If a man's prostate-specific antigen level is increased, they can either choose to actively pursue treatment, or decide to wait and watch with active surveillance.
Active surveillance is closely following a patient's condition without giving any treatment unless there are changes in test results. It is used to find early signs that the condition is getting worse. In active surveillance, patients are given certain exams and tests, including biopsies, on a regular schedule.
Men may wish to pursue the active surveillance approach for a variety of reasons including their age, other health concerns they may have, and family history.
At Penn, we offer the latest advances in chemotherapy and biologic therapies for treating prostate cancer. Our medical oncologists are part of a multidisciplinary team of cancer specialists that work with all other disciplines in your care team to create a treatment plan for prostate cancer.
Chemotherapy is the use of anti-cancer drugs that circulate throughout the entire body. Chemotherapy may be given before or after surgery, or on its own as a treatment for prostate cancer. Chemotherapy may also be a treatment option for metastatic prostate cancer (prostate cancer that has spread) or recurrence.
Hormone therapy keeps cancer cells from receiving the hormones they need to grow and spread. Hormones are chemicals produced by various glands in the body. They circulate in the bloodstream and some hormones can affect the way certain cancers grow.
The prostate gland, and prostate cancer, depend on male sex hormones such as testosterone. One of the ways to treat prostate cancer is to remove testosterone from the body thus making the cancer shrink and grow at a slower rate. Hormone therapy blocks the production or the effects of testosterone and helps stop the cancer from growing. Treatment may include the use of drugs that change the way testosterone works, or surgery to remove the testicles in order to stop hormone production.
Vaccine Therapy (Immunotherapy)
Vaccines have recently been approved to treat prostate cancer. Vaccine therapy uses a patient's own immune system to fight prostate cancer that is no longer responding to other hormonal therapies. It involves harvesting a specific type of the patient's own white blood cells and combining the cells with a protein called prostatic acid phosphatase (PAP) found on prostate cancer cells, in order to activate the white blood cells. The cells are then given back to the patient about three days later in a process similar to a blood transfusion.
Today, more and more people are surviving cancer. Clinical trials benefit patients with access to breakthrough therapies and treatments. These new advances in cancer treatment are occurring every day at Penn Medicine, giving patients hope that even greater discoveries lie ahead. Through clinical trials:
- Diagnosing cancer has become more precise.
- Radiation and surgical techniques have advanced.
- Medications are more successful.
- Combinations of medical, surgical and radiation therapy are improving treatment effectiveness and enhancing outcomes.
- Strategies to address the late effects of cancer and its treatment are improving quality of life.
Radiation therapy uses high-energy X-rays to kill cancer cells. Penn Radiation Oncology uses the latest equipment and technology available to treat prostate cancer. Our radiation oncologists are recognized leaders in techniques that target radiation precisely to the treatment area while sparing normal tissue.
At Penn, men with prostate cancer have access to new and advanced treatment options and ongoing clinical trials in radiation therapy including proton therapy. As part of our commitment to advance cancer care in patients, radiation oncologists are also researching how radiation treatment affects the quality of life for cancer patients.
Image-Guided Radiation Therapy (IGRT)
Image-guided radiation therapy (IGRT) uses frequent imaging during a course of radiation therapy to improve the precision and accuracy of the delivery of the radiation treatment.
In IGRT, the linear accelerators (machines that deliver radiation) are equipped with imaging technology that take pictures of the tumor immediately before or during the time radiation is delivered. Specialized computer software compares these images of the tumor to the images taken during the simulation to establish the treatment plan. Necessary adjustments can then be made to the patient's position and/or the radiation beams to more precisely target radiation at the cancer and avoid exposure to the healthy surrounding tissue.
Intensity-Modulated Radiation Therapy (IMRT)
At Penn, our radiation oncologists use intensity-modulated radiation therapy (IMRT) to treat prostate cancer. This advanced mode of high-precision radiotherapy utilizes computer-controlled linear accelerators to deliver precise radiation doses to tumors or specific areas within the tumors. Radiation therapy, including IMRT, stops cancer cells from dividing and growing, thus slowing or stopping tumor growth. In many cases, radiation therapy is capable of killing all of the cancer cells.
Using 3-D computed tomography (CT) images in conjunction with computerized dose calculations, IMRT allows for the radiation dose to conform more precisely to the three-dimensional shape of the tumor by controlling, or modulating the intensity of the radiation beam in multiple small volumes. The therapy allows higher radiation doses to be focused on regions within the tumor while minimizing the dose to surrounding normal critical structures.
CyberKnife is a non-invasive alternative to surgery for the treatment of both cancerous and non-cancerous tumors anywhere in the body, including the prostate. The treatment delivers beams of high-dose radiation to tumors with extreme accuracy.
Cyberknife therapy is pain free, non-invasive and can be done as an outpatient procedure. Cyberknife can treat hard to reach tumors and requires no anesthesia during treatment.
Penn Medicine's Roberts Proton Therapy Center is the largest and most advanced facility in the world for this precise form of cancer radiation. Our patients have access to one of the most sophisticated weapons against cancer, seamlessly integrated with the full range of oncology services available at the Abramson Cancer Center.
