General Information

Prostate cancer is a type of cancer that develops in the prostate. It is usually confined to the prostate, but as with any cancer, it can spread to other parts of the body at an advanced stage. Early detection of prostate cancer is critical, as most prostate cancer can be cured with treatment. Some grow so slowly that they can even be observed. It is important to get tested as early detection saves lives.

Treatment

Tennessee Valley Urology Center offers the most current treatment options for prostate cancer. Factors such as PSA, pathology grade, and stage, as well as age and general health, are all considered in determining treatment options.

Treatment for localized prostate cancer includes:

• Surgery: The name of the surgery is a robotic radical prostatectomy. This is accomplished using the da Vinci® Surgical System, a sophisticated robotic surgery system that allows surgeons to remove the prostate with enhanced vision, control and precision.
• Radiation: This is done by the radiation oncologist. This is a non-surgical option. Radiation therapy is often combined with medication to decrease testosterone, which is called androgen deprivation therapy or ADT. Examples include Lupron, Eligard, and Orgovyx.
• HIFU: High-Intensity Focused Ultrasound (HIFU) is a non-invasive treatment for prostate cancer. Not all prostate cancer can be treated with HIFU, so it is important to talk to your doctor to determine if you are a candidate. A benefit of HIFU is that it typically preserves continence and sexual function while still treating focal areas of prostate cancer.
• Active surveillance: This is recommended for patients with low-risk prostate cancer. It avoids the unwanted side effects of the above treatments. Surveillance requires PSA testing, imaging, and biopsy over various intervals. If the cancer progresses to a high grade or stage, then treatment may be recommended.

Advanced Prostate Cancer Clinic

Tennessee Valley Urology Center provides an Advanced Prostate Cancer Clinic that is dedicated to men with advanced prostate cancer and their specific needs.

Advanced prostate cancer is prostate cancer that has spread outside of the prostate gland to the lymph nodes, bones, or other areas. This is called metastatic prostate cancer.

Presently, there is no cure for metastatic prostate cancer. However, there are ways to control the spread of the cancer and its symptoms.

Hormonal Treatment / Androgen Deprivation Therapy (ADT)

Testosterone fuels the growth of prostate cancer. ADT is the first line of treatment for aggressive prostate cancer.

Patients are candidates for this if:

• The prostate cancer has spread too far for surgery or radiation or if the patient is not a good candidate for those treatments.
• The cancer remains or reoccurs after initial treatments.

Injectable options for ADT: Eligard – Oral option: Orgovyx

Oral Oncolytic

This is for patients with recurrent or metastatic prostate cancer. In addition to ADT or hormone therapy, an oral pill taken daily may be prescribed.

Novel hormonal therapies (NHT) work along with ADT to further reduce testosterone production or by blocking the effect of testosterone.

These medications include:

• Zytiga (abiraterone) that is taken with a low dose of Prednisone.
• Xtandi (Enzalutamide), Erleada (Apalutamide) and Nubeqa (Darolutamide)

Radiation

Radiation can be necessary to target certain areas where cancer has spread, most commonly to the bone. It can be used by itself or with hormone therapy.

Bone Health

Men with advanced prostate cancer are at risk for the brittle bone disease, osteoporosis. This can be because the disease has spread to the bone or because they are taking a type of prostate cancer treatment (ADT). With ADT, the medication lowers the amount of estrogen, a hormone that keeps the bones strong.

The bones of men who take ADT may become more brittle and at increased risk of breaking.

• Xgeva- Treatment that stops proteins from signaling bone removal within the skeletal system for use in men with bone metastases from prostate cancer. The body naturally destroys old bone material while making new bone material. The drug slows the process of destroying bone and interrupts skeletal damage to the bones by spreading prostate cancer cells. This inhibits bone loss and fractures and relieves pain from prostate cancer in the bone.
• Prolia- Indicated for patients with prostate cancer who are on hormone therapy but have cancer that has not spread to the bone.
• Men should also take Calcium plus vitamin D to help strengthen the bones. Vitamin D helps absorb more of the calcium into the bones.

Advanced Metastatic Castrate Resistant Prostate Cancer

Eventually, most patients with advanced prostate cancer stop responding to hormone therapy. The cancer cells become castrate-resistant and grow strong enough that hormone therapies have a lessening effect on the cancer. This is known as castrate-resistant prostate cancer

Treatment options for metastatic castrate resistant prostate cancer include:

• Immunotherapy- Provenge
• Xofigo

At Tennessee Valley Urology Center, we strive to offer our prostate cancer patients technical expertise and unsurpassed compassion through the process of diagnosis and the formulation and execution of a treatment plan. While we desire to diagnose prostate cancer before it has moved to other areas of the body, we now have many choices to approach prostate cancer when it is advanced.

Our advanced prostate cancer team includes a physician, nurse practitioner, navigator, and medical assistant focusing only on our advanced prostate cancer patients. We also work closely with our colleagues in radiation oncology and medical oncology to ensure options are received promptly and appropriately.

“Receiving news of a prostate cancer diagnosis, recurrence, or progression of previously diagnosed prostate cancer is never easy. Be encouraged, however, that there are now many treatment options available in this setting for you or your loved one.”

– Dr. Edward McIntire