Prostate cancer

Treatment

Prostate cancer is complex. There are a lot of things to think about before you and your doctor choose a treatment plan. First, know that if it’s detected early, prostate cancer is highly treatable, and most men with prostate cancer survive. Our specialists at Fred Hutchinson Cancer Center are here to help you.

Following the merger of long-time partners, Fred Hutchinson Cancer Research Center and Seattle Cancer Care Alliance, the organization was renamed to Fred Hutchinson Cancer Center. We are an independent, nonprofit organization that also serves as UW Medicine's cancer program.

Treatment plan A detailed plan with information about a patient’s disease, the goal of treatment, the treatment options for the disease and the possible side effects and expected length of treatment. A detailed plan with information about a patient’s disease, the goal of treatment, the treatment options for the disease and the possible side effects and expected length of treatment. A treatment plan may also include information about how much the treatment is likely to cost and about regular follow-up care after treatment ends.

Experts at Fred Hutch offer comprehensive prostate cancer care and can talk with you about your unique situation and the best prostate cancer treatment for you. Fred Hutch brings together leading cancer specialists and researchers from both UW Medicine and Fred Hutch.

Unless your doctor tells you otherwise, you can probably take one to three months after diagnosis to learn more, get a second opinion and carefully consider your options.

While the choices you make for your treatment are personal, a key to making good decisions is getting input from experienced prostate cancer specialists who know the outcomes and quality-of-life issues associated with each type of treatment.

We have an experienced, compassionate team ready to help.

Prostate cancer expertise at Fred Hutch

Prostate cancer survival rates

Data collected from cancer centers across the country show that men who begin their prostate cancer treatment at Fred Hutch have higher survival rates on average than those who started treatment at other centers.

Everything you need is here

We have world-class urologic oncologists, medical oncologists, radiation oncologists, nuclear medicine specialists and pathologists who specialize in prostate cancer; the most advanced diagnostic, treatment and recovery programs; and extensive support.

Pathologist A physician who has special training in identifying diseases by studying cells and tissues under a microscope. Radiation oncologist A physician who has special training in using radiation to treat cancer.

Innovative prostate cancer therapies

Fred Hutch patients have access to advanced treatments being explored in ongoing prostate cancer clinical trials conducted at both Fred Hutch and UW Medicine. Our doctors and scientists are at the forefront of research to better prevent, diagnose and treat prostate cancer and to improve quality of life for survivors, including through the Institute for Prostate Cancer Research, a Fred Hutch–UW Medicine collaboration.

Prostate cancer treatment tailored to you

Your Fred Hutch doctors will explain all your options and recommend a treatment plan based on the grade and stage of your prostate cancer and several other factors, including your age, your general health, potential side effects and the probability of curing your disease, extending your life or relieving your symptoms.

Grade In cancer, a grade is a description of a tumor based on how abnormal the cancer cells and tissue look under a microscope and how quickly the cancer cells are likely to grow and spread. In cancer, a grade is a description of a tumor based on how abnormal the cancer cells and tissue look under a microscope and how quickly the cancer cells are likely to grow and spread. Low-grade cancer cells look more like normal cells and tend to grow and spread more slowly than high-grade cancer cells. Grading systems are different for each type of cancer. They are used to help plan treatment and determine prognosis. Also called histologic grade and tumor grade. Side effects A problem that occurs when treatment affects healthy tissues or organs. Some side effects of cancer treatment are nausea, vomiting, fatigue, pain, decreased blood cell counts, hair loss and mouth sores. Stage The extent of a cancer in the body. Staging is usually based on the size of the tumor, whether lymph nodes contain cancer and whether the cancer has spread from the original site to other parts of the body. Symptom A physical or mental problem that a person experiences that may indicate a disease or condition. Symptoms cannot be seen and do not show up on medical tests. A physical or mental problem that a person experiences that may indicate a disease or condition. Symptoms cannot be seen and do not show up on medical tests. Some examples of symptoms are headache, fatigue, nausea and pain. Treatment plan A detailed plan with information about a patient’s disease, the goal of treatment, the treatment options for the disease and the possible side effects and expected length of treatment. A detailed plan with information about a patient’s disease, the goal of treatment, the treatment options for the disease and the possible side effects and expected length of treatment. A treatment plan may also include information about how much the treatment is likely to cost and about regular follow-up care after treatment ends.

Team-based approach

You may choose to visit one of our prostate specialists for a specific type of treatment, or you may choose a multidisciplinary team approach, where Fred Hutch prostate specialists collaborate, discuss all your options and then recommend a plan. Additional experts will be involved in your care if you need them — experts like a geneticist, social worker, physical therapist or dietitian.

Ongoing care and support

After treatment, your team continues to provide follow-up care for at least 10 years on a schedule tailored to you. Our patients say they find it reassuring to see the same doctors who treated them for their follow-up visits. The Fred Hutch Survivorship Clinic is also here to help you live your healthiest life as a prostate cancer survivor.

Overview of treatment options

Your treatment options will depend in part on whether your disease is localized, high risk, recurrent or advanced.

Treating localized prostate cancer

For nearly eight in 10 men with prostate cancer, the disease is diagnosed early, in the local or regional stages. Most will be cured. Active surveillance, watchful waiting, radiation therapy and surgery are the most common treatments.

Radiation therapy The use of high-energy radiation from X-rays, gamma rays, neutrons, protons and other sources to kill cancer cells and shrink tumors. The use of high-energy radiation from x-rays, gamma rays, neutrons, protons and other sources to kill cancer cells and shrink tumors. Radiation may come from a machine outside the body (external-beam radiation therapy), or it may come from radioactive material placed in the body near cancer cells (internal radiation therapy or brachytherapy). Systemic radiation therapy uses a radioactive substance, such as a radiolabeled monoclonal antibody, that travels in the blood to tissues throughout the body. Surveillance Closely watching a patient’s condition but not treating it unless there are changes in test results. Surveillance is also used to find early signs that a disease has come back. In medicine, surveillance means closely watching a patient’s condition but not treating it unless there are changes in test results. Surveillance is also used to find early signs that a disease has come back. It may also be used for a person who has an increased risk of a disease, such as cancer. During surveillance, certain exams and tests are done on a regular schedule. In public health, surveillance may also refer to the ongoing collection of information about a disease, such as cancer, in a certain group of people. The information collected may include where the disease occurs in a population and whether it affects people of a certain gender, age or ethnic group. Watchful waiting Closely watching a patient’s condition but not giving treatment unless symptoms appear or change. During watchful waiting, patients may be given certain tests and exams. Closely watching a patient’s condition but not giving treatment unless symptoms appear or change. Watchful waiting is sometimes used in conditions that progress slowly. It is also used when the risks of treatment are greater than the possible benefits. During watchful waiting, patients may be given certain tests and exams. Watchful waiting is sometimes used in prostate cancer. It is a type of expectant management.

