Prostate Cancer Diagnosis and Treatment

Dr. Julie Graff treats patients and pursues discoveries in the lab. Her work includes finding novel ways to treat patients with advanced prostate cancer and prostate cancer that resists treatment.
Dr. Julie Graff treats patients and pursues discoveries in the lab. Her work includes finding novel ways to treat patients with advanced prostate cancer and prostate cancer that resists treatment.

The OHSU Knight Cancer Institute offers you the most complete and advanced care for prostate cancer. You’ll find:

  • One of the most experienced teams in robotic surgery in the U.S., offering the best chance to save erectile function.
  • Other leading-edge treatments, such as immunotherapy and Calypso radiation therapy.
  • World-class providers on the leading edge of developing new therapies for prostate cancer.
  • Doctors who are fellowship-trained, meaning they completed advanced training in cancer specialties after their residencies.
  • Advanced techniques for diagnosing prostate cancer, such as image-guided biopsy.
  • Full follow-up services at our Urologic Cancer Survivorship Clinic to monitor your health and well-being.
  • A wide range of support services, including a support group where you can connect with other families.

Team-based care

We give you a team-based approach for this complex disease, including:

  • Appointments where you see all the specialists you need in one visit. 
  • A nurse navigator to answer your questions and to arrange tests and treatments. This frees you to focus on your health and family.
  • Doctors from a range of specialties who work together to develop your treatment plan.
  • Doctors and other experts who meet every other week to go over challenging cases as a group. This ensures that all options, including clinical trials, are considered.

Diagnosing prostate cancer

We offer the most advanced diagnostic tools in the Pacific Northwest, including the latest lab tests and imaging technology. 

Screening

Screening is the most important tool our team has for finding prostate cancer when it’s most treatable. Read more about screening on our Understanding Prostate Cancer page.

Imaging tests

Transrectal ultrasound: This test measures the size of the prostate gland. A small probe, about the size of a finger, is placed in the rectum. It uses sound waves to create images of the prostate.

CT scan: Computed tomography scans make detailed images by combining many X-rays. These scans can show if cancer has spread.

Dr. Jeremy Cetnar reviews a patient scan. He is a medical oncologist who focuses on urologic and lung cancers.
Dr. Jeremy Cetnar reviews a patient scan. He is a medical oncologist who focuses on urologic and lung cancers.

MRI: Magnetic resonance imaging scans use magnets and radio waves to produce images of organs, tissues, vessels and bones. These pictures help identify cancer early and show if it has spread. They also highlight suspicious tissue for biopsy testing. OHSU radiologists are among the best in the country at prostate MRIs. You will receive detailed information about your condition. 

Bone scans: These scans show if cancer has spread to bones. We inject a low level of radioactive material into the bloodstream. The material settles in possible sites of cancer cells that show on the scan.

Biopsy

In a biopsy, your doctor removes a small tissue sample so it can be looked at under a microscope. Your doctors can see if there’s cancer and, if so, how aggressive it might be.

MRI-directed biopsy: Your doctor uses a needle to take a small tissue sample from your prostate. Detailed imaging called multiparametric MRI helps doctors tell unhealthy prostate tissue from healthy tissue. 

MRI fusion biopsy: Your doctor uses real-time ultrasound and MRI imaging to guide the needle used to take a tissue sample.
 
Lymph node biopsy: Your doctor uses a needle or small incision to collect lymph node tissue. Lymph nodes are small bean-size structures that act as filters for the immune system. They can trap cancer cells that have broken away from the main tumor. A lymph node biopsy enables your care team to see if your prostate cancer has spread to your lymph nodes.

Treatments

Monitoring

Prostate cancer often grows slowly. Your care team may watch how it progresses before recommending treatment. This is also called active surveillance. 

You may never need treatment if:

  • Your cancer is small and not spreading.
  • You are older, and treatment might lead to other health issues.
  • You are considered at low risk for the disease to advance.

Surgery

A prostatectomy is surgery to remove some or all of your prostate gland. It is most beneficial when the cancer is confined to the prostate. 

Robotic prostatectomy: In our most common prostate-removal surgery, your surgeon sits at a panel and controls robotic arms through small incisions. Our team has done more than 1,100 robotic prostatectomies, making us one of the most experienced teams in the U.S. 

