Why More Men Are Living Well After a Prostate Cancer Diagnosis

One of the biggest advances in prostate cancer treatment isn’t a new drug, a new surgery, or a new piece of technology. It’s recognizing that some men with low-risk prostate cancer may not need treatment right away.

That shift says a lot about how dramatically prostate cancer care has changed. Physicians can now learn far more about how an individual cancer is likely to behave, allowing some men to safely avoid treatment in favor of monitoring, while giving those who need it more precise and personalized options.

And the goal has changed, too. Successfully treating prostate cancer is no longer only about controlling the disease. It’s about protecting urinary and sexual function, reducing unnecessary side effects, and helping men return to the lives they were living before cancer.

“When a patient tells me years later that he almost forgets he ever had prostate cancer, that’s success,” said OU Health urologic oncologist Dr. Michael Cookson, M.D., MMHC, FACS, associate chief physician executive at OU Health Stephenson Cancer Center and professor and chair of the Department of Urology at the University of Oklahoma College of Medicine.

Dr. Cookson explains how advances in active surveillance, more precise surgery and radiation therapy, and targeted therapies for advanced disease are helping more men live well with and after prostate cancer.

Q. What treatments are available for prostate cancer today?

A. Today, we have more treatment options than ever before, and we’re much better at determining which treatment is right for which patient.

For men with low-risk prostate cancer, active surveillance is now a standard of care, not a compromise. We can monitor the cancer closely with a blood test that measures the level of prostate-specific antigen (PSA), MRI, and repeat biopsies and only move to treatment if the cancer shows signs of becoming more aggressive. The goal is simple: treat the cancers that need treating and spare men the side effects of treatment they never needed.

When treatment is necessary, we have surgery and increasingly precise forms of radiation therapy. For advanced prostate cancer, our toolbox has expanded dramatically. We now have next-generation hormonal therapies, chemotherapy, targeted therapies for cancers with specific genetic mutations, PSMA-targeted radioligand therapy, which uses a radioactive drug to seek out and deliver radiation directly to prostate cancer cells by targeting prostate-specific membrane antigen (PSMA), and immunotherapy for select patients.

The important thing is that we’re no longer treating every prostate cancer the same way. We’re matching the treatment to the cancer and the patient.

Q. How different is prostate cancer care today compared with 10 years ago?

A. Almost everything about how we approach this cancer has improved.

Ten years ago, a man with an elevated PSA would often go straight to a biopsy performed without image guidance. If we found cancer, treatment frequently followed, regardless of how likely that particular cancer was to cause harm.

Today, we have much more information before we make those decisions. We use MRI to identify suspicious areas before biopsy and can target those areas much more precisely. Biomarkers and genomic testing can help us understand how a cancer is likely to behave.

For higher-risk cancers, PSMA PET imaging, an advanced scan that can detect small areas of prostate cancer throughout the body, can help us find cancer that older imaging may have missed.

All of that means we have a much clearer picture of the cancer we’re treating, and sometimes that clearer picture tells us that we don’t need to treat it at all.

Q. Why wouldn’t you immediately treat prostate cancer once you find it?

A. Because not every prostate cancer is going to threaten a man’s health.

Some prostate cancers grow very slowly. For men with low-risk cancer, active surveillance allows us to watch the cancer closely without exposing them to the potential side effects of surgery or radiation before those treatments are necessary.

Active surveillance doesn’t mean we’re doing nothing. We monitor PSA, use MRI, and perform repeat biopsies when needed. If we see evidence that the cancer is changing or becoming more aggressive, we can intervene.

Many men can remain on active surveillance for years, and some may never need treatment.

Q. When a man does need treatment, how have surgery and radiation improved?

A. Both have become much more precise.

Robotic-assisted prostatectomy (a minimally invasive surgical procedure performed through small incisions using robotic technology) allows us to operate with magnified, high-definition visualization. That helps us work very carefully around the nerves involved in erections, and the muscles involved in urinary control. When the cancer allows us to preserve those structures safely, we do.

Radiation therapy has also advanced significantly. We can shape radiation very precisely around the prostate and adjust treatment based on a patient’s anatomy. Treatment courses have become shorter, too. What once might have required eight or nine weeks of treatment can often be completed in four weeks, and for some men, in as few as five treatments over two weeks.