Treating high-risk or recurrent prostate cancer

Two in 10 men with prostate cancer are diagnosed with high-risk disease — localized prostate cancer that has a tendency to spread. Among these men, three or four in 10 will have cancer that comes back after treatment.

Doctors use hormone therapy, along with surgery and radiation therapy, to treat prostate cancers that might have spread. Learn more about the special considerations for treating high-risk or recurrent prostate cancer.

Treating advanced prostate cancer

If your cancer has already spread when you are diagnosed (advanced, or metastatic, prostate cancer), new treatments may put your cancer in remission and give you a good quality of life for years, even though the cancer can’t be cured.

Fred Hutch offers immunotherapy, hormone therapy, chemotherapy, radiation therapy, nuclear medicine and access to promising therapies in clinical studies that your community doctor may not know about.

Chemotherapy Treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. It may be given alone or with other treatments. Treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. Chemotherapy may be given by mouth, injection, infusion or on the skin, depending on the type and stage of the cancer being treated. It may be given alone or with other treatments, such as surgery, radiation therapy or biologic therapy. Clinical trial A type of research study that tests how well new medical approaches work in people. These studies test new methods of screening, prevention, diagnosis or treatment of a disease. Hormone therapy Hormones can cause some cancers to grow. To slow or stop growth, synthetic hormones or other drugs can be used to block the body’s natural hormones, or surgery is used to remove a hormone-producing gland. Treatment that adds, blocks or removes hormones. For certain conditions (such as diabetes or menopause), hormones are given to adjust low hormone levels. Hormones can also cause certain cancers (such as prostate and breast cancer) to grow. To slow or stop the growth of cancer, synthetic hormones or other drugs can be used to block the body’s natural hormones, or surgery is used to remove the gland that makes a certain hormone. Also called endocrine therapy, hormonal therapy and hormone treatment. Immunotherapy A type of therapy that uses substances to stimulate or suppress the immune system to help the body fight cancer, infection and other diseases. A therapy that uses substances to stimulate or suppress the immune system to help the body fight cancer, infection and other diseases. Some immunotherapies only target certain cells of the immune system. Others affect the immune system in a general way. Types of immunotherapy include cytokines, vaccines, bacillus Calmette-Guerin (BCG) and some monoclonal antibodies. Metastatic A metastatic cancer is a cancer that has spread to other areas of the body by way of the lymph system or bloodstream. Radiation therapy The use of high-energy radiation from X-rays, gamma rays, neutrons, protons and other sources to kill cancer cells and shrink tumors. The use of high-energy radiation from x-rays, gamma rays, neutrons, protons and other sources to kill cancer cells and shrink tumors. Radiation may come from a machine outside the body (external-beam radiation therapy), or it may come from radioactive material placed in the body near cancer cells (internal radiation therapy or brachytherapy). Systemic radiation therapy uses a radioactive substance, such as a radiolabeled monoclonal antibody, that travels in the blood to tissues throughout the body. Remission A decrease in, or disappearance of, signs and symptoms of cancer. A decrease in, or disappearance of, signs and symptoms of cancer. In partial remission, some (but not all) signs and symptoms of cancer have disappeared. In complete remission, all signs and symptoms of cancer have disappeared, although cancer still may be in the body.

Active surveillance and watchful waiting

If your cancer is not causing any symptoms, is slow growing or is small and confined to the prostate, your doctor may suggest active surveillance or watchful waiting.

Active surveillance means your doctor closely monitors your cancer using prostate-specific antigen (PSA) tests, digital rectal exams, ultrasounds and biopsies. If a change indicates your cancer is becoming more aggressive, your doctor will talk with you about treatment options.
Watchful waiting involves less testing. You and your doctor monitor any changes in your symptoms to determine if you need treatment.

Antigen A foreign substance, such as bacteria, that causes the body’s immune system to respond by making antibodies. Antibodies defend the body against antigens. Biopsy The removal of a sample of tissue or fluid that is examined to see whether cancer is present. This may be done with a large needle or through surgical removal of tissue or fluids. Surveillance Closely watching a patient’s condition but not treating it unless there are changes in test results. Surveillance is also used to find early signs that a disease has come back. In medicine, surveillance means closely watching a patient’s condition but not treating it unless there are changes in test results. Surveillance is also used to find early signs that a disease has come back. It may also be used for a person who has an increased risk of a disease, such as cancer. During surveillance, certain exams and tests are done on a regular schedule. In public health, surveillance may also refer to the ongoing collection of information about a disease, such as cancer, in a certain group of people. The information collected may include where the disease occurs in a population and whether it affects people of a certain gender, age or ethnic group. Symptom A physical or mental problem that a person experiences that may indicate a disease or condition. Symptoms cannot be seen and do not show up on medical tests. A physical or mental problem that a person experiences that may indicate a disease or condition. Symptoms cannot be seen and do not show up on medical tests. Some examples of symptoms are headache, fatigue, nausea and pain. Watchful waiting Closely watching a patient’s condition but not giving treatment unless symptoms appear or change. During watchful waiting, patients may be given certain tests and exams. Closely watching a patient’s condition but not giving treatment unless symptoms appear or change. Watchful waiting is sometimes used in conditions that progress slowly. It is also used when the risks of treatment are greater than the possible benefits. During watchful waiting, patients may be given certain tests and exams. Watchful waiting is sometimes used in prostate cancer. It is a type of expectant management.

Who is a candidate?

