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.
Your Mount Sinai doctor will help you determine the best course of treatment.
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 targets cancerous tissue precisely using high-frequency sound waves. We insert an ultrasound probe into the rectum. The sound waves heat up and remove just the cancerous tissue. At Mount Sinai, we use Focal One robotic HIFU. This technology fuses high-resolution images with biopsy data and real-time ultrasound imaging. It lets our urologist see the cancerous tissue in 3D. Then we draw precise contours around the diseased tissue, and ablate only that portion of the prostate. Called focal therapy, this process minimizes damage to the surrounding tissue. It protects healthy nerves, blood vessels, and muscle tissue. As a result, you’re less likely to develop urinary incontinence or erectile dysfunction. Focal therapy is similar to performing a lumpectomy to remove only the diseased tissue from the breast of a woman with breast cancer. The procedure leaves the options of radical surgery or radiation therapy, should the cancer return.
Theranostics is a new personalized treatment approach that uses radioactive drugs (radiopharmaceuticals) to diagnose and treat different types of cancer. The term theranostics was created by combining “diagnosis” and “therapeutic” because the drugs involved work both to diagnose and treat cancer. Theranostics uses a two-step process. First, you will have a positron emission tomography/computed tomography (PET/CT) scan using a radioactive drug that is specific to your cancer. This PET/CT scan will show if the cancer molecules take up the drug (called molecular expression). In the second step, if there is molecular expression of the drug, you will receive targeted radiopharmaceutical therapy that kills the cancer cells while minimizing harmful effects to healthy cells.
Pluvicto is a radiopharmaceutical that was approved by the U.S. Food and Drug Administration (FDA) in March 2022 for patients with metastatic prostate cancer that is not responding to hormone therapy and chemotherapy. Prior to its FDA approval, Mount Sinai had been using Pluvicto successfully in a clinical trial. Superior outcomes and improved survival experienced by patients in the clinical trial led to FDA approval.
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.