Prostate Cancer

Duke Health’s prostate cancer team uses the latest advances to diagnose and treat your prostate cancer. Our goal is to preserve your urinary and sexual function while treating your prostate cancer and getting you back to an active, full life. As leaders in prostate cancer treatment, people with hard-to-find and difficult-to-treat cancers are often referred to us. We will explore all options to ensure you receive the best possible care while preserving as much healthy tissue as possible.

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Diagnosing Prostate Cancer

Regular screenings, such as a prostate-specific antigen (PSA) test or digital rectal exam, help your doctor assess your risk of prostate cancer. If your PSA test or digital rectal exam indicates you may have prostate cancer, your doctor will recommend additional testing to help them determine a diagnosis.

Imaging

Duke Health uses a specialized prostate MRI exam to determine the size, number, location, and aggressiveness of tumors within the prostate. We use this imaging to determine exact locations for further testing, such as a biopsy, or treatment planning. A CT scan, bone scan, or PET scan may also be recommended to help determine the stage of your cancer or to see if it has returned or metastasized.

Biopsy

The only way to verify that you have prostate cancer is through a biopsy. Guided by prostate MRI, your provider will insert a needle into various parts of your prostate and collect tissue samples that are examined for cancer. Depending on your needs, this procedure may be done either transrectally (via your rectum) or transperineally (the area between the anus and the scrotum).

PSMA Pet Scan

If your doctor thinks your prostate cancer has spread or returned, they may order a PSMA PET scan. This scan includes injecting a safe, FDA-approved radioactive tracer drug that is specially made to find prostate cancer cells. It can identify cancer inside and outside the prostate gland, allowing your providers to track any spread or recurrence, or to determine the effectiveness of a treatment.

Prostate Cancer Treatments

Your doctor will recommend treatments based on the stage of your cancer. Stages describe how much cancer is in your body and/or how far it has spread.

Stage I (Localized)

Stage I prostate cancer is confined (or localized) to the prostate gland and has not spread.

Active Surveillance

Active surveillance may be recommended for prostate cancer when it’s detected early, especially if your tumor is small and nonaggressive. Active surveillance includes a PSA test every six to 12 months and a prostate MRI every one or two years. A biopsy may be taken at the time of your prostate MRI. Duke’s active surveillance process uses sophisticated prostate MRI imaging to analyze the makeup of your tumor and provide a personalized risk assessment.

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Stage II (Localized) and Stage III (Locally Advanced)

Stage II prostate cancer is still confined to the prostate but is at a higher risk of spreading to surrounding lymph nodes or organs. Stage III prostate cancer has spread to both sides of the prostate, or to the seminal vesicles or nearby sites, such as the pelvic wall, bladder, or rectum. If diagnostic tests suggest that your tumor is likely to grow and spread quickly, your doctor may talk to you about one or more of the following treatments.

Surgery

Our goal is to recommend the least-invasive procedure possible and improve your quality of life.

Radical Prostatectomy

Radical retropubic prostatectomy is performed through a single, small abdominal incision. It results in smaller scars and less pain.
During robot-assisted laparoscopic prostate surgery, your surgeon uses tiny robotic instruments to remove the prostate and tissue. The robotic approach allows your surgeon to operate with extreme precision.

Learn how we treat your prostate cancer while working to preserve your urinary and sexual function.

Focal Therapy

Focal therapy is a minimally invasive procedure most often used to treat smaller tumors that are confined to one area of the prostate (Stage II). It uses an energy source to target a small section of the prostate gland and kill the cancer with intense heat, cold, or electrical pulses while leaving healthy tissue intact. This treatment can minimize the impact on sexual and urinary function.

Cryosurgery

Cryosurgery is a type of focal therapy. During this outpatient procedure, doctors use ultrasound images to guide the insertion of a needle into the prostate. Cool argon is injected to freeze and kill cancerous prostate tissue.

Radiation Therapy

Radiation beams target the tumor on your prostate to damage the cancer cells. All prostate radiation treatments are with intensity modulated radiation therapy (IMRT), which reduces radiation exposure to nearby healthy tissues and decreases the risk of side effects. Treatments are individualized so if you meet with a radiation oncologist for consultation, they will discuss which course of radiation they recommend for you.

Prostate Stereotactic Body Radiotherapy (SBRT)

Standard radiation courses for prostate cancer are usually done over five to six weeks. However, you may be a candidate for shorter courses of radiation called stereotactic body radiotherapy, commonly referred to as SBRT. The typical course of prostate SBRT is five treatments given every other day over two weeks.

Rectal Spacer

A rectal spacer can be placed to further reduce the risk of radiation side-effects. The spacer is a gel that is placed between the rectum and prostate before starting radiation treatments. The gel is absorbable and breaks down about six months after treatment. Your radiation oncologist will discuss whether a spacer is an option for your treatment.

Systemic Therapies

Systemic therapies are medications that circulate through your bloodstream to attack cancer cells throughout your entire body, rather than focusing on a single spot like radiation or surgery.

