Prostate Cancer Care

Talk with your doctor about which prostate cancer treatment option(s) are best for you. Your treatment options may include one or more of the following:

Active Surveillance: Active surveillance is an option for men with early stage, low-risk or favorable intermediate-risk prostate cancer and who are likely to live more than 10 years. It consists of closely monitoring of your cancer on a regular basis so that treatment can be started when needed. Monitoring can include regular exams, blood tests, prostate MRI and prostate biopsies. Click here to view the Active Surveillance guidelines at MaineHealth.

Radiation: Radiation therapy uses high-powered energy to destroy cancer cells. Prostate cancer radiation therapy can be delivered in several ways. Talk with your doctor about which option(s) is best for you.

• Radiation that comes from outside of your body (external beam radiation). External beam therapy uses highly focused beams of radiation to destroy cancer cells. The radiation is directed to the site where the cancer is found. 

Locations within the MaineHealth system:

• Maine Medical Center/Spectrum Medical Group in Bath, Portland, Scarborough, Sanford
• MaineGeneral Medical Center in Augusta

• Radiation placed inside your body (brachytherapy). Some patients may be candidates for high-dose-rate (HDR) brachytherapy for treatment of their prostate cancer. HDR brachytherapy involves the placement of a powerful radiation source into the prostate for several minutes through multiple tubes called catheters. It is usually given in multiple doses over two days and involves an overnight hospital stay.

Locations within the MaineHealth system:

• Maine Medical Center/Spectrum Medical Group in Portland

Surgery | Robotic Assisted Radical Prostatectomy: This minimally invasive surgical approach, which enables major surgery to be performed through the smallest of incisions, is ideal for delicate urologic surgery. Using hand controls that manipulate robotic instruments, surgeons can access spaces inside the body otherwise very difficult to reach. This leading-edge technology has been shown to improve patients’ recovery experience and clinical outcomes.

Locations within the MaineHealth system:

• Maine Medical Center/MMP Urology, Portland, Scarborough
• Maine General Medical Center, Augusta 

Surgery | Open Radical Prostatectomy: In the more traditional approach to doing a prostatectomy, the surgeon operates through a single skin incision (cut) to remove the prostate and nearby tissues. This type of surgery, sometimes referred to as an open approach, is now done less often than in the past.

Locations within the MaineHealth System:

• Maine Medical Center/MMP Urology, Portland, Scarborough
• MaineGeneral Medical Center, Augusta
• PenBay Urology, Rockland
• Southern Maine Medical Center, Biddeford

Hormone Therapy: Most prostate cancer cells rely on the male hormone testosterone to help them grow. Hormone therapy for prostate cancer is a treatment to lower the testosterone levels in your body. It can slow tumor growth or shrink the tumor for a period of time. Hormone therapy is sometimes given in conjunction with radiation therapy. Hormone therapy for prostate cancer is also known as androgen deprivation therapy (ADT).

Chemotherapy / Immunotherapy: Chemotherapy is any treatment involving the use of drugs to destroy cancer cells. It may consist of single drugs or combinations of drugs, and can be administered through a vein or delivered orally in the form of a pill. Immunotherapy is a type of treatment that uses the body’s immune system to facilitate the killing of cancer cells. It uses materials made either by the body or in a laboratory to improve, target, or restore immune system function.

Watchful Waiting: Now more commonly referred to as observation, it involves testing on a regular basis so that supportive care can be given if symptoms from the cancer are likely to start. Testing includes PSA and DRE. Watchful waiting can involve fewer tests and screenings. This recommendation may be made if the cancer is not expected to cause you major problems, or you have health conditions that would make treatment too difficult.

Clinical Trials: MaineHealth physicians and scientists are continuously looking for better ways to treat patients with cancer. They create research studies involving volunteers, called clinical trials. In fact, every drug that is now FDA-approved was previously tested in clinical trials. Click here to learn more about clinical trials.

Prostate cancer treatment decision aids are available to help you as you prepare for a discussion with your physicians about the best options for your treatment. The resources below are from other websites and can be used as tools to discuss with your physician.

Begin by completing the P3P Personal Patient Profile. This is a web-based program to help men prepare for making a decision with their doctors about how to manage a diagnosis of early stage prostate cancer.

Risk Calculators and Decision Aids
Men diagnosed with prostate cancer have many options. Below are some decision aids and calculators that can help to estimate your risk for disease spread and recurrence. They will help you understand the potential benefits and harms of different treatment for prostate cancer. They will also prepare you to talk with your doctor about your options. Which tool you use depends on where you are in the stage of your disease and what treatment you have already had.

• Pre-Treatment Prediction Tool 
  This nomogram predicts the extent of the cancer and long-term results following radical prostatectomy (surgery to remove the prostate gland and surrounding lymph nodes).
  
  
• Partin Tables 
  This tool predicts whether the prostate cancer extends beyond the prostate after surgery.

Getting a second opinion is not uncommon in cancer care. At MaineHealth, we know how important it is to be confident in your prostate cancer care approach and treatment. We want to make every effort to facilitate a second opinion, whenever the patient – and in many situations, the provider – wants to seek a second opinion. This is important to us, and our focus on patient-centered care.

What is a second opinion?

A second opinion is when a patient or physician seeks another physician specialist’s review of a patient’s diagnosis or recommended treatment. It is common in cancer, especially if a patient has an unusually complicated condition or rare form of the disease.

When you choose to obtain a second opinion for your prostate cancer care, your physician forwards test results such as radiology images, blood work and pathology slides. The physician may recommend another physician specializing in that cancer, or the patient may find a specialist through a primary care physician, online research or a relative or friend’s recommendation.

To confirm that insurance will cover the cost of second opinion visits, it is recommended that you verify by contacting your insurance company directly.

Preparing for your visit

Like all visits for cancer care, when you are getting a second opinion, it’s helpful to write down your questions in advance and take notes during the conversation. Physicians often recommend that you bring someone with you to help you recall the discussion later. It can be difficult to process what you’re hearing especially if you’re scared or anxious about your condition.

Physicians also may seek another physician’s opinion either on a one-on-one basis, or by asking a multidisciplinary group of cancer specialists to review and weigh in on a patient’s diagnosis or treatment. This team of specialists includes medical oncologists, radiation oncologists and surgical oncologists, as well pathologists, pharmacists and patient navigators. They meet regularly to review patients’ cases.

Where to go for a second opinion?

MaineHealth has sites where patients and their physicians may obtain second opinions. Each site includes cancer experts with advanced training and experience.

Maine Medical Center

MaineGeneral Medical Center’s Harold Alfond Center for Cancer Care

Maine Medical Center: Maine Medical Center's ongoing commitment to the collection and reporting of clinical outcomes data reinforces its unique role both as a community hospital and a regional referral center. The Genitourinary Cancer Program at MMC's Cancer Institute consistently demonstrates clinical outcomes that meet or exceed national benchmarks. Below are Quality of Life measures for men who were treated for prostate cancer.

Radiation Therapy

* Includes patients treated with High Dose Rate (HDR) brachytherapy, or Intensity-Modulated Radiation Therapy (IMRT) external beam, or both.