Cancer - Oncology

Treatments

At the Center of Excellence for Prostate Cancer, we offer the latest and most effective treatment options. The approach we use will depend on the stage and grade of your cancer, your age, any other health issues you may have, and your goals for treatment. We use the Gleason Score grading system to determine appropriate treatment options based on how aggressive your cancer is. The higher the score, the more quickly the cancer will grow.

Determining whether and how to treat prostate cancer is a personal decision. Some people prefer active surveillance, if appropriate. Others would rather have surgery because it makes them feel reassured that the cancer is out of their body. Still other men are more comfortable with a non-invasive approach such as radiation.

Our treatment options include:

Active surveillance is an option for men with low-risk prostate cancer. This means that instead of providing treatment such as surgery or radiation, we monitor you regularly for signs of more aggressive disease. It is a proactive regimen. We set up a surveillance program that meets your needs and situation. Generally, this means we perform a PSA blood test and a digital rectal exam every three months, a magnetic resonance imaging (MRI) test yearly, and a biopsy every three years. You will also meet with Jillian Capodice, LAC, Director of Integrative Urology and Wellness. She will create a personalized program that treats your mind, body, and spirit. The plan may include diet assessment and evaluation for psychosocial needs.

Surgery for prostate cancer can be performed in one of two ways. When possible, we use a minimally invasive or robotic approach. Sometimes, a traditional open procedure is most appropriate. Radical prostatectomy involves removing the prostate, nearby tissues, and seminal vesicles. It is effective if your cancer has not spread beyond the prostate gland. Mount Sinai is home to some of the foremost leaders in robotic prostate surgery. We have designed techniques to preserve normal sexual function and bladder function. Our doctors can also reconstruct the parts of the body that help with controlling flow of urine. This method can minimize or prevent leakage.

Radiation therapy uses high-energy beams to kill cancer cells. It is also known as radiotherapy. Mount Sinai offers the most advanced radiation therapies available. These include intensity modulated radiation therapy; Novalis shaped beam radiosurgery; real-time, ultrasound-guided prostate seed implants (called brachytherapy). These approaches let us precisely target the tumor while sparing as much normal tissue as possible.

Hormone therapy lowers your level of male sex hormones (androgens) that feed prostate cancer cells and cause them to grow. The main androgen is testosterone. Lowering androgen levels can cause prostate cancers to shrink or to grow more slowly. Hormone therapy does not cure cancer. We often use this treatment when the cancer has spread beyond the prostate or has come back after treatment. This approach is also called androgen deprivation therapy or androgen suppression therapy.

Chemotherapy uses drugs to stop the growth of cancer. There are many types of chemotherapies. We use these drugs in various combinations. Chemotherapy is most appropriate when the cancer has spread beyond the prostate and is not responding to hormone therapy.

Immunotherapy uses your body’s immune system to attack cancer cells. One type of immunotherapy is Provenge® (sipuleucel-T), an IV infusion that treats advanced prostate cancer. Mount Sinai researchers helped develop this approach. We are researching other types of immunotherapy.

High Intensity Focused Ultrasound (HIFU) is a minimally invasive procedure that precisely targets cancerous cells. Patients can go home the same day. An ultrasound probe is inserted into the rectum and sound waves ablate—or heat up—the cancerous cells, sparing the surrounding tissue and reducing the risk of side effects such as incontinence and erectile dysfunction.

As a patient at Mount Sinai, you may be able to take part in a clinical trial. Clinical trials study new drugs or treatment approaches that are not available as part of routine care. Your Mount Sinai doctor will determine whether you are a candidate for a clinical trial.

Support Programs and Services

All cancer patients at Mount Sinai have access to specialized support programs and services. These services include palliative care, treatment for pain, and integrative medicine. Integrative medicine involves using complementary and traditional medicine together.  Our social workers, psychiatrists, dietitians, chaplains, and experts in palliative care are here to help. We focus on you with individual needs that may change over time. We work with you and your loved ones to evaluate your concerns and develop a personal plan. This plan may include counseling, practical help, education, symptom management, and wellness programs.

For a full list of our support programs and services, please visit Men’s Health and Integrative Urology and Wellness.