• Prostate Cancer

    Dana-Farber/Brigham and Women's Cancer Care

    How We Treat Prostate Cancer

    You can feel confident in the treatment at the Lank Center for Genitourinary Oncology at Dana-Farber/Brigham and Women's Cancer Center (DF/BWCC), since our specialists focus exclusively on genitourinary cancers. If you need surgery, radiation, or chemotherapy, you will see experts in each area who deal specifically with prostate cancer. Studies have shown that recovery and survival rates are higher for patients who are treated at a comprehensive medical center with a multidisciplinary team of experts, such as those found at the Lank Center. Our experts see more than 2,500 prostate cancer patients each year, giving you an unmatched level of treatment expertise.

    For referring physicians

    Because the patient's primary care physician or community specialist is an integral part of the patient's care team, we are committed to collaborating with you in the care of your patient.

    If you are a physician and have a patient with prostate cancer, we look forward to working with you.

    Find out more about how to refer a patient to DF/BWCC.

    Find out about Physician Gateway, our portal that helps you keep track of patients you have referred for care. Physician Gateway is available for primary care providers, referring providers, and your authorized office staff.

    Multidisciplinary approach

    Our clinical and support teams are not just here to manage your cancer; they are here to care for you. We create a unique plan for every patient, and we consider all aspects of your health when making our recommendations.

    Our multidisciplinary team includes experienced urologists, medical oncologists, radiation oncologists, radiologists, pathologists, researchers, nurses, physician assistants, and social workers devoted to well-rounded patient care. At DF/BWCC, you have the advantage of meeting with your entire medical team in a single visit. Your team will also meet regularly to review your health and treatment options and ensure you receive the best possible care for your needs.

    Beginning with your first appointment, our nurses will walk you through the entire treatment process, making sure you know what to expect and where to find helpful resources, such as counseling, nutrition advice, or palliative care. In addition, each patient has a personal social worker to provide extra support and guidance.

    Prostate cancer treatment by disease risk

    Paul Nguyen, MD Paul Nguyen, MD, Director of Prostate Brachytherapy 

    Depending on how much the cancer has spread, you may have one treatment or a combination of treatments. Treatment depends largely on the estimated risk and Gleason score, but other factors, such as your age and overall health, are always considered before treatment.

    For nearly all cases of non-recurrent prostate cancer, active surveillance will be included as part of your treatment before and/or after additional treatments.

    • Treatment for low-risk prostate cancer is often active surveillance. Surgery may be performed to remove a portion of the prostate. Radiation may be suggested for early-stage patients, as surgery and radiation produce similar outcomes.
    • Treatment for intermediate-risk prostate cancer generally includes hormone therapy (androgen deprivation) combined with surgery to remove a portion of or the entire prostate, and possibly radiation.
    • Treatment for high-risk prostate cancer often includes an emphasis on clinical trials. Hormone therapy and radiation will likely be introduced to the plan, as well. A prostatectomy may be performed, along with removal of affected tissue or lymph nodes.
    • Metastatic prostate cancer treatment often includes immunotherapy and hormone therapies. Chemotherapy may be introduced if these therapies aren't successful. Radiation may be suggested at this stage of the disease to ease pain or symptoms.
    • For prostate cancer patients with recurrent prostate cancer, surgery will include a prostatectomy and radiation. Hormone therapy is occasionally suggested for recurrent cases, as well.

    For young men with prostate cancer

    We recommend that you take the time to discuss your post-treatment goals with your doctors, as most treatment therapies for prostate cancer come with side effects. Prostate cancer in young men is less common. However, if you are a young man with prostate cancer and would still like to have children, our doctors will discuss your best options to preserve your sexual function and fertility. Surgery for prostate cancer usually affects the production of semen or the delivery of sperm, and radiation significantly decreases the amount of semen that can be produced (semen is necessary to carry the sperm). We suggest discussing your fertility options and sexual concerns with the dedicated fertility and reproductive specialists at DF/BWCC. For example, you may consider sperm retrieval or sperm banking before treatment begins.

    Surgery

    Surgical approaches to the treatment of prostate cancer include:

    • Radical prostatectomy: Open surgery to remove the entire prostate through an incision in the abdomen or area behind the scrotum.
    • Robotic prostatectomy: Uses a combination of high-definition 3D magnification, robotic technology, and miniature instruments to enhance a urologic surgeon's skills when removing a cancerous prostate gland.