Proton therapy is external beam radiotherapy in which protons are directed at a tumor. The radiation dose that is given through protons is very precise, and limits the exposure of normal tissues. This allows the radiation dose delivered to the tumor to be increased beyond conventional radiation. The result is a better chance for curing cancer with fewer harmful side effects. Proton therapy, like all forms of radiation therapy, works by aiming the energized particles, in this case protons, onto the target tumor. These particles damage the DNA of cells, ultimately causing their death. Unlike X-rays, protons can be manipulated to release most of their energy only when they reach their target. With more energy reaching the cancerous cells, more damage is administered by each burst of radiation.
Surgery is an essential part of treatment for many men with prostate cancer. In some prostate cancer cases, a radical prostatectomy, removal of the prostate gland, is needed. At Penn, we are national leaders in the surgical treatment of prostate cancer and our surgeons are at the forefront of developing and using new minimally invasive surgical techniques. Benefits of minimally invasive surgical techniques include:
- Smaller incisions/less scarring
- Significantly less pain
- Less blood loss
- Shorter recovery time
- Faster return to normal daily activities
A radical prostatectomy is complete removal of the prostate gland, surrounding tissue and seminal vesicles. A prostatectomy can be performed via traditional surgery, or robotic-assisted surgery.
Traditional prostatectomy involves removing the prostate and surrounding tissues through an incision in the body. Nearby lymph nodes may be removed at the same time. The surgical incision can be made either though the abdomen or through the perineum, the area between the scrotum and the anus.
One of the most innovative treatments for prostate cancer is robotic-assisted laparoscopic prostatectomy — removal of the prostate gland via computer-assisted surgery.
Laparoscopic robotic-assisted prostatectomy is the complete removal of the prostate using long, narrow instruments that are introduced through very small skin incisions. To perform the procedure, six tiny incisions are made in the patient's abdomen and the laparoscopic instruments are carefully inserted and attached to the robot.
Robotic prostatectomy offers similar and sometimes better outcomes than traditional prostate cancer surgery. The margins obtained around the prostate are just as precise, if not more so, than with open surgery. This leads to cancer cure rates equal to traditional surgery. Better precision also means better nerve sparing, thereby maximizing the chances of preserving sexual and urinary function. Most men who have robotic-assisted prostatectomies return to work in two to three weeks and can resume activities such as golf and weightlifting in about three weeks.
While these technological advantages are significant, a surgeon's skill and experience remain the most important elements for achieving good outcomes. We have one of the most experienced robotic-assisted surgery teams in the world, with full-time surgeons dedicated to robotic-assisted prostatectomies. It's their experience, understanding of the body and prostate cancer, and the dexterity of the robot's tools that help rank Penn Urology the highest in the Philadelphia region and among the nation's best for cancer care.
Cryosurgery is a treatment currently offered through clinical trial studies. Cryosurgery is the application of extreme cold to destroy tumors and cancer cells. Cryosurgery may be an option to treat prostate cancer if other treatment options are not successful.
In addition to standard treatments and clinical trials, patients at Penn Medicine may wish to add additional therapies and treatments such as massage therapy, acupuncture and art therapy. These therapies do not have curative intent, and are designed to complement standard treatments, not take their place.
Pelvic Floor Rehabilitation
Pelvic floor rehabilitation physical therapy is a type of non-invasive therapy that focuses on the muscles of the pelvic floor. This specialized technique utilizes both internal and external stretching and release techniques, strengthening exercises, education, and modalities to improve muscle and tissue function along the floor of the pelvis.
Integrative Oncology Services
At Penn, our integrative oncology services can supplement traditional cancer treatments such as chemotherapy, surgery and radiation therapy. While conventional medicine plays a critical role in eradicating cancer, integrative medicine and wellness programs offer you ways to enhance the quality of your life, minimize or reduce the side effects of cancer and cancer treatment, and promote healing and recovery.
Our cancer specialists are knowledgeable and supportive of complementary cancer treatments. Our cancer team works with you and your family to integrate these supportive programs into the overall care plan, while ensuring your health and safety.
The Abramson Cancer Center's range of integrative oncology services is designed to help you cope with the cancer experience and improve your overall sense of well-being. Services include:
Joan Karnell Supportive Services at Pennsylvania Hospital offers an extensive variety of supportive care programs for patients and families, from diagnosis through survivorship. These programs are available at no cost to the patients treated at Pennsylvania Hospital, and some are open to patients treated elsewhere. These services include social work counseling, nutrition counseling, psychological counseling and spiritual counseling.
The Cancer Appetite and Rehabilitation Clinic focuses on patients with loss of appetite and weight.
The Supportive Oncology Clinic helps to manage cancer related symptoms. Integrative support programs include:
Support groups and educational programs are available at Pennsylvania Hospital throughout the year.
Palliative care provides medical and non-medical interventions to ease the symptoms of cancer and its treatment. Palliative care includes physical, emotional and spiritual care that can enhance the quality of life for cancer patients. Palliative care can be used to complement traditional cancer therapies, or can be used when curative therapies are no longer an option to treat symptoms and improve quality of life.
Palliative care is an approach to patient care that can be integrated with curative therapies at any point from diagnosis to survivorship or end of life care. Palliative care services include palliative chemotherapy, radiation therapy and surgery as well as psychological counseling, art therapy and support groups for patients and families.
Penn Home Care and Hospice Services
Penn Medicine offers a full range of “at home” health care services, including specialized therapies and medications, for patients with cancer and cancer-related conditions.
Learn more about Penn Medicine at Home