For many men with prostate cancer, standard treatments like surgery, radiation therapy and hormone therapy remain highly effective and are often the foundation of care. But prostate cancer treatment is constantly changing. According to Daniel Nethala, MD, a genitourinary surgical oncologist with Banner MD Anderson Cancer Center, care is shifting away from a one-size-fits-all approach.
“For a long time, treatment options were straightforward: either whole-gland surgery or whole-gland radiation,” he said. “While those options are still very good and the gold standard for aggressive or widespread disease, we can now choose from a more detailed set of tools.”
New tools like advanced MRI imaging and biomarker tests (tests that check for disease signs in blood or tissue) now help cancer specialists better understand each patient’s cancer and choose treatment more precisely. This means some men may have access to newer options that fit their cancer type, stage and personal goals.
Keep reading to learn about newer prostate cancer treatments and if they might be suitable for your diagnosis and cancer stage.
Standard prostate cancer treatments still play a major role
Before looking at new options, remember that standard treatments are still the main way to treat prostate cancer. Your cancer care team might recommend one or more of these, depending on your stage and overall health:
- Active surveillance for low-risk cancer
- Surgery to remove the prostate
- Radiation therapy
- Hormone therapy
- Chemotherapy for more advanced cases
These treatments are well researched and remain highly effective, especially for aggressive or widespread cancer. Newer therapies are not replacing them but are giving men more options when it comes to care.
Why prostate cancer treatment is becoming more personalized
One of the biggest changes in prostate cancer is personalization. Dr. Nethala explains that high-quality MRI scans and biomarker tests help doctors see the unique fingerprint of each tumor.
“This helps care teams move beyond general treatment categories and match therapy to how a specific cancer behaves,” he said. “As a result, prostate cancer treatments are becoming more precise and tailored.”
This shift helps doctors:
- Better identify tumor location and aggressiveness
- Match treatment intensity to risk level
- Consider quality-of-life outcomes earlier in planning
Newer treatment options for prostate cancer
TULSA (transurethral ultrasound ablation)
TULSA is one of the newest treatments for select patients with localized disease (the cancer hasn’t spread outside the prostate). It is a minimally invasive, incision-free treatment that uses MRI guidance and focused ultrasound energy to destroy cancer tissue in the prostate.
How TULSA works:
- Performed inside an MRI scanner
- Ultrasound energy heats and destroys targeted cancer cells
- Real-time imaging guides treatment precision
- Nearby healthy tissue is actively protected
“By using MRI in real time, we can target only the tissue that needs treatment while doing our best to protect urinary and sexual function,” Dr. Nethala said. “For the right patient, this can be a meaningful option to consider alongside more traditional treatments.”
TULSA may be considered for patients with:
- Localized prostate cancer
- Low- to intermediate-risk disease (often Gleason 7)
- Tumors visible on MRI
- Cancer confined to the prostate
It may not be appropriate for:
- Metastatic prostate cancer (cancer that has spread to other organs)
- Tumors that are highly aggressive or spreading
- Significant prostate calcifications (small duct blockages caused by calcium deposits)
Precision medicine and genetic testing
Precision medicine is a fancy way of saying “treatment matched to the biology of your cancer.” It uses information from your genes and those in your tumor to guide your treatment.
“We treat your specific prostate cancer based on its unique biology,” Dr. Nethala said. “It helps us understand how the aggressiveness of the cancer, which treatments might work best and familial cancer risk.”
What it includes:
- Tumor DNA testing
- Germline (inherited) genetic testing
- Identification of mutations such as BRCA
Your care team may discuss these options when:
- Cancer has spread
- Cancer has come back after earlier treatment
Targeted therapy and immunotherapy
Some advanced prostate cancers can be treated with targeted therapies. These medicines attack specific changes inside cancer cells, like gene mutations. Other men might benefit from immunotherapy, which helps the immune system fight cancer.
Your care team may discuss these options when:
- Cancer has spread
- Cancer has come back after earlier treatment
- Standard hormone therapy is no longer working, such as in castration-resistant prostate cancer
Theranostics for metastatic prostate cancer
Theranostics is an exciting area that combines two important steps, finding cancer and treating it, using closely related molecules. Dr. Nethala said to think of it as a radioactive heat-seeking missile.
“First, we do a special PET scan to locate a protein called PSMA that sits almost exclusively on the surface of prostate cancer cells,” he said. “Then, we place a radioactive drug into the bloodstream that finds those exact PMSA proteins. It locks on and delivers radiation directly into the cancer cell, while largely sparing healthy tissue.”
Theranostics is mainly used for advanced prostate cancer, especially when hormone therapy stops working. Like other new treatments, it might not be suitable for everyone but it is an option for some patients.
Questions to ask your cancer team
Newer treatments are not one-size-fits-all. Whether you may be a good fit depends on many things, including:
- Whether your cancer is localized or has spread
- Your PSA levels and biopsy results
- The treatments you've already tried
- Your overall health
- Your personal goals about side effects and quality of life
Dr. Nethala advises patients to take their time and understand their diagnosis fully before starting treatment.
“I always wish more patients would pause and ask: ‘Does this cancer actually need to be treated right now?’” he said. “Many low-grade prostate cancers are incredibly slow-growing and may never pose a threat to a man’s life.”
He encourages patients to ask their provider:
- What is my Gleason score and risk group?
- Is active surveillance a safer option?
- Should I have genetic testing?
- What are the exact rates of erectile dysfunction and incontinence in your specific practice?
- Am I a candidate for TULSA or focal therapy?
- How will treatment affect my daily life and recovery?
Why a multidisciplinary cancer center matters
Prostate cancer care often involves more than one type of provider. When choosing a treatment center, it’s best to find a place where urologic oncologists, radiation oncologists and medical oncologists work as a team. These doctors share information, review your imaging and biopsy results and consider all your options together.
“If you only see a surgeon, you’re probably going to be offered surgery,” Dr. Nethala said. “If you only see a radiation doctor, you’ll get radiation. You want a comprehensive center that has all the tools and specialists under one roof. That way, you get multi-approach advice that’s right for you.”
Takeaway
Prostate cancer treatments are now using more options beyond surgery and radiation. New methods like TULSA, precision medicine, targeted therapy and theranostics offer more personalized care for some patients.
If you have been diagnosed with prostate cancer, make an appointment with a Banner Health provider to help you understand your treatment options and build a personalized care plan.
Frequently asked questions
Is surgery still the best way to treat prostate cancer?
It depends on the cancer's stage, grade and your overall health. Many men have several good options. Your doctor can help you decide which is best for you.
What is TULSA for prostate cancer?
TULSA is a treatment that uses MRI guidance and focused ultrasound to target cancer in the prostate. It treats cancerous tissue while trying to protect nearby structures.
Can prostate cancer be treated with precision medicine?
Some advanced cancers may respond well to treatments based on genetic testing. Talk with your doctor to see if testing is right for you.
What is theranostics?
Theranostics is a technique that combines imaging and treatment focused on the same area. Doctors often discuss it for advanced or spreading prostate cancer.
Are newer treatments safer than older ones?
Every treatment can cause side effects. Some new options may have fewer side effects but the best choice depends on your specific cancer and your health goals.