Hormone Therapy

Prostate cancers rely on testosterone to grow. Medications can be given to reduce how much testosterone your body produces, which may help shrink tumors. Hormone therapy is sometimes given to make radiation therapy more effective.

Novel Hormonal Agents

Novel hormonal agents block the interaction between testosterone and prostate cancer cells. Your doctor may recommend their use alongside hormone and other therapies if they believe your cancer is fast-growing and/or likely to spread.

Clinical Trials

We offer clinical trials in all stages of prostate cancer to improve care for people with prostate cancer and expand treatment options. Your oncologists may talk to you about participating in a clinical trial as part of your prostate cancer care.

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Stage IV: Metastatic or Recurrent Prostate Cancer

Stage IV prostate cancer is metastatic, meaning it has spread to the lymph nodes and/or distant organs, such as the lungs or bones. Your doctor may talk to you about the following treatment options for metastatic or recurrent prostate cancer.

Hormone Therapy

Hormone therapy can slow the progression or growth of cancer in advanced cases or if cancer has returned by reducing the production of testosterone. Prostate cancer relies on testosterone to grow. While it cannot cure prostate cancer, hormone therapy may help improve your quality of life and length of life.

Novel Hormonal Agents

Novel hormonal agents block the interaction between testosterone and prostate cancer cells. They can be used alongside hormone therapy or may be used if your cancer has become resistant to hormone therapy.

Chemotherapy

Chemotherapy kills or slows the growth of cancers when surgery and/or radiation therapy aren’t effective alone. It may help lengthen your life and relieve your symptoms.

Radioligand Therapy

Radioligand therapies, such as PLUVICTO^TM (lutetium Lu 177 vipivotide tetraxetan), deliver targeted, concentrated doses of radiation to prostate cancer cells anywhere in the body while limiting damage to surrounding healthy cells.

Ned Steele's cancer shrunk significantly after being on Pluvicto®. Learn how the therapy works.

Immunotherapies

Immunotherapies help your immune system find and destroy cancer cells. For instance, one type of immunotherapy called sipuleucel-T (Provenge) uses your own white blood cells to fight your cancer. Your cells are sent to a lab, trained to identify and attack prostate cancer cells, and then returned to your body. While immunotherapy will not cure your prostate cancer, it can help prolong your life.

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Leaders in Diagnosing and Treating Prostate Cancer

The Duke Cancer Institute

The Duke Cancer Institute brings together the extensive resources of Duke University, Duke Health, and the Duke Comprehensive Cancer Center. We are committed to making innovative discoveries, developing new ways to prevent, diagnose, and treat cancer, and delivering those therapies in a patient- and family-centric way.

National Reputation

We are one of the select centers designated by the National Cancer Institute as a Comprehensive Cancer Center, and we are part of the National Comprehensive Cancer Network, an alliance of the nation’s leading cancer centers dedicated to improving care for our patients. Duke is also a designated Comprehensive Radiopharmaceutical Therapy Center of Excellence. Our team includes surgeons, radiation oncologists, medical oncologists, nuclear medicine physicians, radiologists, and pathologists who specialize in prostate and urologic cancers.

Surgical Expertise

Robotic prostate surgery is the gold standard for prostate cancer surgery. Duke was one of the earliest adopters of robotic surgery in North Carolina, and our care team includes surgeons who are fellowship-trained, meaning they studied for additional years to become experts in urologic surgery.

Advanced Imaging

A prostate MRI helps your team find tumors and determine a course of treatment. Our 3-Tesla MRI machines are twice as powerful as conventional scanners and just as safe. This advanced technology allows us to provide the most specific diagnosis possible so radiologists and oncologists can collaborate on your course of treatment. We also offer state-of-the art PSMA PET imaging combined with high-resolution, contrast-enhanced CT to provide the most accurate staging of prostate cancer.

Expertise in Systemic Therapy

We are one of 13 Department of Defense Prostate Cancer Clinical Trial Consortium sites where new drugs and innovative therapies are being developed and delivered to people with advanced prostate cancer. Duke researchers have been closely involved in the development and approval of treatments for men with advanced prostate cancer, including newer hormonal therapies, immunotherapies, chemotherapies, and radiopharmaceuticals.

We Support You

Our comprehensive cancer support services help you with concerns ranging from how to minimize the side effects of treatment to coping with the emotional and psychological elements of your diagnosis and treatment. This includes a Prostate Cancer Survivors clinic and pelvic floor physical therapy to rehabilitate urinary function. Learn more about our prostate cancer support groups.

Best Cancer Hospital in North Carolina

Where you receive your cancer care is important. Duke University Hospital is proud of our team and the exceptional care they provide. They are why our cancer program is nationally ranked, and the highest-ranked program in North Carolina, according to U.S. News & World Report for 2025–2026.

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This page was medically reviewed on 02/26/2026 by

Hannah Dzimitrowicz McManus, MD | Medical Oncologist