The team of prostate cancer specialists at the Perlmutter Cancer Center offers a variety of treatment options and strategies to maximize the chances of cure and survival for patients with all stages of the disease. These include both local treatment options and systemic therapies directed to kill cancer cells that may have escaped the prostate. These include:
- surgery to remove the tumor and nearby affected tissues, with emphasis on techniques that preserve function
- radiation therapy (the delivery of finely focused beams of radiation to kill cancer cells and shrink tumors)
- brachytherapy (a form of radiation therapy in which tiny radioactive seeds are placed inside the prostate to kill cancer cells)
- high-intensity focused ultrasound (HIFU)
- hormonal therapy
- chemotherapy (the administration of drugs to kill cancer cells)
- novel agents
Because we care about delivering the best treatment for your needs, we also work with your personal physician to assure continuity of care.
Minimally Invasive Surgical Approaches
For patients who need surgery, Perlmutter Cancer Center surgeons have extensive experience performing procedures to remove the prostate, including novel nerve-sparing approaches that preserve urinary and sexual function in select patients. We also have experts who specialize in the surgical and/or pharmacological treatment of incontinence and erectile dysfunction, which can sometimes develop after treatment for prostate cancer.
High-Intensity Focused Ultrasound (HIFU)
HIFU is designed to treat localized prostate cancer using ultrasound waves traveling through the rectal wall and focused on the prostate gland. The waves produce intense heat, leading to the destruction of cancerous prostate tissue within the targeted zone without damaging surrounding healthy tissue. The HIFU procedure is performed on an outpatient basis and takes just a few hours. Patients generally are mobile and can return home the same day, and can return to a normal routine within a few days of having the procedure.
Refining Radiation Therapy
The Perlmutter Cancer Center also offers seed implantation to treat prostate cancer. Through this approach, which is used to treat localized cancer, radiation can be delivered from dozens of tiny radioactive seeds implanted directly into the prostate gland. This approach has the advantage of delivering a high dose of radiation to tissues in the immediate area, while minimizing damage to nearby healthy tissues such as the rectum and bladder. Perlmutter Cancer Center radiation oncologists are assessing novel ways of placing seeds more accurately so radiation is delivered in a highly targeted way to cancerous tissue, improving a patient's outcome.
Patients with localized prostate cancer that have a high risk of recurring are a focus of special interest to our multidisciplinary team of prostate cancer experts. Because of the high probability of recurrence and progression after surgery or radiation therapy alone, we are exploring strategies that combine surgery and radiation therapy with hormones and chemotherapy to diminish the chance of recurrence and optimize quality of life.
Novel Treatments for Recurrent and Advanced Disease
About 30 percent of men experience rising PSA levels after surgery or radiation therapy. Some of these men demonstrate cancer spread to the lymph nodes or bones (metastasis). While PSA increases can be monitored for some time to determine the PSA doubling time, many men will require hormone therapy to lower the level of testosterone. The “biochemical castration” induced by such hormone therapy is among the most effective treatments to decrease PSA levels and impede the growth of prostate cancer cells.
The effectiveness of hormone therapy, however, is not permanent, and over time many prostate cancers progress in spite of hormones. This so-called castration-resistant prostate cancer state is also marked by a PSA rise and/or the appearance of new metastases. In these cases, other types of hormone therapy and chemotherapy are usually effective.
At the Perlmutter Cancer Center, our medical oncologists specializing in the treatment of prostate cancer are evaluating new ways of treating men with recurrent and castration resistant prostate cancer.
- Hormonal therapies. A novel approach under evaluation in clinical trials is substituting castration-inducing hormone therapies for agents that don’t induce castration and to reverse the resistance to hormones that develops over time in men who were on castration-inducing hormone therapy. These new treatments build on our innovative research findings regarding the androgen receptor — a protein which is essential for testosterone to promote the growth of prostate cells under normal conditions. Prostate cancer cells become “addicted” to the androgen receptor, which helps them to continue to grow even in the absence of testosterone. Our investigators found that drugs that turn off the androgen receptor have the potential to slow down tumor growth and possibly eliminate tumors that have become resistant to hormones and chemotherapy. Examples of such novel therapies that target the androgen receptor include combining the drug bicalutamide with enzastaurin — a drug that inhibits an enzyme capable of stimulating the androgen receptor — and inhibitors of an enzyme called deacetylase, such as the drug panobinostat.
- Immunotherapy is another area of major research interest to Perlmutter Cancer Center investigators. They are involved in clinical trials assessing a prostate cancer vaccine designed to stimulate the immune system to recognize, fight, and kill prostate cancer cells, wherever they may be in the body. These vaccines are extremely well tolerated and are currently being evaluated alone or in combination with hormone therapy and chemotherapy.
- Chemotherapy is also a very important weapon against prostate cancer that has become refractory to hormones and has metastasized to the lymph nodes or the bones. Several clinical trials are assessing the efficacy of chemotherapy combined with novel agents or with hormone therapy to improve patient outcome.
- Quality of life. Our team of medical oncology experts advises patients on diet and exercise and provides guidelines to maximize and enhance quality of life and performance through the various stages and treatments of prostate cancer.