Treatment Options for Prostate Cancer at Virginia Oncology Associates

The prostate cancer treatment option that’s right for you depends mainly on your age, the grade of the tumor (the Gleason score), the number of biopsy tissue samples that contain cancer cells, the stage of cancer, your symptoms, and your general health. Your doctor can describe your treatment options, the expected results of each, and the possible side effects. You and your doctor can work together to develop a treatment plan that meets your medical and personal needs.

Prostate Cancer Treatment Options

Although surgery is a common approach, prostate cancer removal is not always a part of the treatment plan. Active surveillance may be recommended for men with early-stage prostate cancer before beginning other therapies.

Treatment for prostate cancer can include one or a combination of the following treatments: 

• Active Surveillance
• Radiation Therapy
• Radiopharmaceuticals for Advanced Prostate Cancer
• Hormone Therapy
• Immunotherapy
• Surgery
• Chemotherapy
• Cryotherapy
• Clinical Trials

Determining the Type and Timing of Prostate Cancer Treatment 

Risk groups help determine the likelihood of localized cancer growing outside of the prostate. Your prostate cancer oncologist uses this classification as a guide when developing your treatment plan, including the best time to start treatment and which therapies will be most effective. Generally, the more likely cancer is to grow and spread, the sooner treatment should begin.

Risk Groups of Prostate Cancer

Risk groups are categorized into five classifications based on various factors, including your prostate-specific antigen (PSA) levels, digital rectal exam (DRE) results, and biopsy results. These groups include:

1. Very low-risk: The cancer is confined to the prostate, is a grade group 1 (Gleason score of 6 or less), and has a PSA level less than 10. These tumors cannot be detected by a digital rectal exam, and fewer than three of the biopsy samples contain cancer cells.

2. Low-risk: The cancer is confined to the prostate, is a grade group 1 (Gleason score of 6 or less), and has a PSA level less than 10. At this risk level, the tumor is less aggressive and likely to grow slowly.

3. Intermediate-risk: Tumors are still confined to the prostate, but the PSA level is between 10 and 20, and the grade is elevated to group 2 or 3 (Gleason score is 7), indicating cancer cells are actively growing.

4. High-risk: High-risk groups indicate the tumor has grown outside the prostate, with a PSA level greater than 20, and the grade is elevated to group 4 or 5 (Gleason score is 8-10). At this risk level, the tumor may be highly aggressive and likely to grow faster.

5. Very high-risk: Very-high risk has all of the indications of high-risk, plus four of the tissue samples have a grade group of 4 or 5, or the tumor has invaded the seminal vesicles, rectum, or beyond.

Active Surveillance

You may choose active surveillance if the risks and possible side effects of treatment outweigh the possible benefits. Your prostate cancer specialist may recommend active surveillance, also known as watchful waiting, if you’re diagnosed with early-stage prostate cancer that seems to be slowly growing. This option might also be suggested if you are older or have other serious health problems.

Choosing active surveillance doesn’t mean you’re giving up. It means you’re putting off the side effects of prostate cancer treatments like surgery or radiation therapy. Having surgery or radiation therapy is no guarantee that a man will live longer than a man who chooses to put off treatment. If you and your doctor agree that active surveillance is a good idea, your doctor will check you regularly (such as every 3 to 6 months). After about one year, your doctor may order another biopsy to check the Gleason score. You may begin treatment if your Gleason score rises, your PSA level starts to rise, or you develop symptoms. 

Active surveillance avoids or delays the side effects of surgery and radiation therapy, but this choice has risks. For some men, it may reduce the chance of controlling cancer before it spreads. Also, it may be harder to cope with surgery or radiation therapy when you’re older.
If you choose active surveillance but grow concerned later, you should discuss your feelings with your doctor. 

Related Read: Significant Shifts in the Management of Prostate Cancer

Radiation Therapy for Prostate Cancer

Radiation therapy is an option for men with any stage of prostate cancer. Men with early-stage prostate cancer may choose radiation therapy instead of surgery. It may also be used after surgery to destroy any cancer cells that remain in the area. In later stages of prostate cancer, radiation treatment may be used to help relieve pain.