At Stephenson Cancer Center, we offer both photon radiation therapy (traditional radiation that uses high-energy X-rays) and proton radiation therapy (a form of radiation that uses proton beams to more precisely target tumors), and we can use a protective gel spacer, a temporary material placed between the prostate and rectum, to help reduce bowel side effects.

We’re treating the cancer, but we’re also thinking very deliberately about protecting the healthy tissue and function around it.

Q. Men often worry about urinary control and sexual function. How do you address those concerns?

A. The most important thing we do is talk about these issues honestly before treatment, not after. Patients do better when they know what to expect and have a plan.

Before surgery, pelvic floor physical therapy can help strengthen the muscles involved in urinary control, and continuing that therapy afterward can help with recovery.

We’re also proactive about sexual health. We can use medications and other therapies to support function while the nerves recover, and there are additional options available if a man needs them.

For men receiving hormonal therapy, we pay attention to exercise, bone health, fatigue, and the other ways side effects of treatment can affect daily life. None of these side effects should be suffered in silence. Nearly all of them can be improved, and helping men get their lives back is as much a part of my job as treating the cancer.

Q. What has changed for men with advanced prostate cancer?

A. We’ve seen tremendous progress.

We now have next-generation hormonal therapies that can work even when standard hormone therapy stops working, and we’ve learned that using some treatments earlier — including certain combinations with chemotherapy — can help men live substantially longer.

We’re also increasingly able to target specific characteristics of an individual man’s cancer. PARP inhibitors, a type of targeted therapy that can take advantage of certain inherited or acquired genetic mutations in cancer cells, can exploit a weakness in cancer cells with those mutations.

PSMA-targeted radioligand therapy is another important advance. Through an IV, we give a radioactive drug that travels through the body looking for prostate cancer cells that express PSMA. It can then deliver radiation directly to those cancer cells wherever they are.

Immunotherapy may also be appropriate for select patients, and clinical trials continue to give us new ways to treat advanced disease.

Today, we have options for men with advanced prostate cancer that we simply didn’t have a decade ago.

Q. Why is genetic testing becoming such an important part of prostate cancer care?

A. Genetic testing can give us information that directly affects treatment. We routinely recommend it for men with advanced or high-risk prostate cancer, and for those with strong family histories of prostate, breast, ovarian, or pancreatic cancer.

Some genetic tests look for inherited changes a man was born with. Other tests look for mutations that developed in the cancer itself. Those results can help us understand how the cancer may behave, and whether it may respond to a particular targeted treatment.

There can also be implications for the man’s family. If we discover an inherited genetic change, that information may be important for his children and siblings as well.

Q. What does “living well” after prostate cancer mean to you?

A. It means that curing or controlling the cancer is the beginning of the story, not the end.

Living well means a man can get back to work, travel, exercise, intimacy with his partner — the life he had before his diagnosis.

We accomplish that by treating the whole person: choosing the treatment that fits his cancer and his life, being aggressive about managing side effects, and supporting his physical and emotional health through survivorship.

Q. What does Stephenson Cancer Center offer men with prostate cancer?

A. When it comes to cancer treatment, it’s not meant to be an “away game.”

Men in Oklahoma shouldn’t have to leave home to get world-class prostate cancer care, and at Stephenson Cancer Center, they don’t.

Within one academic health system, we provide the full spectrum of prostate cancer care — MRI-guided biopsy, advanced PSMA imaging, genetic and genomic testing, robotic surgery, focal therapy, photon and proton radiation therapy, advanced systemic therapies, clinical trials, and survivorship care.

We also have specialists in urology, medical oncology, radiation oncology, radiology, and pathology working together to coordinate care. For complex cases, this multidisciplinary team looks at the cancer from different perspectives and determines the best approach for that individual man.

Our goal isn’t simply to offer the newest treatment. It’s to have the expertise and range of options needed to choose the right treatment for the right patient at the right time.

Expert Prostate Cancer Care at Stephenson Cancer Center

More men are living well after prostate cancer thanks to earlier detection and more personalized treatment options. To learn about screening, treatment, or survivorship care, contact Stephenson Cancer Center at (572) 244-0106.