      Robotic prostatectomy benefits: Our surgeons perform hundreds of minimally-invasive robotic prostatectomies each year using the FDA-approved da Vinci® Surgical System. Robotic surgery's miniaturization, increased range of motion, enhanced vision, and mechanical precision offer significant benefits for our prostatectomy patients, including:

      • Decreased length of stay
      • Less blood loss
      • Less post-surgical pain/less medication
      • Quicker recovery and return to normal activities
      • Less scarring
      • Greater probability of maintaining urinary continence
      • Less risk of erectile dysfunction
       

    Active surveillance

    Active surveillance (also known as "watchful waiting") is a crucial part of any treatment plan for prostate cancer patients. Prostate cancer usually grows slowly, and some forms of the disease are not harmful. For that reason, some men with a prostate cancer diagnosis may not require immediate treatment or may not receive treatment at all. Instead, doctors may recommend active surveillance.

    This means doctors will closely monitor the prostate and tumor without active treatment. Biopsies, MRI procedures, and PSA tests will be taken periodically to monitor the tumor. If the tumor shows an increase in size or Gleason score, treatment may then be pursued. Long-term studies of "watchful waiting" show that men with small and early-stage tumors can maintain this approach for up to ten years without requiring treatment. In addition, active surveillance is always a part of any post-treatment plan.

    Radiation

    Leading-edge techniques and the outstanding skill of DF/BWCC doctors allow for remarkable precision in the delivery of radiation treatment. Our radiation oncologists have perfected prostate MRI imaging, so they can carefully target cancer cells in order to safely deliver high doses of treatment, while minimizing damage to healthy nearby cells. Because the prostate may move within the body, our experts use additional imaging techniques to precisely target the prostate before radiation treatment.

    Additionally, DF/BWCC radiation oncologists are experts in treating difficult or complex cases. Our radiation oncology team is one of the few teams nationally that treats recurrent cases of prostate cancer.

    Radiation therapy is generally an option for patients whose prostate cancer hasn't spread beyond the prostate or surrounding tissue. Radiation therapy may be delivered before or after surgery, or used in combination with hormone therapy. In rare cases, radiation may also be used for patients who cannot have surgery, or to relieve pain and other symptoms in late or recurrent stages of the disease.

    Radiation therapies for prostate cancer may include:

    • 3D imaging radiation therapy called image-guided radiation therapy (IGRT) (sometimes referred to as intensity-modulated radiation therapy (IMRT). IGRT for prostate cancer utilizes a unique balloon designed to keep the prostate in place for precise delivery of radiation treatment. IGRT employs computer images to find and target the cancerous tumor. This reduces the damage to the surrounding healthy tissue. The Lank Center for Genitourinary Oncology is one of the few centers nationwide to offer this technique.
    • In brachytherapy or interstitial brachytherapy a tiny radioactive seed is directly implanted in or near the tumor. This is the most minimally-invasive procedure possible and results in very little discomfort.

      In addition, our radiation oncologists at DF/BWCC developed the urethral-sparing technique, and are among the limited few nationwide to deliver this type of radiation with image-guided techniques. The technique greatly minimizes the risk of urinary incontinence and urinary symptoms in patients with prostate cancer.

    Our radiation oncologists take the time to review and discuss your treatment options, and consider your health history and future before creating your personal treatment plan. If you have sexual health concerns, we are here to help. DF/BWCC offers private, expert counseling and education to help you and your partner manage any sexual health concerns or issues that arise before, during, or after cancer treatment. Find out more about our Sexual Health Program.

    Revolutionary imaging therapies

    All prostate cancer patients requiring radiation therapy will be cared for in an innovative operating and research environment developed at Brigham and Women's Hospital (BWH) in 2011. Called the Advanced Multimodality Image Guided Operating (AMIGO) Suite, our team of surgeons, interventional radiologists, imaging physicists, computer scientists, biomedical engineers, nurses, and technologists use the latest imaging tools to develop and deliver the safest, state-of-the-art therapies. The AMIGO suite is unique, as it combines PET/CT, MRI and OR technologies in one operating room. BWH is one of the few hospitals in the United States to operate an AMIGO suite.

    Chemotherapy

    Medical oncologists are doctors who study cancer tumors and deliver chemotherapy (drugs that eliminate cancer cells or stop them from dividing). Medical oncologists at DF/BWCC offer the most effective therapies possible, while helping you maintain your quality of life during treatment. Medical oncologists at DF/BWCC are constantly testing and studying new combinations of chemotherapy drugs to improve outcomes, decrease side effects, and slow the growth or recurrence of tumors.

    In general, chemotherapy is reserved for prostate cancer patients who are not responding to hormone therapy, or those with recurrent cases of the disease. This type of therapy is not a frontline treatment, but it may be suggested in rare cases.