Prostate cancer can take 10 or more years to spread enough to become life threatening, so if you already have a life expectancy of less than 10 years, it might not make sense to undergo aggressive cancer treatment, and your doctor might suggest active surveillance or watchful waiting.

These methods might also be appropriate if:

You have a low-grade cancer and wish to defer treatment and potential side effects until treatment is necessary.
You prefer not to undergo aggressive treatment.
You want to avoid side effects of aggressive treatment.
You have health problems that prevent you from being a candidate for other types of treatment.

Side effects A problem that occurs when treatment affects healthy tissues or organs. Some side effects of cancer treatment are nausea, vomiting, fatigue, pain, decreased blood cell counts, hair loss and mouth sores. Surveillance Closely watching a patient’s condition but not treating it unless there are changes in test results. Surveillance is also used to find early signs that a disease has come back. In medicine, surveillance means closely watching a patient’s condition but not treating it unless there are changes in test results. Surveillance is also used to find early signs that a disease has come back. It may also be used for a person who has an increased risk of a disease, such as cancer. During surveillance, certain exams and tests are done on a regular schedule. In public health, surveillance may also refer to the ongoing collection of information about a disease, such as cancer, in a certain group of people. The information collected may include where the disease occurs in a population and whether it affects people of a certain gender, age or ethnic group. Watchful waiting Closely watching a patient’s condition but not giving treatment unless symptoms appear or change. During watchful waiting, patients may be given certain tests and exams. Closely watching a patient’s condition but not giving treatment unless symptoms appear or change. Watchful waiting is sometimes used in conditions that progress slowly. It is also used when the risks of treatment are greater than the possible benefits. During watchful waiting, patients may be given certain tests and exams. Watchful waiting is sometimes used in prostate cancer. It is a type of expectant management.

Treatment types

Treatment looks different for different people depending on your diagnosis. We tailor your treatment plan to you. Learn more about the treatment types offered at Fred Hutch.

Chemotherapy

Chemotherapy does not cure prostate cancer, which is one reason it is not used to treat localized prostate cancer the first time it occurs.

Your doctor may recommend chemotherapy as an option to extend your life or improve your quality of life if:

You have been diagnosed with advanced prostate cancer.
Your cancer has returned after treatment.

For prostate cancer, chemotherapy is typically given as a single medicine, orally or by injection. Prostate cancer is usually treated with one of the following:

Docetaxel (Taxotere)
Cabazitaxel (Jevtana)
Mitoxantrone (Novantrone)
Carboplatin (Paraplatin)

Chemotherapy

Chemotherapy does not cure prostate cancer, which is one reason it is not used to treat localized prostate cancer the first time it occurs.

High Intensity Focused Ultrasound (HIFU)

HIFU offers an incisionless and radiation-free alternative to treatment that is done in one outpatient treatment visit. During treatment, a rectal probe is placed and HIFU is delivered into the prostate through the intervening tissues. HIFU produces rapid heating via highly-focused ultrasound targeted to a point within the prostate to destroy cancer cells. Because there is minimal heating applied outside of the tumor area, there are minimal side effects to the patient.

Your physician may recommend HIFU as a treatment option if:

you have a Gleason score of 6 or 7 and an MRI indicating prostate cancer, or,
you have recurrent localized prostate cancer after radiation.

Magnetic resonance imaging A procedure in which radio waves and a powerful magnet linked to a computer are used to create detailed pictures of areas inside the body. A procedure in which radio waves and a powerful magnet linked to a computer are used to create detailed pictures of areas inside the body. These pictures can show the difference between normal and diseased tissue. MRI makes better images of organs and soft tissue than other scanning techniques, such as computed tomography (CT) or X-ray. MRI is especially useful for imaging the brain, the spine, the soft tissue of joints and the inside of bones. Side effects A problem that occurs when treatment affects healthy tissues or organs. Some side effects of cancer treatment are nausea, vomiting, fatigue, pain, decreased blood cell counts, hair loss and mouth sores. Gleason score A way of describing prostate cancer based on how abnormal the cancer cells in a biopsy sample look under a microscope and how quickly they are likely to grow and spread.

A way of describing prostate cancer based on how abnormal the cancer cells in a biopsy sample look under a microscope and how quickly they are likely to grow and spread. Most prostate cancers contain cells that are different grades. The Gleason score is calculated by adding together the two grades of cancer cells that make up the largest areas of the biopsied tissue sample. The Gleason score usually ranges from 6 to 10. The lower the Gleason score, the more the cancer cells look like normal cells and are likely to grow and spread slowly. The Gleason score is used to help plan treatment and determine prognosis (outcome).

High Intensity Focused Ultrasound (HIFU)

High Intensity Focused Ultrasound (HIFU) is a non-invasive treatment that is FDA-approved for prostate ablation.

Hormone treatment

Hormonal therapy keeps prostate cancer cells from getting testosterone, the main androgen (male hormone) in men, which may cause prostate cancers to grow. It reduces androgen levels in the body or prevents androgen from reaching prostate cancer cells.

Hormone therapy is among the most effective forms of systemic therapy (about 85 to 90 percent effective) for this disease. Used alone, it does not cure prostate cancer, but it does stop the disease from progressing for a while.

Your doctor may suggest hormone therapy if any of these is true:

You have advanced or high-risk prostate cancer at the time of diagnosis.
Your PSA level is rising despite previous treatment for prostate cancer.
You can’t have surgery or radiation therapy for your disease.

Several types of hormone therapy are available, including:

Medicines that prevent the production of testosterone in the body
Medicines that block the action of testosterone that has already been produced
Surgery to remove the testicles, the main source of testosterone in men

Hormone therapy is also called androgen-deprivation therapy or androgen-suppression therapy.

Prostate cancer may become resistant to hormone therapy over time. Much work by Fred Hutch investigators has focused on trying to prevent this.