This experience and precision offer you:

  • The best chance of preserving your nerves and erectile function. 
  • Better outcomes and a lower risk of side effects. 
  • A minimally invasive option with less scarring and faster recovery.

Open prostatectomy: This option uses a larger incision, resulting in a longer recovery time than less-invasive methods. Depending on your needs, your doctor may decide it offers the best long-term results.

Radiation therapy

Radiation therapy uses targeted beams of energy to kill cancer cells. You may receive radiation therapy instead of surgery or after surgery. Your care team will recommend the best option for your needs and wishes.

Calypso image-guided radiation therapy: We were the first center in Oregon with Calypso radiation therapy, a system that tracks the exact location of your prostate. The Calypso system, also called GPS for the body, directs focused therapy to your prostate while sparing healthy tissue. This  approach lowers the risk of side effects and better protects your bladder, rectum and sexual organs.

Your care team places tiny sensors in your prostate called beacons. A machine outside your body (a form of external radiation therapy) uses the beacons during therapy to track your prostate with pinpoint precision. Our experienced therapists have treated hundreds of patients with Calypso.

Intensity-modulated radiation therapy: This type of external beam radiation, also known as IMRT, uses computers to map the cancer in three dimensions. This precision allows us to deliver higher doses of radiation because it zeroes in on cancer and avoids healthy tissue.

Brachytherapy: This internal radiation therapy places radiation inside the prostate gland. Guided by ultrasound, CT or MRI scans, we insert radioactive seeds into your prostate using a needle or catheter (thin flexible tube). Each seed is about the size of a grain of rice. The seeds can deliver a high or low dose of radiation. In some cases, doctors combine brachytherapy with external radiation therapy.

Hormone therapy

Nurse navigator Justina Lynch explains test results and what to expect throughout your care.
Nurse navigator Justina Lynch explains test results and what to expect throughout your care.

Hormones in the body called androgens help prostate cancer cells grow. Androgens, mainly testosterone and dihydrotestosterone, attach to proteins on prostate cells to deliver a chemical signal to grow. 

Medications work by lowering the amount of these hormones in the body or by attaching to the proteins, blocking the androgens. They are given by shot, pill or as small implants under the skin. It’s important to know that hormone therapy doesn’t work for everyone. It also tends to lose effectiveness over time as the cancer develops resistance.

You may have hormone therapy:

  • Before other treatments, to shrink the tumor or to lower the risk of the cancer coming back.
  • After other treatments, to kill any remaining cancer cells, lowering the risk that the cancer will come back.
  • By itself, to manage prostate cancer that can’t be surgically removed or that has returned after surgery or radiation therapy.

Cryotherapy

For cancer confined to the prostate gland, your care team might use liquid nitrogen to freeze and kill cancer cells. This minimally invasive technique uses ultrasound-guided instruments, called probes, that are inserted through the skin between the anus and scrotum.

Chemotherapy

Chemotherapy uses medications to stop cancer cells from growing or reproducing. Chemotherapy may be given for more advanced prostate cancers when:

  • Hormone therapy is less effective.
  • The cancer has spread to lymph nodes.
  • The cancer has spread to bones.

Chemotherapy medications are usually given by mouth (pill or liquid) in combination with an IV drip. 

Immunotherapy

Immunotherapy medications use your body’s immune system to attack cancer cells while avoiding healthy cells. 

Provenge: The prostate cancer vaccine sipuleucel-T (Provenge) is one type of immune therapy. It boosts the body’s ability to destroy cancer cells, particularly for advanced cases that have stopped responding to hormone therapy. Each dose is made just for you: Your own white blood cells are withdrawn, treated and returned to your body in an IV.

Keytruda: Keytruda (pembrolizumab) is an option for some men with prostate cancer that has spread to other parts of the body. It helps prevent cancer cells from hiding from the immune system. Clinical trials at OHSU were among research studies showing its effectiveness for some patients.

Additional OHSU services

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For patients

Call 503-494-7999 to:

  • Request an appointment
  • Seek a second opinion
  • Ask questions

Location

Parking is free for patients and their visitors.

Center for Health & Healing Building 2
3485 S.W. Bond Ave.
Portland, OR 97239

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