    Chemotherapy is provided at Dana-Farber's Yawkey Center for Cancer Care, one of the most advanced outpatient cancer centers in the country – designed by patients, for patients.

    Hormone therapy

    Hormone therapy is a treatment that blocks the action of naturally occurring hormones in order to stop cancer cells from growing. Hormones are substances made by glands in the body and circulated in the bloodstream. Sometimes hormones can cause certain cancers to grow. If tests show that the cancer cells have hormone receptors, drugs, surgery, or radiation therapy is used to reduce the production of male hormones or block them from working.

    The majority of prostate cancers thrive off male hormones (androgens) such as testosterone. Sometimes prostate cancer patients will require hormone therapy to block testosterone production or testosterone interaction with the tumor cells (also called androgen deprivation). Hormone therapy may help control prostate cancer, but it will not cure it.

    Hormone therapy is generally used for intermediate- to high-risk prostate cancer. Occasionally, hormone therapy will be suggested for cancers that have spread beyond the prostate or when cancer is likely to return after treatment. It may also be recommended when surgery or radiation is not possible. Hormone therapy for prostate cancer may include the following:

    • Antiandrogen drugs, which block the production of male hormones, such as testosterone, in the adrenal glands, as well as the action of male hormones.
    • Luteinizing hormone-releasing hormone (LHRH) agonists can stop the testicles from making testosterone. These drugs work by creating a spike in testosterone levels to release the specific luteinizing hormone-releasing hormone. Following the spike, the testicles receive a signal to temporarily halt testosterone production. The effects of LHRH are usually not permanent, and testosterone production typically resumes once medication is complete.
    • An orchiectomy, a surgical procedure to remove one or both testicles, may be performed to decrease the amount of the hormone testosterone being made in the testes; this procedure is not commonly used today, as does not afford breaks from therapy.

    Your medical oncologist will carefully review your options for hormone therapy and its permanent or temporary side effects. Side effects from hormone therapies may include hot flashes, impaired sexual function, loss of desire for sex, decreased muscle and bone mass, weight gain, and higher cholesterol, as well as an increased risk of heart attack, diabetes, and high blood pressure.

    Immunotherapy

    Immunotherapy is a type of treatment that uses the patient's immune system to fight cancer cells. Substances made by the body, or in a lab, may be used to boost, drive, or restore a patient's immune system defenses against cancer. These may be used on occasion for prostate cancer patients with recurrent cases.

    Provenge

    For certain men with advanced, metastatic (spreading) prostate cancer that is resistant to hormone therapy, a newly FDA-approved cancer vaccine — called Provenge — is now available.

    • As a vaccine, Provenge harnesses the body's immune system to fight cancer. Unlike preventive vaccines, which protect people from developing particular diseases, Provenge is a therapeutic vaccine which is given to people who have already developed prostate cancer.
    • The vaccine is produced by removing some of a patient's white blood cells, then exposing them to a protein from prostate cancer cells and a stimulatory molecule. This process primes the white cells to attack prostate cancer when they are re-injected into the body.

    Clinical trials

    DF/BWCC offers one of the largest and most active clinical trial programs available in the area, including clinical trials for patients with prostate cancer. We are passionate about discovering and offering novel trial opportunities that can't be found at any other comprehensive cancer center. We offer a wide range of clinical trials of new treatments for all stages of prostate cancer. The clinical trials conducted at DF/BWCC have had a profound impact on the type of care administered worldwide.

    For some patients with prostate cancer, taking part in a clinical trial is the best treatment option. Clinical trials may be suggested at any stage of the disease. Our researchers are committed to creating trials for all stages of prostate cancer, and are especially dedicated to creating hormone therapy and immunotherapy trial options. If you qualify for a clinical trial, your doctor will carefully discuss all options and the best time to begin a trial (before, during, or after cancer treatment).

    Clinical trials are part of the cancer research process; they are safe and regulated research studies to determine if new cancer treatments are effective, or better than a current plan. Not only can trials lead to new discoveries and improve cancer care, but they can have life-saving benefits. Clinical trials may include biologic therapies, or treatments that use the patient's immune system to fight the cancer (immunotherapy or biotherapy). Trials also include targeted therapy or therapies using drugs to identify and attack the specific prostate cancer cells without harming healthy cells.

    Find out more about clinical trials at DF/BWCC.

    Detailed information about clinical trials is available from the NCI Web site.

    For nationally run clinical trials, please visit ClinicalTrials.gov.

    Questions to ask your doctor about clinical trials

    If your doctor suggests a clinical trial as part of your cancer treatment, you may have questions before you get started. Review some commonly asked questions about clinical trials and discuss them with your doctor.

    Next: Our Prostate Cancer Specialists 

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