Hormone therapy Hormones can cause some cancers to grow. To slow or stop growth, synthetic hormones or other drugs can be used to block the body’s natural hormones, or surgery is used to remove a hormone-producing gland. Treatment that adds, blocks or removes hormones. For certain conditions (such as diabetes or menopause), hormones are given to adjust low hormone levels. Hormones can also cause certain cancers (such as prostate and breast cancer) to grow. To slow or stop the growth of cancer, synthetic hormones or other drugs can be used to block the body’s natural hormones, or surgery is used to remove the gland that makes a certain hormone. Also called endocrine therapy, hormonal therapy and hormone treatment. Hormone therapy Hormones can cause some cancers to grow. To slow or stop growth, synthetic hormones or other drugs can be used to block the body’s natural hormones, or surgery is used to remove a hormone-producing gland. Treatment that adds, blocks or removes hormones. For certain conditions (such as diabetes or menopause), hormones are given to adjust low hormone levels. Hormones can also cause certain cancers (such as prostate and breast cancer) to grow. To slow or stop the growth of cancer, synthetic hormones or other drugs can be used to block the body’s natural hormones, or surgery is used to remove the gland that makes a certain hormone. Also called endocrine therapy, hormonal therapy and hormone treatment. Radiation therapy The use of high-energy radiation from X-rays, gamma rays, neutrons, protons and other sources to kill cancer cells and shrink tumors. The use of high-energy radiation from x-rays, gamma rays, neutrons, protons and other sources to kill cancer cells and shrink tumors. Radiation may come from a machine outside the body (external-beam radiation therapy), or it may come from radioactive material placed in the body near cancer cells (internal radiation therapy or brachytherapy). Systemic radiation therapy uses a radioactive substance, such as a radiolabeled monoclonal antibody, that travels in the blood to tissues throughout the body. Systemic therapy Treatment using substances that travel through the bloodstream, reaching and affecting cells all over the body. Prostate-specific antigen A protein made by the prostate gland and found in the blood. Prostate-specific antigen blood levels may be higher than normal in men who have certain prostate diseases or conditions.

A protein made by the prostate gland and found in the blood. Prostate-specific antigen blood levels may be higher than normal in men who have prostate cancer, benign prostatic hyperplasia (BPH), or infection or inflammation of the prostate gland.

Learn More About Hormone Treatment Side Effects

Hormone treatment

Immunotherapy

Immunotherapies are designed to use the patient’s own immune system to fight cancer. Vaccines are one form of immunotherapy.

Sipuleucel-T (Provenge) is a vaccine for advanced, metastatic prostate cancer that is no longer responding to hormone therapy (called castration-resistant disease) and that is causing few or no symptoms.

Sipuleucel-T is made from your own immune cells.
Your white blood cells are collected and sent to a facility where they are activated by exposure to a protein found in most prostate cancers (prostatic acid phosphatase). This is linked to a protein that stimulates the immune system, enhancing the response of your immune cells against the cancer.
Then your treated immune cells are returned to the clinic and infused into your bloodstream.

This treatment does not lower your PSA level or treat prostate cancer symptoms, and it has not been shown to cure metastatic prostate cancer. However, it has been shown to prolong life by about four months on average.

Fred Hutch was the location for several of the clinical studies that led to the approval of sipuleucel-T. Though no other immunotherapies are approved for treating prostate cancer, we're actively developing clinical trials of novel immunotherapy agents. .

Clinical trial A type of research study that tests how well new medical approaches work in people. These studies test new methods of screening, prevention, diagnosis or treatment of a disease. Hormone therapy Hormones can cause some cancers to grow. To slow or stop growth, synthetic hormones or other drugs can be used to block the body’s natural hormones, or surgery is used to remove a hormone-producing gland. Treatment that adds, blocks or removes hormones. For certain conditions (such as diabetes or menopause), hormones are given to adjust low hormone levels. Hormones can also cause certain cancers (such as prostate and breast cancer) to grow. To slow or stop the growth of cancer, synthetic hormones or other drugs can be used to block the body’s natural hormones, or surgery is used to remove the gland that makes a certain hormone. Also called endocrine therapy, hormonal therapy and hormone treatment. Immunotherapy A type of therapy that uses substances to stimulate or suppress the immune system to help the body fight cancer, infection and other diseases. A therapy that uses substances to stimulate or suppress the immune system to help the body fight cancer, infection and other diseases. Some immunotherapies only target certain cells of the immune system. Others affect the immune system in a general way. Types of immunotherapy include cytokines, vaccines, bacillus Calmette-Guerin (BCG) and some monoclonal antibodies. Immunotherapy A type of therapy that uses substances to stimulate or suppress the immune system to help the body fight cancer, infection and other diseases. A therapy that uses substances to stimulate or suppress the immune system to help the body fight cancer, infection and other diseases. Some immunotherapies only target certain cells of the immune system. Others affect the immune system in a general way. Types of immunotherapy include cytokines, vaccines, bacillus Calmette-Guerin (BCG) and some monoclonal antibodies. Metastatic A metastatic cancer is a cancer that has spread to other areas of the body by way of the lymph system or bloodstream. Symptom A physical or mental problem that a person experiences that may indicate a disease or condition. Symptoms cannot be seen and do not show up on medical tests. A physical or mental problem that a person experiences that may indicate a disease or condition. Symptoms cannot be seen and do not show up on medical tests. Some examples of symptoms are headache, fatigue, nausea and pain. Prostate-specific antigen A protein made by the prostate gland and found in the blood. Prostate-specific antigen blood levels may be higher than normal in men who have certain prostate diseases or conditions.

Learn More About Immunotherapy at Fred Hutch

Immunotherapy

Immunotherapies are designed to use the patient’s own immune system to fight cancer. Vaccines are one form of immunotherapy.

Nuclear medicine therapy

These therapies are a way to get radiation straight to your tumor cells.

In 2022, the FDA approved lutetium-177 vipivotide tetraxetan (Pluvicto). The drug vipivotide tetraxetan targets tumor cells in your body. It delivers the radioactive part, lutetium-177 (Lu-177), into these cells. There, the Lu-177 damages the cells, causing cell death.

Physicians use this treatment for prostate cancer which:

Has the biomarker prostate-specific membrane antigen (PSMA+)
Has spread to other parts of the body (metastatic)
Does not respond to treatment to lower testosterone (which may be called castration-resistant disease)

Two other nuclear medicine therapies can also be used for prostate cancer: Lu-177 dotatate for certain types of prostate cancer with a neuroendocrine component (off-label use) and radium-223 dichloride for castration-resistant prostate cancer that has traveled to the bones. They work in the same way, using a drug to deliver radiation to cancer cells.

