Active surveillance: Not every patient receives immediate treatment after a prostate cancer diagnosis. “About 25% of patients, specifically those with low- or intermediate-risk prostate cancer, are put on active surveillance instead of other more aggressive treatments,” says Dr. Scherr. “We monitor patients closely and every six months, we conduct PSA blood tests and rectal exams. And then once a year, we do an MRI on them. Occasionally, we will do confirmatory biopsies on these patients.”
Surgery: “With surgery, which is called a radical prostatectomy, we remove the entirety of the prostate and surrounding lymph nodes. It is a laparoscopic surgery, done robotically,” says Dr. Scherr. “Patients typically either go home on the same day or stay in the hospital for one night. The risks of surgery have to do with urinary control, sexual dysfunction, and urinary tract infection, although we take great precautions to avoid that.”
Radiation therapy and hormone therapy: The standard of care now for radiation therapy is stereotactic radiation therapy, which is a five-day course of radiation therapy. “It is a brief treatment for around 20 to 30 minutes each day,” says Dr. Scherr. Radiation therapy is sometimes combined with hormone treatments or medications that lower a man’s testosterone. “In intermediate and high-risk diseases, there is evidence to suggest that hormone therapy enhances the effects of radiation in those individuals, or sometimes men who have a large prostate. We may give them hormone treatments to shrink it down in anticipation of the radiation therapy,” he says.
Chemotherapy: For patients with advanced disease, such as if the cancer has spread outside of the prostate, chemotherapy may be recommended. “It can be used with hormone therapy,” says Dr. Scherr.