Radiation therapy (also called radiotherapy) uses high-energy rays to kill cancer cells. It affects cells only in the treated area. Radiation oncologists use two types of radiation therapy to treat prostate cancer. Some men may receive both types:

• External Radiation for Prostate Cancer: The radiation comes from a large machine outside the body. You will go to a hospital or clinic for treatment. Treatments are usually 5 days a week for several weeks. Many men receive 3-dimensional conformal radiation therapy (3D CRT) or intensity-modulated radiation therapy (IMRT). These types of treatment use computers to more closely target the cancer to lessen the damage to healthy tissue near the prostate.
• Internal Radiation for Prostate Cancer (Implant Radiation or Prostate Seed Brachytherapy): The radiation comes from radioactive material usually contained in very small implants called seeds. Prostate seed brachytherapy is a one-time, minimally invasive procedure usually performed in an outpatient setting. The procedure involves the placement of dozens of tiny seeds that contain a radioactive isotope inside the prostate via the guidance of ultrasonic equipment. The seeds left inside the prostate give off radiation for months. They don’t need to be removed once the radiation is gone. Patients are given local or general anesthesia to block pain and help with relaxation during the procedure. On average, the treatment takes just under one hour from start to finish. Data shows shorter recovery time, fewer long-term complications, and excellent long-term survival rates.

Both internal and external radiation can cause impotence. You can talk with your doctor about ways to help cope with this side effect. Read more about managing radiation treatment side effects.

Radiopharmaceuticals for Men with Advanced Prostate Cancer

Virginia Oncology Associates (VOA) offers access to the latest treatments for prostate cancer, including Pluvicto®, an FDA-approved liquid form of radiation therapy. This radiopharmaceutical is considered a targeted therapy and is a suitable treatment option for men diagnosed with PSMA-positive metastatic prostate cancer.

What to Expect with PSMA Therapy for Advanced Prostate Cancer

Patients who qualify for this treatment will undergo an imaging exam followed by an injection of a PSMA targeting agent (Pylarify, Posluma, or Illucix). This agent provides clearer and earlier visibility of tumors compared to imaging technologies. 

After the imaging procedure, patients will receive Pluvicto® for 6-9 months. Pluvicto® is designed to release radiation that specifically targets the prostate-specific membrane antigen (PSMA) protein found on prostate cancer cells, destroying them while preserving healthy surrounding tissue.

The combination of a PSMA targeting agent and Pluvicto® offers new hope to prostate cancer patients whose disease has either spread or become resistant to other treatments. Clinical trials have shown that this therapy can prolong survival for patients with PSMA-positive metastatic prostate cancer.

A radiation oncologist at Virginia Oncology Associates can discuss this treatment option with you if you have been diagnosed with this advanced form of prostate cancer. Pluvicto® is available at VOA's Brock Cancer Center in Norfolk, Virginia, and Careplex Cancer Center in Hampton, Virginia. 

Hormone Therapy for Prostate Cancer

Male hormones (androgens) can cause prostate cancer to grow. Hormone therapy keeps prostate cancer cells from getting the male hormones they need to grow. The testicles are the body’s main source of the male hormone testosterone. The adrenal gland makes other male hormones and a small amount of testosterone. Hormone therapy for prostate cancer might be recommended before, during, or after receiving radiation therapy. Doctors usually treat prostate cancer that has spread to other parts of the body with hormone therapy, but it is also used alone for cancer that has returned after treatment.

Hormone therapy can be administered through drugs that can block natural hormones or surgery to remove the testicles. Several types of hormone therapies may be part of the prostate cancer treatment process and can be broken into two basic categories: therapies that lower androgen production and therapies that block androgen production. The most common therapies reduce androgen production in the body.

Learn more about hormone therapy for prostate cancer. 

Genetic Testing and Immunotherapy for Prostate Cancer

In patients with prostate cancer, identifying a gene mutation can use targeted medicines like immunotherapy to help ensure the best chance of long-term survival with the best possible quality of life. Oncologists can use the results from a genetic test to determine a prostate cancer treatment plan that is more likely to work for each patient based on the genetic makeup of their tumor.

