Prostate cancer is complex. There are a lot of things to think about before you and your physician 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.
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 physician 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.
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.
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.
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 physicians 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.
Your Fred Hutch physicians 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 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 registered dietitian.
Learn more about Supportive Care Services
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 physicians 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.
Lean more about Fred Hutch Survivorship Clinic
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.
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.
Physicians 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.
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.
If your cancer is not causing any symptoms, is slow growing or is small and confined to the prostate, your physician may suggest active surveillance or watchful waiting.
Active surveillance means your physician 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 physician monitor any changes in your symptoms to determine if you need treatment.
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 Physician might suggest active surveillance or watchful waiting.
These methods might also be appropriate if:
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:
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 physician may recommend chemotherapy as an option to extend your life or improve your quality of life if:
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:
High Intensity Focused Ultrasound (HIFU) is a non-invasive treatment that is FDA-approved for prostate ablation.
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:
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 physician may suggest hormone therapy if any of these is true:
Several types of hormone therapy are available, including:
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.
Learn more about Hormone Treatment Side Effects
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.
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.
Learn more about Immunotherapy
Nuclear medicine uses drugs with small amounts of radiation attached to diagnose and treat diseases. We have several options for treating prostate cancer.
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:
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.
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.
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 here show the amount and location of radiation that the body receives during treatment with proton therapy (right) and conventional radiation (left). Proton therapy limits the radiation delivered outside the prostate.
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.
Learn more about Proton Therapy for Prostate Cancer
Radiation therapy is an option for men with various stages of prostate cancer.
Two main types of radiation therapy are used for prostate cancer: internal radiation therapy and external-beam radiation therapy. You might have both types.
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 (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:
Aligning Your Body for Treatment
Typically, physicians 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, physicians 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.
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.
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.
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.
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 physicians detailed information about your cancer, including how aggressive it is, which can help guide other treatment decisions.
Your Fred Hutch team will:
Typically patients stay in the hospital overnight after surgery and then need to recuperate at home for one to four weeks before returning to normal daily activities.
Your surgeon may operate using one of these approaches:
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.
When you are choosing a surgeon to treat your prostate cancer, it is important to select someone you trust and have confidence in. They 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 these questions.
What to Expect After Surgery
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, physicians diagnose the disease early, in the local or regional stages. Physicians 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.
Various tools have been developed to help patients and physicians 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:
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 physician about the specific features of your prostate cancer, how to understand your risk of relapse and all your treatment options.
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.
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.