Our Approach & Expertise

Sidney Kimmel Center for Prostate & Urologic Cancers Our state-of-the-art outpatient facility offers comprehensive care more

Our approach is based on a dynamic model of prostate cancer, in which physicians define therapeutic goals for each patient at the time of diagnosis and continue to redefine them as the disease unfolds and the patient's needs evolve.

To implement this approach, we consider the disease as a series of clinical states. Each state represents a clinically significant milestone that patients may experience during the complete course of prostate cancer. Some patients may have cancer confined to the prostate gland itself. Some may develop a rising prostate-specific antigen, or PSA, level after either removal of the prostate or radiation therapy. PSA is a protein produced by the prostate; it is a good indicator of activity (such as cell division) in the gland. (For more information on Screening, click here.) Some patients may have disease in distant sites such as the bones. Some patients may only experience one clinical state. Others may experience many states, especially if the disease does not respond to treatment.

Even though patients in a given clinical state share certain commonalities, all patients are individuals and face different risks. Each man has an individual chance of responding to treatment or progressing through treatment, just as each faces an individual risk of dying of prostate cancer or of dying from something entirely unrelated. At Memorial Sloan-Kettering, we believe that treatment needs to be tailored to each of these risks. Focusing on patients within a particular state allows the objectives of therapy to be defined clearly. Given that more men die with their cancers rather than from them, our approach allows a distinction between cure (the elimination of all cancer cells) and cancer control (modulating the rate of growth).

Our Prostate Nomogram Our Prostate Nomogram helps physicians and patients decide which treatment will result in the greatest benefit more

Computerized nomograms are recent additions to the decision-making process. These mathematical algorithms were developed by Memorial Sloan-Kettering researchers and are used to assess the probability of cure or transition to the next phase of the disease, based on the best predictive factors that we know today. For patients with localized prostate cancer, those factors include the extent of the tumor on digital examination, the Gleason score of the tumor, and baseline PSA (prostate-specific antigen). Specific nomograms have been developed for radical prostatectomy, external-beam radiation therapy, and brachytherapy (radioactive seed implantation), and for patients whose cancer has progressed after hormonal therapy.

Computer-Assisted Family History Analysis

Memorial Sloan-Kettering is one of the few centers that offers computer-assisted-family history analysis. Men with a family history of prostate cancer that suggests an increased genetic risk may be referred to our genetic counselors, who can help further evaluate their risks. Family members, too, may be offered genetic counseling. See Prostate Cancer & Heredity in our Hereditary Cancer & Genetics section for more information.

Our Surgical Technique

Our surgeons have built upon and refined techniques for a procedure called nerve-sparing radical prostatectomy, in which the cancer is removed completely but normal tissue is spared. ^{1 2 3 4} During this operation, surgeons use optical magnification to better see this intricate area of the body and help preserve the nerves responsible for sexual function. If these nerves must be removed due to their proximity to the cancer, our surgeons may perform a nerve-graft procedure to replace these nerves with healthy nerves taken from the foot -- this procedure can help restore sexual function in some men.

Radical prostatectomy can be performed through different surgical approaches, including traditional "open" surgery or minimally invasive surgery using a laparoscopic or robotic-assisted technique. Each of these approaches allows complete removal of the prostate while maintaining the highest quality of life possible for each patient.

If the cancer recurs, we are also experienced in the surgical removal of the prostate after other treatments, such as radiation or seed implants, have failed. Surgery after failure of radiation therapy, which is called salvage surgery, is more technically demanding than standard radical prostatectomy. Memorial Sloan-Kettering surgeons perform nearly 30 of these procedures each year.

Memorial Sloan-Kettering has pioneered the use of high-dose intensity-modulated 3-D conformal radiation therapy (IMRT), a high-precision technique that shapes the radiation beam to the contours of the tumor, allowing for more effective, higher doses of radiation and significantly reduced risk of injury to nearby healthy tissues. Our physicians have demonstrated that this advanced form of therapy can significantly improve the long-term cure rates for localized prostate cancer and further reduce the risks of side effects compared with standard forms of external beam radiotherapy.