Local clinical trials for prostate cancer continue research on multiple targeted medications for additional genetic defects. As genomic targets and immunotherapy grow increasingly relevant in prostate cancer treatment, we hope that providers treating prostate cancer will embrace genetic testing for higher-risk patients.

Related Read: The Evolution of Genetic Testing and Immunotherapy in Prostate Cancer

Surgery for Prostate Removal

Surgery is an option for men with early (Stage I or II) prostate cancer and is sometimes an option for men with Stage III or IV prostate cancer. The surgeon may remove the whole prostate or only part of it.

Before the surgeon removes the prostate, the lymph nodes in the pelvis may be removed. If prostate cancer cells are found in the lymph nodes, the disease may have spread to other parts of the body. If cancer has spread to the lymph nodes, the surgeon does not always remove the prostate and may suggest other types of treatment.

There are several types of surgery for prostate cancer. Each type has benefits and risks. You and your doctor can talk about the types of surgery and which may be right for you:

• Open Surgery: The surgeon makes a large incision (cut) into your body to remove the tumor. There are two approaches:
  • Through the abdomen: The surgeon removes the entire prostate through a cut in the abdomen. This is called a radical retropubic prostatectomy.
  • Between the scrotum and anus: The surgeon removes the entire prostate through a cut between the scrotum and anus. This is called a radical perineal prostatectomy.
• Laparoscopic Prostatectomy: The surgeon removes the entire prostate through small cuts, rather than a single long cut in the abdomen. A thin, lighted tube (a laparoscope) helps the surgeon remove the prostate.
• Robotic Laparoscopic Surgery: The surgeon removes the entire prostate through small cuts. A laparoscope and a robot are used to help remove the prostate. The surgeon uses handles below a computer display to control the robot’s arms.
• Cryosurgery: For some men, cryosurgery is an option. The surgeon inserts a tool through a small cut between the scrotum and anus. The tool freezes and kills prostate tissue. Cryosurgery is under study. 
• TURP: A man with advanced prostate cancer may choose TURP (transurethral resection of the prostate) to relieve symptoms. The surgeon inserts a long, thin scope through the urethra. A cutting tool at the end of the scope removes tissue from the inside of the prostate. TURP may not remove all of the cancer, but it can remove tissue that blocks the flow of urine.

Surgery can damage the nerves around the prostate. Damaging these nerves can make a man impotent (unable to have an erection). In some cases, your surgeon can protect the nerves that control erection. But if you have a large tumor or a tumor that’s very close to the nerves, surgery may cause impotence. Impotence can be permanent. You can talk to your doctor about medicine and other ways to help manage the sexual side effects of cancer treatment.

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

Chemotherapy for Prostate Cancer

 

Chemotherapy may be used for prostate cancer that has spread and no longer responds to hormone therapy. 

Drugs are administered through an IV or in pill form. They enter the bloodstream and spread throughout the body to kill cancer cells. Chemotherapy is not a common early treatment for prostate cancer

 

Cryotherapy

Very cold temperatures are used to freeze and kill cancer cells. This is not commonly used as the first treatment option for prostate cancer, but it can be an option if cancer comes back after radiation.

Clinical Trials for Prostate Cancer

At VOA, we prioritize personalized prostate cancer care. Our oncologists actively research new treatments and diagnostic tools to provide patients with the latest advancements in cancer.

Clinical trials help improve existing treatments or develop new options for cancer patients. When proven effective, these treatments may become the new standard of care. Talk to your VOA cancer care team to see if a clinical trial is right for you.

Learn more about prostate cancer research and the clinical trials available. 

Prostate Cancer Treatment Available in Hampton Roads & Eastern North Carolina

The comprehensive and compassionate approach offered by our prostate cancer specialists at Virginia Oncology Associates combines the most advanced treatments with education and support services. Our oncologists specialize in prostate cancer care and are ready to talk to you about your specific diagnosis and personalized treatment options. 

Request an appointment at our cancer centers located across Hampton Roads and Eastern North Carolina, including Virginia Beach, Norfolk, Hampton, Williamsburg, Chesapeake, Suffolk (Harbour View and Obici), Newport News, and Elizabeth City.