Each of these medicines is given by infusion. Liquid medicine is put into a vein through an intravenous (IV) line. This is done on a schedule in repeating cycles. The schedule depends on the therapy. For example, Lu-177 vipivotide tetraxetan is given every six weeks for up to six cycles.

We offer all of these nuclear medicine therapies at our South Lake Union clinic.

Antigen A foreign substance, such as bacteria, that causes the body’s immune system to respond by making antibodies. Antibodies defend the body against antigens. Infusion An injection of medications or fluids into a vein over a period of time.

Nuclear medicine therapy

Nuclear medicine uses drugs with small amounts of radiation attached to diagnose and treat diseases. We have several options for treating prostate cancer.

Proton therapy

Precision of proton therapy

Proton therapy is precise, and therefore better able to avoid surrounding organs. The radiation dose deposited by protons increases gradually until it peaks suddenly, called the Bragg Peak, and then falls to zero. Radiation oncologists can control where the Bragg Peak occurs, pinpointing it to peak exactly within the prostate.

The images below show the amount and location of radiation that the body receives during treatment with proton therapy (right) and X-rays/IMRT (left). Proton therapy limits the radiation delivered outside the prostate.

Radiation oncologist A physician who has special training in using radiation to treat cancer.

Proton therapy (right) and X-rays/IMRT (left).

Pencil beam scanning

For many patients, innovative pencil beam scanning (PBS) is a great option. PBS "paints" the prostate with a very thin, very precise beam of protons that's accurate within millimeters, reducing even further the amount of radiation to healthy tissue. PBS sends rapid pulses of protons to each planned spot within the prostate until the entire cancer is treated.

What are the advantages of proton therapy?

While proton therapy and IMRT (X-ray radiation therapy) both treat prostate cancer by killing cancer cells when they attempt to divide and multiply, there is an important difference. IMRT can deliver excess radiation that can cause side effects to the sexual organs, bladder and bowel. Protons can be better controlled to release most of their energy within the prostate.

One study found that patients with prostate cancer treated with proton therapy do not experience testosterone suppression from the radiation treatment (1). Testosterone is the major male hormone that controls sex drive and overall energy and stamina. Clinical trials have also shown that patients with lower risk prostate cancer can be treated with proton therapy with a cure rate of 90-99%, and a 1-2% risk of serious side effects (2) and great quality of life reported.

Radiation exposure to healthy tissue from IMRT can cause side effects years, even decades, after treatment is completed. These side effects include erectile and bladder dysfunction, and a small risk of secondary cancers (3).

SpaceOAR vs. Rectal balloon

If you've heard about the rectal balloons used during proton therapy, you need not worry about that daily discomfort. Some of our patients use SpaceOAR, the first FDA-cleared spacing device to protect the rectum in men undergoing radiation therapy for prostate cancer. The SpaceOAR System is intended to temporarily position the anterior rectal wall away from the prostate during radiotherapy for prostate cancer, creating space to protect the rectum from radiation exposure. Placed through a small needle at UW Medicine, the hydrogel is administered as a liquid, but quickly solidifies into a soft gel that expands the space between the prostate and rectum. The hydrogel spacer maintains this space until radiation therapy is complete. The spacer then liquefies and is absorbed and cleared from the body in the patient’s urine.

Certain prostate cancer patients do not need any kind of spacer placed. Talk to your physician to determine which approach is most appropriate for you.

Radiation therapy The use of high-energy radiation from X-rays, gamma rays, neutrons, protons and other sources to kill cancer cells and shrink tumors. The use of high-energy radiation from x-rays, gamma rays, neutrons, protons and other sources to kill cancer cells and shrink tumors. Radiation may come from a machine outside the body (external-beam radiation therapy), or it may come from radioactive material placed in the body near cancer cells (internal radiation therapy or brachytherapy). Systemic radiation therapy uses a radioactive substance, such as a radiolabeled monoclonal antibody, that travels in the blood to tissues throughout the body. Radiation therapy The use of high-energy radiation from X-rays, gamma rays, neutrons, protons and other sources to kill cancer cells and shrink tumors. The use of high-energy radiation from x-rays, gamma rays, neutrons, protons and other sources to kill cancer cells and shrink tumors. Radiation may come from a machine outside the body (external-beam radiation therapy), or it may come from radioactive material placed in the body near cancer cells (internal radiation therapy or brachytherapy). Systemic radiation therapy uses a radioactive substance, such as a radiolabeled monoclonal antibody, that travels in the blood to tissues throughout the body. Side effects A problem that occurs when treatment affects healthy tissues or organs. Some side effects of cancer treatment are nausea, vomiting, fatigue, pain, decreased blood cell counts, hair loss and mouth sores.

Proton Therapy Treatment for Prostate Cancer

Proton therapy

More than 241,000 new cases of prostate cancer are diagnosed in men every year. For most patients with prostate cancer, radiation therapy is a treatment option. Proton therapy is a type of radiation therapy that can decrease the risk of damage to surrounding organs caused by excess radiation.

Radiation therapy

Radiation therapy is an option for men with various stages of prostate cancer.

If you have localized prostate cancer, your doctor will probably give you a choice of treating your disease with either radiation or surgery because cure rates are about the same for both treatments and studies haven’t definitively proved one is better than the other.
If your cancer returns, you may have radiation therapy after surgery.
If you have advanced prostate cancer, you may have radiation therapy in combination with other therapies.
If cancer has spread elsewhere in your body, such as to your bone, radiation may help relieve pain at these sites.

Two main types of radiation therapy are used for prostate cancer: internal radiation therapy and external-beam radiation therapy. You might have both types.

Internal radiation therapy

For prostate cancer, internal radiation therapy typically means surgically implanting radioactive seeds in the prostate to kill the cancer (brachytherapy). The seeds deliver low doses of radiation for weeks or months. This method is generally used in men with the earlier stages of localized cancer.

