Prostate Cancer Treatment Options

Your oncologist may recommend starting with active surveillance (also called watchful waiting) if the risks and possible side effects of treatment outweigh the benefits. Your prostate cancer doctor may suggest this approach if you’re diagnosed with early-stage prostate cancer that seems to be growing slowly. Active surveillance is often suggested if the patient is older or has other serious health problems.

Choosing active surveillance does not mean you are giving up. Instead, it gives you the opportunity to avoid the side effects of surgery, radiation therapy, hormone therapy, and other treatments.

If you and your doctor agree that active surveillance is a good idea, your doctor will monitor you regularly (typically every 3 to 6 months, at first). After about one year, your doctor may order another biopsy to check the Gleason score. Treatment may begin if your Gleason score rises, your PSA level rises, or you develop symptoms. You may receive surgery, radiation therapy, or another approach.

If you choose active surveillance but later have concerns, you should discuss your feelings with your doctor so you can develop a treatment plan that will begin soon.

OA is proud to offer advanced treatment options as part of our comprehensive care for patients with prostate cancer. Metastatic prostate cancer can now be treated with radiopharmaceuticals approved by the US Food and Drug Administration.

Lutetium-177 PSMA Therapy (Pluvicto)

Pluvicto™, or lutetium-177 vipivotide tetraxetan PSMA therapy, is specifically designed to target a molecule on the surface of prostate cancer cells called PSMA, or prostate-specific membrane antigens. Men with metastatic, castration-resistant prostate cancer (mCRPC) who qualify for this innovative treatment undergo a PET scan using Pylarify®, a tracer that attaches to PSMA found on cancer cells. This allows for a highly precise image of the tumor that is more advanced than traditional imaging methods.

After the PET scan, treatment with Pluvicto™ begins. This therapy targets the PSMA protein present on prostate cancer cells and emits radiation to destroy cancerous tissue while preserving healthy cells. The treatment is given through an IV or an injection, and the regimen spans 6 to 9 months and involves multiple sessions.

This combination of Pylarify® imaging and Pluvicto™ therapy represents a significant advancement for patients diagnosed with metastatic castration-resistant prostate cancer. Clinical trials show promising results, including extended survival rates for individuals undergoing this targeted treatment.

Radium-223

Men with prostate cancer that has spread to the bones may benefit from a treatment called radium-223 dichloride. This FDA-approved radiopharmaceutical is given through a simple intravenous (IV) injection once a month for six months. Once in the bloodstream, the radiation travels directly to areas of bone affected by prostate cancer. There, it delivers targeted radiation to destroy cancer cells while minimizing damage to healthy tissue.

This therapy has proven to extend survival, relieve bone pain, and improve quality of life for men with metastatic prostate cancer involving the bones.

While there are several other prostate cancer treatment options, some men need or choose to have surgery. The prostate cancer surgeon may remove the whole prostate or only part of it.

During surgery, the surgeon removes part or all of the prostate, and the lymph nodes in the pelvis may be removed. Prostate cancer cells found in the lymph nodes are an indication that the disease may have spread to other parts of the body. In cases such as this, the surgeon might suggest alternative treatment options rather than removing the prostate.

In some cases, your surgeon can protect the nerves that control erection. However, if you have a large tumor or a tumor that’s very close to the nerves, surgery may cause impotence, which can sometimes be permanent. Your doctor can explain options for managing the sexual side effects of cancer treatment.

If your prostate is removed, you will no longer produce semen, which leads to dry orgasms. If you wish to father children, consider sperm banking or a sperm retrieval procedure before surgery.

Immunotherapy is a treatment that uses your immune system to fight cancer. It uses substances produced naturally by the body or created in a laboratory to enhance, direct, or restore the body’s natural defenses against cancer.

Immunotherapy is rapidly advancing and is becoming a promising option for prostate cancer treatment. Patients with metastatic prostate cancer receiving immunotherapy may be offered a therapeutic cancer vaccine, such as Sipuleucel-T.

Another class of immunotherapy drugs used for prostate cancer is immune checkpoint inhibitors. These drugs target PD-1, a checkpoint protein on immune system cells called T cells. By blocking PD-1, these drugs boost the immune response. Patients whose tumor has defects in a mismatch repair gene (dMMR) may be treated with an immunotherapy drug.

A clinical trial is a cancer research study aimed at improving existing cancer treatments or discovering new ones. When a trial demonstrates that a new treatment is more effective than the current standard, that new treatment may replace the standard.

Our participation in breakthrough clinical trials provides patients with access to innovative prostate cancer treatments and technologies that may not be widely available elsewhere. Consult with your HOA cancer care team to learn more about clinical trials for prostate cancer and to determine if one is right for you.

Learn more about clinical trials available at HOA