factors, which include prostate biopsy & PSA test results, as well as a patient's desire to optimize lifestyle and cancer control.
New & emerging technologies utilized at Weill Cornell Medicine allow us to more accurately follow patients on active surveillance, and provide effective treatments through minimally-invasive & non-surgical therapies. The multidisciplinary emphasis within our prostate cancer program gives us an edge for accurate diagnosis, and enables us to provide all treatment options, including surveillance, image-guided therapy, radiation and surgery.
- Surgical removal of the prostate cancer for men with low risk disease may be considered under certain situations. For instance, younger men in their 40's and 50's who may face several decades of active surveillance involving repeated prostate needle biopsies and PSA testing may elect to undergo radical prostatectomy.
- Moreover, the risks for erectile dysfunction and urinary incontinence are lower for younger versus older men opting for radical prostatectomy.
- Presently, approximately 80% of all radical prostatectomies are performed minimally invasively with robotic assistance, shortening recovery times and hospital stays.
- The nerve-sparing technique is typically performed during most radical prostatectomies, but the extent of the tumor, as defined through prostate biopsies and MRI staging determines the degree of nerve-sparing that is performed and is an individualized discussion between patient and surgeon.
- Men with low risk prostate cancer may choose from the full spectrum of radiation therapy options, including brachytherapy (radioactive seeds), intensity modulated radiation therapy (IMRT), proton beam therapy, or combination therapy.
Treatment for Metastatic Prostate Cancer
- Prostate cancer grows in response to testosterone. Testosterone is produced in the testicles and the adrenal gland. Testosterone production can be stopped in two ways.
- The testicles may be surgically removed with a procedure called an orchiectomy.
- Similarly, testosterone production may be stopped with medications such as degarelix, leuprolide or goserelin acetate that suppress the pituitary gland and thus decrease production in the testes. This is know as androgen deprivation therapy (ADT). ADT is not a curative therapy, but is reserved for metastatic disease. It can relieve symptoms from painful bone metastases and slow the overall growth rate of prostate cancer cells.
- For radiation therapies, randomized trials have demonstrated a benefit to adding androgen deprivation therapy to radiation therapy.
- For men with hormone-resistant prostate cancer growth, several options, including investigational treatments, are available through clinical trials. Most men treated for hormone-resistant prostate cancer have symptomatic disease.
Cryo-Ablation is a minimally invasive treatment that involves targeting freezing of cancerous tissue within the prostate. Using needles called cryoprobes, prostate tissues are repeatedly frozen and thawed in order to kill the cancerous tissue. Cryo-Ablation can be performed either as a whole-gland or partial-gland procedure. Whole gland cryoablation is used when the cancer is evenly distributed and spread across the entire prostate. An advanced procedure, called focal cryoablation allows the surgeon to utilize location data from biopsies to guide & target the needles to kill only the specific parts of the prostate that are cancerous. This allows the prostate to remain intact while the cancerous sections are destroyed.
HIFU Image-Guided Therapy
High Intensity Focused Ultrasound (HIFU) is a minimally-invasive and non-surgical therapy that utilizes focused ultrasound waves to heat and destroy prostate tissue. During a HIFU treatment, an ultrasound probe is placed inside a man's rectum and aimed towards the prostate. Just as intensified light can cause powerful heating, focused ultrasound waves create heat that is used to kill specific tissues within the prostate.
HIFU may be performed either as a whole gland or partial gland procedure. In a partial gland HIFU, the ultrasound waves are focused on the specific portions of the prostate that were identified of concern. In a whole gland HIFU, the entire prostate is targeted.
HIFU is performed under US or MRI guidance and at Weill Cornell Medicine we are currently enrolling patients MRI-guided HIFU (MRgFUS). Learn more about our current MRgFUS clinical trial for prostate cancer patients.