If you have advanced prostate cancer, your team may recommend nuclear medicine therapies. These are intravenous (IV) drugs that deliver “packages” of radiation to cancer cells anywhere in your body.

External-beam radiation therapy

External-beam radiation therapy (EBRT) aims radiation beams from outside your body at your cancer. This treatment can be used to cure localized prostate cancers or help relieve symptoms of cancer that has spread.

Fred Hutch incorporates the latest technology to provide the most precise treatment possible.

Depending on your exact needs, your radiation oncologist will likely recommend one of these forms of external-beam radiation:

Proton therapy, an advanced form of radiation treatment. Because doctors can focus proton beams so precisely on tumors, limiting radiation to surrounding healthy tissues, we use proton therapy most often for anatomically complex tumors, like prostate cancer, where it’s imperative to avoid damaging nearby structures, like the bladder and rectum.
IMRT, or intensity modulated radiation therapy, which uses a computer-controlled linear accelerator to move around the patient to deliver radiation. In addition to shaping the beams and aiming them at the tumor from several angles, the intensity of the beams can be adjusted to lessen the dose that reaches sensitive normal tissue.
VMAT, or volumetric modulated arc therapy, is a type of IMRT. Similar to IMRT, the beam shape and intensity are varied to contour the radiation to the tumor. However, VMAT is delivered in one continuous arc of the linear accelerator around the patient. This maximizes the contouring and typically takes even less time than IMRT. Monitoring tools and 3D volumetric imaging allow doctors to accurately locate the tumor and precisely deliver the dose.

Aligning your body for treatment

Typically, doctors place markers into your prostate before EBRT to align you with the radiation beam for your daily treatment sessions. Different markers can be used, including gold markers that are imaged each day by computed tomography (CT) scanning built into the linear accelerator.

Another marker, known as the Calypso System, allows electromagnetic tracking of your tumor’s position without needing daily CT scans. If your prostate moves during treatment, the radiation can be adjusted in real time — so the tumor receives the correct amount and nearby organs don’t receive radiation not meant for them. Fred Hutch radiation oncologists were involved in developing the Calypso System, also known as GPS for the Body.

In some cases, doctors inject gel between the prostate and rectum before radiation treatment starts. This spacer separates the rectum from the prostate and protects the rectum from the radiation.

Computed tomography A procedure that uses a computer linked to an X-ray machine to make a series of detailed pictures of areas inside the body. The pictures are used to create three-dimensional (3-D) views of tissues and organs. A procedure that uses a computer linked to an X-ray machine to make a series of detailed pictures of areas inside the body. The pictures are taken from different angles and are used to create three-dimensional (3-D) views of tissues and organs. A dye may be injected into a vein or swallowed to help the tissues and organs show up more clearly. This scan may be used to help diagnose disease, plan treatment or find out how well treatment is working. Computed tomography A procedure that uses a computer linked to an X-ray machine to make a series of detailed pictures of areas inside the body. The pictures are used to create three-dimensional (3-D) views of tissues and organs. A procedure that uses a computer linked to an X-ray machine to make a series of detailed pictures of areas inside the body. The pictures are taken from different angles and are used to create three-dimensional (3-D) views of tissues and organs. A dye may be injected into a vein or swallowed to help the tissues and organs show up more clearly. This scan may be used to help diagnose disease, plan treatment or find out how well treatment is working. Imaging In medicine, a process that makes pictures of areas inside the body. Imaging uses methods such as X-rays (high-energy radiation), ultrasound (high-energy sound waves) and radio waves. Oncologist A physician who has special training in diagnosing and treating cancer. Some oncologists specialize in a particular type of cancer treatment, such as treating cancer with radiation. A physician who has special training in diagnosing and treating cancer. Some oncologists specialize in a particular type of cancer treatment. For example, a radiation oncologist specializes in treating cancer with radiation. Radiation oncologist A physician who has special training in using radiation to treat cancer. Radiation therapy The use of high-energy radiation from X-rays, gamma rays, neutrons, protons and other sources to kill cancer cells and shrink tumors. The use of high-energy radiation from x-rays, gamma rays, neutrons, protons and other sources to kill cancer cells and shrink tumors. Radiation may come from a machine outside the body (external-beam radiation therapy), or it may come from radioactive material placed in the body near cancer cells (internal radiation therapy or brachytherapy). Systemic radiation therapy uses a radioactive substance, such as a radiolabeled monoclonal antibody, that travels in the blood to tissues throughout the body. Symptom A physical or mental problem that a person experiences that may indicate a disease or condition. Symptoms cannot be seen and do not show up on medical tests. A physical or mental problem that a person experiences that may indicate a disease or condition. Symptoms cannot be seen and do not show up on medical tests. Some examples of symptoms are headache, fatigue, nausea and pain.

Radiation therapy

Radiation therapy is an option for men with various stages of prostate cancer.

Surgery

If your cancer is in the early stages or localized to your prostate, your doctors may recommend surgery to remove your prostate (prostatectomy) to try to cure the disease.

Surgery for Fred Hutch patients is performed at University of Washington Medical Center by experienced UW Medicine surgeons who are leaders in prostate cancer surgery.

The experience level of your surgeon can affect your results. We recommend choosing a surgeon who has done at least 250 prostatectomies total and who does at least 40 a year. Read more about choosing your prostate cancer surgeon.

Radical prostatectomy

The most common surgery for prostate cancer is a radical prostatectomy — removing the entire prostate gland, some lymph nodes and other nearby tissue, such as the seminal vesicles.

This offers a very good chance for a cure and gives your doctors detailed information about your cancer, including how aggressive it is, which can help guide other treatment decisions.

Your Fred Hutch team will:

Talk with you in detail about what to expect.
Carefully consider the risk of side effects from surgery.
Plan ways to reduce any risks you may face.
Provide advice and care to support your recovery.

Typically patients stay in the hospital overnight after surgery and then need to recuperate at home for one to four weeks before returning to work.

Nerve-sparing prostate surgery

Your Fred Hutch surgeon will try to save the tiny bundles of nerves, one on each side of your prostate, that control your ability to have an erection (nerve-sparing surgery). If your cancer is growing into or very close to the nerve bundles, these nerves may need to be removed.