We also helped to develop brachytherapy, the use of radioactive seed implants to kill tumor cells. Recent improvements in this form of therapy now allow for better placement of the radiotherapeutic seeds, ensuring more effective treatment and fewer side effects. Since 1997, we have used a sophisticated 3-D conformal system for intraoperative implants. Radiation oncologists use computers in the operating room to help them target the radioactive seeds more accurately to the prostate, minimizing the radiation dose to normal tissues. Our radiation oncologists are also using information from magnetic resonance spectroscopy to help intensify the radiation doses to abnormal regions of the prostate. Our results have indicated excellent long-term results with fewer side effects than traditional radiation because of the precision associated with this approach.

Find a Clinical Trial Find out about new research studies for prostate cancer more

When prostate cancer spreads beyond the prostate itself, it usually involves the lymph nodes and bones, and symptoms may be wide ranging. There are many tools available to treat systemic disease, and at Memorial Sloan-Kettering our physicians tailor each patient's treatment regimen to meet his unique medical needs.

For many patients, standard treatments such as hormones and docetaxel are not sufficient to control systemic disease. This fact drives our research program to develop more effective treatments that exert more durable cancer control while preserving quality of life. Our clinical trials are based on our growing understanding of how prostate cancer is distinctive from other cancers, and are increasingly "translational," meaning they bring discoveries made in the research lab directly to the patient. Our research efforts fall into the following general categories:

• Novel Hormonal Treatments

  Prostate cancer cells are dependent on male sex hormones to grow and spread. Memorial Sloan-Kettering researchers are testing new drugs that may have fewer side effects and be more effective than traditional hormonal therapies.

• New Chemotherapy Approaches

  Chemotherapy drugs work in different ways to kill tumor cells or to stop them from dividing. Our physicians are investigating the effectiveness of various combinations of chemotherapeutic agents and other drugs for prostate cancer.

• Pathway-Directed (Biologic) Therapies

  Investigators are testing drugs designed to interrupt or inhibit the molecular processes tumor cells require to grow and spread.

• Bone-Directed Treatments

  Systemic prostate cancer usually spreads to the bones. Our doctors are exploring ways to alter the ability of the cancer cells to live in bone and reduce bone-related complications.

• Immune Strategies

  Memorial Sloan-Kettering has an active immunotherapy program testing investigational drugs that produce or encourage the body's immune system to identify and react against prostate cancer cells.

• Tumor-Directed Therapies (Antibodies)

  Memorial Sloan-Kettering researchers are investigating the effectiveness of antibodies, which are proteins that specifically target prostate cancer cells.

For more information about our approaches, see our clinical trials for prostate cancer.

MYMSKCC Patient Portal Learn how you can access information about your care go

Memorial Sloan-Kettering has developed a secure Web site -- called MYMSKCC -- for Kimmel Center patients to access personalized information about their care. Patients who voluntarily enroll to use MYMSKCC can view and keep track of appointments; make changes to contact and insurance information; send and receive e-mail messages to and from their nurse; and view hospital bills. PSA lab results can also be accessed through the MYMSKCC Web site.

To enroll in or learn more about MYMSKCC, please ask a session assistant in clinic or contact your physician's office.

¹Saranchuk JW, Kattan MW, Elkin E, Touijer AK, Scardino PT, and Eastham JA. Achieving optimal outcomes after radical prostatectomy. J Clin Oncol 2005; 23:4146-4151. [PubMed Abstract]

²Touijer K, Kuroiwa K, Eastham JA, Vickers A, Reuter VE, Scardino PT, Guillonneau B. Risk-adjusted analysis of positive surgical margins following laparoscopic and retropubic radical prostatectomy. Eur Urol 2007 Oct;52(4):1090-6. Epub 2006 Dec 13. [PubMed Abstract]

³Vickers AJ, Bianco FJ, Serio AM, Eastham JA, Schrag D, Klein EA, Reuther AM, Kattan MW, Pontes JE, Scardino PT. The surgical learning curve for prostate cancer control after radical prostatectomy. J Natl Cancer Inst. 2007; 99(15):1171-7. [PubMed Abstract]

⁴Eastham JA. Surgery Insight: optimizing open nerve-sparing radical prostatectomy techniques for improved outcomes. Nat Clin Pract Urol. 2007; 4(10):561-569. [PubMed Abstract]