Prostate Cancer Treatment Options

Prostate cancer often grows slowly. Because of this, treatment is not always necessary right away. For many men, surgery is not the only option, which is an important consideration.

Our radiation and medical oncologists will review the test results, stage, grade, and risk group to determine the right set of treatments and their timing.

Treatment planning by risk group

After staging and grading the cancer, patients are often categorized into risk groups based on how likely the cancer is to grow and spread. This drives the urgency of treatment and which therapies are recommended.

• Low risk - For many men in this category, active surveillance is often recommended rather than immediate treatment. This approach allows careful monitoring while avoiding unnecessary side effects.
• Intermediate risk - Treatment recommendations for this risk group vary depending on the grade of cancer, the patient’s age and overall health, and their preferences.
• High risk - Men in this category are more likely to start a treatment plan quickly because the cancer is growing aggressively or has already spread to other nearby areas of the body.

Prostate Cancer Treatment Options

Active Surveillance

For men with low-risk, slow-growing prostate cancer, active surveillance may be recommended. This approach involves closely monitoring the cancer with:

• Regular PSA testing
• Digital rectal exams
• Repeat biopsies or advanced imaging when appropriate

Treatment begins only if there are signs that the cancer is progressing. This strategy allows many men to avoid or delay side effects while remaining under careful medical supervision.

Radiation Therapy for Prostate Cancer

Radiation therapy uses precisely targeted high-energy beams to destroy cancer cells. For some men, it can be used as the primary treatment for cancer confined to the prostate. Other men will receive hormone therapy in addition to radiation to slow the hormones causing the cancer to grow. And for men who have surgery, radiation can be used to treat the prostate and ensure that all of the cancer cells are destroyed.

External Beam Radiation Therapy (EBRT)

External beam radiation delivers radiation from outside the body, precisely targeting the prostate. Careful measures are used to protect surrounding organs such as the bladder and rectum.

Brachytherapy (Internal Radiation)

This type of radiation can be given in a low dose or a high dose, depending on the stage of cancer.

• Low-dose rate brachytherapy - Involves placing small radioactive seeds directly into the prostate gland that remain there and deliver low doses of radiation to the prostate over time. The seeds are not removed at the end of the treatment.
• High-dose rate (HDR) brachytherapy - For early-stage prostate cancer patients, treatment can be given internally in short sessions over the course of 1-2 days. The radiation is placed in a tube that is surgically inserted into the prostate. The radiation remains in place only for a few minutes before it’s removed. The tubes are removed from the prostate when the treatments are complete.

Some patients benefit from brachytherapy alone, while others receive it in combination with external beam radiation therapy.

Hormone Therapy (Androgen Deprivation Therapy)

Prostate cancer cells often rely on male hormones, known as androgens, including testosterone, to grow.

Hormone therapy reduces hormone production or blocks the effects of hormones on cancer cells. It’s often used concurrently with radiation therapy and can be given as injections, implants, or oral medications, depending on the specific drugs. It is more commonly used when the cancer has spread to other parts of the body or has recurred after initial treatment.

Surgery (Radical Prostatectomy)

A radical prostatectomy involves the surgical removal of the prostate gland and sometimes nearby lymph nodes. Surgery is typically recommended for men whose cancer is confined to the prostate and who are healthy enough for an operation.

Your urologist and oncology team will discuss potential benefits, risks, and long-term considerations before proceeding. Many men will receive additional treatments after surgery to ensure all of the cancer cells are gone.

Targeted Therapy for Prostate Cancer

Targeted therapies are designed to attack specific molecular features of prostate cancer cells. These treatments interfere with pathways that help cancer cells grow, repair DNA, or survive.

Targeted therapy can be used to treat advanced prostate cancer, particularly when the disease progresses after using hormone therapy. The right targeted therapy for a patient is based on biomarker test results that indicate a genetic change that is related to the cancer’s growth.

Radiopharmaceutical Therapy for Advanced Prostate Cancer

Radiopharmaceuticals are an advanced form of targeted radiation treatment. These drugs deliver radiation directly to cancer cells throughout the body. Unlike traditional radiation therapy, which uses external machines or implanted seeds to treat a specific area, radiopharmaceuticals are given as an injection, infusion, or sometimes orally. These medications contain radioactive isotopes attached to molecules that seek out specific markers on cancer cells. Once in the bloodstream, they travel through the body, bind to cancer cells, and release radiation directly at the tumor site. This approach allows treatment to reach cancer that has spread to areas such as the bones or other distant locations.

Radiopharmaceutical treatment is an option for castrate-resistant, metastatic prostate cancer.

Chemotherapy

Chemotherapy uses medications that travel through the bloodstream to destroy rapidly dividing cancer cells. Because prostate cancer is often contained in the prostate for a while, chemotherapy is not often used. It can be effective for men with prostate cancer that has spread to the lymph nodes or other areas of the body.

Clinical research trials access

The Blue Ridge Cancer Care team is dedicated to bringing the latest treatment options to our patients through access to trials. Our affiliation with the Sarah Cannon Research Institute makes this possible. If a clinical trial is right for you, we will discuss it with you as one of your options at our cancer centers.

Leading Prostate Cancer Care in Southwest Virginia

Choosing where to receive prostate cancer treatment matters. For men who will receive radiation therapy, weekday visits to a cancer center are needed for treatment. Choose the cancer care team you’re comfortable with and that you can access easily.

With locations in Roanoke, Salem, Rocky Mount, Bedford, Low Moor, Lexington, Blacksburg, Pulaski, Wytheville, Fairlea, and Princeton, we serve patients in the entire Southwest Virginia region.

Our team is here to guide you through every step of your care with experience, compassion, and advanced treatment options close to home.