Open surgery vs. robot-assisted laparoscopic prostatectomy

Your surgeon may operate using one of these approaches:

Through an incision in your lower abdomen (retropubic prostatectomy)
Through an incision between your anus and scrotum (perineal prostatectomy, less common)
Laparoscopicaly, meaning through multiple very small incisions using special instruments and cameras

The potential advantages of laparoscopic surgery include faster recovery, less pain, less blood loss and lower risk of infection than with a conventional (open) retropubic or perineal procedure.

If you are having laparoscopic surgery, your UW Medicine surgeon may use a robotic surgery system. This is sometimes called robot-assisted or robotic prostatectomy. With the da Vinci Surgical System, your surgeon uses hand and foot controls to move robotic arms that hold a laparoscope (camera) and surgical instruments. The system allows your surgeon to perform very precise, complex motions and helps prevent fatigue.

Your Fred Hutch surgeon will talk with you about the approach they recommend for you and why and will answer all your questions about your options.

Cryosurgery for prostate cancer

If you have early-stage prostate cancer or your cancer recurred after radiation therapy, your team may recommend cryosurgery. In this procedure, your surgeon makes a small incision to insert probes that freeze and kill prostate tissue. Your surgeon may use ultrasound imaging, along with a catheter and precise temperature monitoring of nearby tissues, to help target your prostate and minimize any damage to healthy tissue.

Choosing a prostate cancer surgeon

When you are choosing a surgeon to treat your prostate cancer, it is important to select someone you trust and have confidence in. He or she should have enough experience to not only perform the operation you need but also to make an informed clinical judgment and change course, if necessary.

The prostate cancer experts at Fred Hutch recommend choosing a surgeon who has done at least 250 prostatectomies (prostate removals) total and who does at least 40 a year.

As you consider your options, you might want to ask your surgeon these questions.

Which procedure does your surgeon prefer and why?
What type of surgery does he or she recommend for you?
Is nerve-sparing surgery an option?
How many of these surgeries has he or she performed?
How many of these surgeries does he or she do each year?
What are the statistics on incontinence and impotence for your surgeon’s patients?

Imaging In medicine, a process that makes pictures of areas inside the body. Imaging uses methods such as X-rays (high-energy radiation), ultrasound (high-energy sound waves) and radio waves. Laparoscopic surgery A surgery done with the aid of a thin, tube-like instrument with a light and a lens for viewing. It may also have a tool to remove tissue to be checked under a microscope for signs of disease. Surgery done with the aid of a laparoscope. A laparoscope is a thin, tube-like instrument with a light and a lens for viewing. It may also have a tool to remove tissue to be checked under a microscope for signs of disease. Radiation therapy The use of high-energy radiation from X-rays, gamma rays, neutrons, protons and other sources to kill cancer cells and shrink tumors. The use of high-energy radiation from x-rays, gamma rays, neutrons, protons and other sources to kill cancer cells and shrink tumors. Radiation may come from a machine outside the body (external-beam radiation therapy), or it may come from radioactive material placed in the body near cancer cells (internal radiation therapy or brachytherapy). Systemic radiation therapy uses a radioactive substance, such as a radiolabeled monoclonal antibody, that travels in the blood to tissues throughout the body. Side effects A problem that occurs when treatment affects healthy tissues or organs. Some side effects of cancer treatment are nausea, vomiting, fatigue, pain, decreased blood cell counts, hair loss and mouth sores. Ultrasound A procedure that uses high-energy sound waves to look at tissues and organs inside the body. The sound waves make echoes that form pictures of the tissues and organs on a computer screen. A procedure that uses high-energy sound waves to look at tissues and organs inside the body. The sound waves make echoes that form pictures of the tissues and organs on a computer screen (sonogram). Ultrasound may be used to help diagnose diseases, such as cancer. It may also be used during pregnancy to check the fetus (unborn baby) and during medical procedures, such as biopsies. Also called ultrasonography. radical prostatectomy Surgery to remove the entire prostate gland, the seminal vesicles and nearby tissue.

What to Expect After Surgery

Surgery

If your cancer is in the early stages or localized to your prostate, your doctors may recommend surgery to remove your prostate (prostatectomy) to try to cure the disease.

Potential side effects

Unfortunately, all treatments for prostate cancer have side effects, including some that may have a negative impact on urinary and sexual health. Infertility, urinary incontinence (inability to control urine flow), reduced sexual desire, impotence or erectile dysfunction, and changes in orgasm are all potential side effects of prostate cancer treatment.

Your Fred Hutch team will talk with you about the side effects you can expect. This page provides some general information. The side effects you might experience will depend on a number of factors, including the details of your cancer (location, stage, and grade), your age, your general health, your treatment, and the skill of your doctor. Your team will help you weigh the benefits and risks of your treatment options and will do everything possible to reduce the risk of side effects and to help you manage any side effects that occur.

Fred Hutch offers extensive support for patients being treated here. If you have psychological concerns or concerns related to sexuality and cancer, learn about Fred Hutch’s psychosocial and sexuality resources that are available to you.

Infertility

If you have surgery to remove your prostate (prostatectomy), you will lose your fertility and no longer be able to father a child. If you have radiation therapy to your pelvic region, you probably will be infertile as well. If infertility is a concern for you, talk to your doctor about options such as freezing your sperm before your treatment so that it will be available if you want to father a child in the future.

Incontinence

Urinary incontinence is the loss of bladder control or involuntary leakage of urine. Before and after treatment for prostate cancer, doing Kegel exercises to strengthen your pelvic-floor muscles may help minimize incontinence.

You may need to wear a small pad to catch leaking urine. Ask your doctor about medications that may help. Severe incontinence can often be corrected later with surgery.

Short-term incontinence, lasting a few weeks or months, is a common side effect after a radical prostatectomy. With an expert surgeon, the life-long risk of severe incontinence is less than 5 percent.

With radiation therapy, urinary incontinence is also a possible side effect; however, severe incontinence is uncommon. The likelihood of needing to wear a pad for mild leakage several years after treatment is less than 5 percent in younger men and around 10 percent in men who are older. The typical incontinence experienced is usually a mild urge to urinate with a small amount of leakage.

