The good news is that we have more effective treatment options for prostate cancer than ever before. At Mount Sinai, our experts use all of the latest techniques. Determining whether and how to treat prostate cancer are personal decisions. Some people prefer surgery because it may provide reassurance to know that the cancer is out of the body. Others are more comfortable with a non-invasive procedure such as radiation. A third group of men opt for active surveillance, if it is appropriate for the condition.
Treatment options depend on the stage and grade of your cancer, age, and any other health issues you may have as well as your goals for treatment. The treatment options include:
Active surveillance, also referred to “watchful waiting” or “expectant management,” means a period of active observation, including periodic testing (such as prostate-specific antigen (PSA) tests digital rectal exams (DRE); ultrasounds and biopsies), and watching for symptoms to see if a cancer is growing. We take this approach for early stage prostate cancer when the tumors are small, contained within one area of the prostate (localized), and slow-growing. We may also use it for older prostate cancer patients or those with serious medical conditions and are not good candidates for surgery.
Surgery for prostate cancer can be performed traditional open procedures or with a minimally invasive or robotic approaches. Radical prostatectomy, a procedure that removes the prostate as well as the nearby tissues and seminal vesicles, is effective if your cancer has not spread beyond the prostate gland. Ash Tewari, MD, Chair of the Department of Urology and one of the foremost leaders in robotic prostate surgery, has designed techniques to preserve normal sexual function and bladder function. This approach reconstructs the supporting structures responsible for urinary continence to minimize and prevent urinary leakage.
Radiation therapy, also known as radiotherapy, uses high-energy beams to kill cancer cells and eliminate tumors. Mount Sinai offers the most advanced radiation therapies, including intensity modulated radiation therapy, Novalis-shaped beam radiosurgery, real-time ultrasound guided prostate seed implants (called brachytherapy), and Mammosite. All of these approaches allow us to meticulously target the tumor while sparing as much normal tissue as possible.
Hormone therapy, also called androgen deprivation therapy (ADT) or androgen suppression therapy, lowers levels of male sex hormones (androgens) that feed prostate cancer cells and cause them to grow. The main androgen is testosterone. We administer hormone therapy using medication or surgery. Lowering androgen levels can cause prostate cancers to shrink or to grow more slowly, but it does not cure cancer. We often use ADT when the cancer has spread beyond the prostate or has recurred after treatment.
Chemotherapy uses drugs to stop the growth of cancer. There are many types of chemotherapies that we use in various combinations. We typically use chemotherapy when the cancer has spread beyond the prostate and is not responding to hormone therapy.
Immunotherapy, or therapeutic vaccines, harness your immune system’s ability to attack cancer. One vaccine, Provenge® (sipuleucel-T) was approved by the U.S. Food and Drug Administration in 2010 to treat advanced prostate cancer. Our researchers were integral in its approval process. We are currently working on other types of immunotherapy.
Clinical trials are research studies that are in the final stages of investigation. Since we are heavily involved in research, as a patient at Mount Sinai, you have the opportunity to take part in a clinical trial.