Treatment Options

Active surveillance is careful monitoring without immediate treatment. For men with low-risk prostate cancer, this approach avoids treatment side effects while maintaining the opportunity for cure if the cancer changes.

Our active surveillance program follows the Johns Hopkins protocol, the world's largest and longest-running program with over 2,000 men enrolled and more than 25 years of experience. The data shows this approach is safe. Less than 1% of men develop metastasis at 10 years, and about half remain on surveillance at 10 years without needing treatment.

Who It's For

Men with low-risk disease (Grade Group 1) and select men with favorable intermediate-risk cancer (Grade Group 2). You need a life expectancy over 10 years, comfort with the monitoring approach, and the ability to follow up reliably.

How It Works

We check your PSA every 6 months and do a digital rectal exam once a year. You'll have an MRI every one to two years. We do a confirmatory biopsy within the first year, then surveillance biopsies every two to four years. If your Gleason grade increases to Grade Group 2 or higher, if cancer volume grows, or if your PSA shows concerning changes, we'll discuss treatment. You can also choose treatment at any time if your preferences change.

Outcomes

Men on active surveillance have excellent cancer-specific survival and preserved quality of life. The approach lets you avoid treatment unless and until it becomes necessary.

Radical prostatectomy removes the entire prostate and seminal vesicles. Our surgeons use robotic-assisted techniques for this procedure.

Robotic-Assisted Surgery

Robotic surgery offers smaller incisions, less blood loss, shorter hospital stays (one to two nights), and faster recovery. The enhanced visualization helps with nerve-sparing techniques. You'll have a catheter for 7 to 10 days, can return to light activities in two to three weeks, and typically reach full recovery in 6 to 12 weeks.

Nerve-Sparing Technique

When it's safe from a cancer standpoint, we preserve the nerves responsible for erectile function. For some men, we can spare nerves on both sides. For others with intermediate-risk cancer, we may spare one side. The goal is cancer control while preserving function when possible.

Outcomes

At high-volume centers, surgery provides 85 to 95% cancer control at 10 years for organ-confined disease. About 90 to 95% of men recover continence within a year. Potency recovery ranges from 40 to 70% depending on age, baseline function, and whether nerves could be spared.

Side Effects

Urinary incontinence is common initially but usually improves. Erectile dysfunction varies in severity and recovery. Rarely, bladder neck narrowing or urinary retention can occur.

Our radiation oncologists provide personalized, patient-centered radiation treatment using several approaches.

External Beam Radiation

Intensity-modulated radiation therapy (IMRT) uses precisely shaped beams that minimize exposure to your bladder and rectum. Treatment runs daily for 7 to 9 weeks. Image-guided radiation therapy (IGRT) uses daily imaging to ensure accurate targeting and accounts for prostate movement.

Stereotactic body radiation therapy (SBRT) delivers ultra-precise, high-dose radiation in just 5 sessions over one to two weeks. This newer approach has excellent outcomes with a much faster treatment course.

For certain patients, we can coordinate proton therapy at specialized centers. This may reduce radiation exposure to surrounding tissues, especially for younger patients or those needing re-treatment.

What to Expect

After simulation and planning (one to two weeks), treatment takes 5 to 9 weeks for IMRT or one to two weeks for SBRT. You won't need a hospital stay and can continue normal activities during treatment.

Outcomes are similar to surgery for localized disease, with 85 to 95% biochemical control at 10 years. Side effects include urinary symptoms like frequency and urgency, and bowel symptoms like diarrhea, usually temporary. Erectile dysfunction develops gradually over two to five years. Rarely, rectal bleeding or urinary narrowing can occur.

Brachytherapy (Seed Implants)

Low-dose rate brachytherapy involves permanent radioactive seed implants in a single outpatient procedure. It's best for low and favorable intermediate-risk cancers. The advantage is one-time treatment with minimal disruption to daily life and excellent outcomes for appropriate candidates.

High-dose rate brachytherapy uses temporary high-dose radiation combined with external beam for intermediate and high-risk disease.

Combination Therapy

For intermediate and high-risk disease, radiation works better when combined with hormone therapy. Treatment typically lasts 4 to 6 months for intermediate-risk cancer or 2 to 3 years for high-risk disease.

Prostate cancer growth depends on testosterone. Hormone therapy lowers testosterone levels or blocks its effects.

When It's Used

We combine hormone therapy with radiation for intermediate and high-risk disease. It's the primary treatment for metastatic disease. We also use it if PSA rises after surgery or radiation, or for locally advanced disease that can't be treated with surgery.

Types Available

LHRH agonists and antagonists (like Lupron, Zoladex, Firmagon, Orgovyx) are injections given monthly, every three months, or every six months. They lower testosterone to very low levels.

Anti-androgens (like bicalutamide, enzalutamide, apalutamide, darolutamide) are daily pills that block testosterone from reaching cancer cells.

For metastatic disease, combination therapy using both types together works better than either alone.

Side Effects and Management

Common side effects include hot flashes, decreased libido and erectile dysfunction, fatigue, weight gain, muscle loss, bone loss, and metabolic changes that can affect diabetes and cardiovascular risk. We manage these with bone-strengthening medications, exercise programs, dietary changes, and treatment of metabolic effects.

Focal therapy treats only part of the prostate rather than the whole gland. This emerging approach is for select patients with localized disease visible on MRI and confirmed by targeted biopsy.

Options include high-intensity focused ultrasound (HIFU), cryotherapy, irreversible electroporation, and laser ablation. The goal is cancer control while minimizing side effects and preserving urinary and sexual function. Long-term outcome data is still being collected.