Reduced sexual desire

Lack of sexual desire, or low libido, is a continued lack of desire to have sex. In men it can be caused by aging and physical factors that reduce testosterone as well as emotional distress that may come with having cancer. Reduced sexual desire occurs in most men being treated with hormone therapy.

Impotence

Impotence, or erectile dysfunction, is the inability to have or maintain an erection. Treatment may completely or partially injure the two nerve bundles near the prostate that are responsible for allowing a normal erection.

During surgery, unless both nerve bundles are sacrificed due to the extent of the cancer, there is a chance of recovering erectile function, but it may be very slow, taking up to two years after surgery for full recovery.

Both external-beam radiation therapy and internal radiation therapy frequently cause impotence as well. Usually it does not occur right after radiation therapy but develops slowly over several years. The majority of men who undergo radiation therapy notice some decrease in their erectile function, with more than 50 percent having a permanent change.

Recovery of erectile function is related to your age, erectile function prior to treatment, and whether the nerve bundles were damaged by treatment. In general, the younger you are and the better your sexual function before surgery, the more likely you will be to regain function after treatment. Some men notice that their erections are less rigid and durable, even after they get return of some function. Ask your doctor about medications or devices that can help.

Changes in orgasm

You will still be able to experience orgasm after a radical prostatectomy or radiation therapy, even if you have erectile dysfunction, but you may note a change in the nature of the sensation of orgasm and there will be very little, if any, ejaculate. Some men may experience the release of urine with orgasm (climacturia) after surgery

Quality-of-life outcome studies

Outcome studies measure changes in quality of life, including bowel, urinary and erectile function, after prostate cancer treatment. The results vary between centers and between doctors based on their technical skill. Fred Hutch tracks outcomes of prostate cancer care, and our results have been consistently better than those typically seen.

Treating high-risk or recurrent cancer

Fred Hutch is at the forefront of developing new treatment strategies designed to improve results in men with high-risk prostate cancer.

For nearly 80 percent of men with prostate cancer, doctors diagnose the disease early, in the local or regional stages. Doctors expect most of these men will be cured with radiation or surgery (prostatectomy).

However, one in five men with prostate cancer is diagnosed with high-risk disease — which has a tendency to spread even though, by all clinical appearances, it is localized. Despite having been treated for prostate cancer, about 30 to 40 percent of men suffer a relapse, meaning their cancer returns. Among these men, fewer than 50 percent are cured.

The only therapy that has been adequately tested in clinical studies to treat prostate cancers that might have spread is hormone therapy, which lowers serum testosterone, depriving prostate cancer cells of a growth factor critical for their survival. Hormone therapy is commonly used in combination with radiation therapy or after surgery for men whose cancer has spread to lymph nodes. It is also used to treat cancers that weren’t cured with either radiation or surgery.

The new approaches we’re working on involve treating both the cancer in the prostate and any cancer that might have spread. A new generation of systemic therapies is showing clinical promise when combined with surgery or radiation therapy. Learn more about prostate cancer clinical studies at Fred Hutch.

Risk of relapse despite treatment

Various tools have been developed to help patients and doctors decide on treatment for prostate cancer by predicting how effective surgery or radiation is likely to be and how likely these treatments are to cure the patient’s disease.

The main pretreatment factors that predict the likelihood of cure (ability to suppress and maintain low levels of prostate-specific antigen without androgen deprivation) are:

Prostate-specific antigen (PSA) level
Clinical stage by digital rectal exam
Gleason score
Extent of disease by biopsy

These factors are a general means of assessing the volume and biologic aggressiveness of prostate cancer and, thus, the likelihood that the cancer will spread beyond the prostate.

Researchers have evaluated how the PSA doubling time (how quickly PSA is rising) before treatment affects cure. Some studies have found that an increase in PSA of greater than 2 ng/mL in the year preceding the diagnosis predicted a higher risk of recurrence and a higher likelihood of death despite therapy.

Studies have shown that some patients are at high risk for biochemical progression (further cancer growth), regardless of whether they had surgery or radiation, if they had a pretreatment PSA level greater than 20 ng/mL or advanced cancer (stage T2b or greater) or high-grade disease (Gleason score of 8 to 10). Many men with a PSA level of 10 to 20 ng/mL or stage T2a cancer or intermediate-grade disease (Gleason score of 7) also have an unacceptably high risk of relapse.

Talk with your doctor about the specific features of your prostate cancer, how to understand your risk of relapse and all your treatment options.

Prostate-specific antigen A protein made by the prostate gland and found in the blood. Prostate-specific antigen blood levels may be higher than normal in men who have certain prostate diseases or conditions.

Detecting prostate cancer recurrence

Fred Hutch offers an imaging test called prostate-specific membrane antigen (PSMA) positron emission tomography (PET), which is considered the most sensitive measure of prostate cancer detection. This test may help find prostate cancer that has come back in men whose PSA levels rise after they have had treatment. We also have an imaging test called Axumin® PET. Before the scan, you get an injection of fluciclovine F 18 (Axumin®), a radioactive agent that tends to collect in areas with cancer activity, which then light up on your scan.

These tests are ways to detect cancer that has spread. If your cancer has spread, it may affect your treatment options. It may also make you eligible for clinical trials. Fred Hutch researchers are working on trials to better find and get rid of low-volume (less extensive) disease.

Antigen A foreign substance, such as bacteria, that causes the body’s immune system to respond by making antibodies. Antibodies defend the body against antigens. Imaging In medicine, a process that makes pictures of areas inside the body. Imaging uses methods such as X-rays (high-energy radiation), ultrasound (high-energy sound waves) and radio waves. Prostate-specific antigen A protein made by the prostate gland and found in the blood. Prostate-specific antigen blood levels may be higher than normal in men who have certain prostate diseases or conditions.

Diet and exercise

There are many ways you can positively influence your health. Lifestyle choices, such as diet, exercise, and smoking or drinking, are influenced by habit, culture, and preferences and are different for each individual. Every day the foods you choose to eat and the amount of physical activity you get can impact your overall health as well as your prostate cancer risk, recovery, and survival.

Learn More About the Impact of Diet and Exercise