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.
Experts at Seattle Cancer Care Alliance (SCCA) offer comprehensive prostate cancer care and can talk with you about your unique situation and the best prostate cancer treatment for you. SCCA brings together leading cancer specialists and researchers from UW Medicine and Fred Hutchinson Cancer Research Center.
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.
- Expertise at SCCA
- Overview of options
- Active surveillance and watchful waiting
- Radiation treatment
- Hormone treatment
- Clinical studies
- Next steps
Prostate cancer expertise at SCCA
Prostate cancer survival rates
Data collected from cancer centers across the country show that men who begin their prostate cancer treatment at SCCA 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 and pathologists who specialize in prostate cancer; the most advanced diagnostic, treatment and recovery programs; and extensive support.
Innovative prostate cancer therapies
SCCA patients have access to advanced treatments being explored in ongoing prostate cancer clinical trials conducted at SCCA, 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 SCCA 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.
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 SCCA 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 SCCA Survivorship Clinic is also here to help you live your healthiest life as a prostate cancer survivor.
Overview of prostate cancer 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.
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.
SCCA offers immunotherapy, hormone therapy, chemotherapy, radiation therapy and access to promising therapies in clinical studies that your community doctor may not know about.
Active surveillance and watchful waiting for prostate cancer
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.
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.
Surgery for prostate cancer
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 SCCA 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.
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 SCCA 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 SCCA 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 SCCA 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.
Learn more about:
- What to expect after prostate cancer surgery
- Potential urinary and sexual side effects of prostate cancer treatment
Radiation treatment for prostate cancer
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.
Another option, radium 223 dichloride (Xofigo), is used for advanced prostate cancer that is resistant to testosterone-lowering treatments and has spread to the bones. It is given by intravenous (IV) injection every four weeks for six cycles.
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.
SCCA 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. Learn more about proton therapy for prostate cancer.
- 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. SCCA 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.
Learn more in our radiation oncology section.
Hormone treatment for prostate cancer
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.
Learn more about:
Prostate cancer may become resistant to hormone therapy over time. Much work by SCCA investigators has focused on trying to prevent this. Learn more.
Immunotherapy for prostate cancer
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.
SCCA 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. Learn more about immunotherapy at SCCA.
Chemotherapy for prostate cancer
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)
Learn more about chemotherapy in our medical oncology section.
Clinical studies for prostate cancer
For some people, taking part in a clinical study may be the best treatment choice. Access to clinical studies by researchers at SCCA and our founding organizations Fred Hutch and UW Medicine is one reason many patients come to SCCA.
We’re active in finding new prostate cancer treatment options.
The Institute for Prostate Cancer Research (IPCR), a Fred Hutch–UW Medicine collaboration, brings together experts to devise therapies and new technologies in hopes of one day finding a cure. IPCR faculty received one of only 10 prostate cancer Specialized Program of Research Excellence (SPORE) grants nationwide from the National Cancer Institute to study prostate cancer progression.
SCCA also has researchers on the Stand Up 2 Cancer Prostate Cancer Dream Team.