Prostate Cancer Diagnosis and Treatment

Justina Lynch, RN
Our prostate cancer nurse navigator, Justina Lynch, is here to arrange your care and answer questions for you and your family.

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.
  • Genetic testing for more treatment options.
  • 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.
Dr. Jeremy Cetnar reviews a patient scan. He is a medical oncologist who focuses on urologic and lung cancers.

Prostate cancer diagnosis

Accurate diagnosis is a critical part of your care. Early detection leads to better outcomes. We use the most advanced technology in the Pacific Northwest to see if you have cancer.

Screening

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

Scans and biopsy

These tests can show where the cancer is and whether it has spread.

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 or CAT (computed tomography) scan: Doctors use an X-ray beam that circles the body to create a detailed picture of your prostate.

MRI (magnetic resonance imaging): This scan uses magnets and radio waves to produce images of soft tissues in your body. It yields clear images of the prostate gland.

PET (positron emission tomography): This scan uses a slightly radioactive tracer to produce detailed images. This is particularly good at detecting cancer cells.

PET/MRI: This advanced scan combines PET and MRI.

PSMA PET-CT: This advanced scan combines PET and CT. The PET scan uses a radioactive tracer that latches onto a protein called PSMA (prostate-specific membrane antigen). PSMA is concentrated on the surface of prostate cancer cells. This scan can detect whether the cancer has spread.

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.

Prostate cancer 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 helpful 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.

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.

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.

Radiopharmaceutical therapy

Radiopharmaceutical therapy (also known as targeted radioligand therapy) combines the precision of targeted therapy with the power of radiation therapy.

A radiopharmaceutical is a chemical compound with two parts: a head and a tail. Once injected into the bloodstream, the head seeks out a prostate cancer cell the way a bumble bee seeks a type of flower.

Then the tail delivers the sting: a radioactive isotope that bombards the cancer cell with beta particles. The radiation knocks out the cell.

In 2022, the FDA approved a radiopharmaceutical known as Pluvicto for an aggressive type of prostate cancer. The approval was based on research at the Knight Cancer Institute and other places.

Prostate Cancer Genetics Clinic

Genes play an important role in cancer. People who inherited certain genetic changes have a higher risk of cancer. (These changes, or mutations, are also known as germline mutations or germline variants.) Prostate cancer from a genetic change can be more aggressive.  

Genetic counseling and testing may help identify the best treatment for you. It can open the door for more ways to treat your cancer with targeted therapies. It can also inform your children and other relatives about their risk of developing cancer. This information can help them find ways to lower their risk of prostate, breast, ovarian, pancreatic, colorectal and other types of cancer. 

Our Prostate Cancer Genetics Clinic provides complete care for patients who: 

  • Have prostate cancer or 
  • Have a genetic change that puts them at higher risk of prostate cancer 

Our doctors and genetic counselors can talk with you about the risks and benefits of testing. We will also help you understand what the results mean for you and your family. 

We follow guidelines of the National Comprehensive Cancer Network. It recommends germline genetic testing if you have prostate cancer and any of the following: 

  • Your prostate cancer is only in your prostate and high-risk; or your prostate cancer has spread to another part of your body .
  • You have a family history that includes at least one of the following:
    • Ashkenazi Jewish ancestry
    • Inherited mutations such as BRCA1, BRCA2 or Lynch syndrome 
    • Prostate cancer
    • Breast cancer before age 50
    • Ovarian cancer, pancreatic cancer or certain other types of cancer

First you meet with a genetic counselor. They will review your family history, give you more information about testing options, and review potential results.

We then can test for inherited changes with a blood draw or a spit sample. Your results come back in two to four weeks. Your genetic counselor will help you understand the results and what they mean for you and your family.

Talk with your care team about whether genetic counseling and testing is right for you. 

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

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