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Prostate Cancer

Duke’s prostate cancer experts use the latest medical, surgical, and radiation therapies to treat your prostate cancer while working to preserve your urinary and sexual function. As leaders in care, we receive referrals for hard-to-find and difficult-to-treat cancers and use specialized equipment to confirm a diagnosis, even when prostate cancer tumors are very small. We are experts at diagnosing these challenging cases with advanced imaging technologies that include specialized prostate MRI and prostate specific membrane antigen (PSMA) PET scans.

We will explore all options to ensure you receive the best possible care while preserving as much healthy tissue as possible. Our prostate cancer team includes surgeons, radiation oncologists, and medical oncologists who specialize in prostate and urologic cancers and can help you improve your prostate health and return to an active life as quickly as possible.

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Tests for Prostate Cancer

Your doctor may prescribe one or more of the following tests to diagnose, locate, and stage your prostate cancer. Testing may involve radiologists specifically trained in prostate MRI, who have expert knowledge to determine the best treatment for you.

Prostate-Specific Antigen (PSA) Test

Blood test that measures levels of PSA produced by your prostate. High levels may indicate cancer.

Digital Rectal Exam

Your doctor inserts a surgically gloved finger into your rectum to examine your prostate, including an assessment of its size and if anything feels out of the ordinary.

Prostate MRI

Our providers can use a specialized prostate MRI exam to determine the size, number, location, and aggressiveness of tumors within the prostate. We can use this imaging to determine exact locations for further testing, such as a biopsy, or treatment.

PSMA PET Scan

If our providers suspect your prostate cancer may have spread, a PSMA PET scan includes injecting a safe, FDA-approved radioactive tracer drug that is specially made to find cancerous cells on a PET scan. This test can identify cancer in and outside the prostate gland, allowing for providers to track any spread and determine how well a treatment is working.

Biopsy

Guided by prostate MRI, a provider inserts a needle into your prostate and collects a tissue sample that is analyzed for cancer. Depending on your individual needs, we may do this procedure either transrectally (via your rectum) or transperineally (the area between the anus and the scrotum or vulva).

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Duke Health offers locations throughout the Triangle. Find one near you.

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Active Surveillance for Prostate Cancer

Our active surveillance process uses sophisticated prostate MRI imaging to analyze the makeup of your tumor and provide a personalized risk assessment. This process is used for small, nonaggressive tumors that have a low probability of impacting your health and are not likely to grow or spread.

Your doctor may recommend active surveillance and periodic imaging tests to monitor your prostate cancer and determine whether treatment is needed. Active surveillance includes a prostate-specific antigen 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 as well.

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Surgical Treatments for Prostate Cancer

When surgery to remove the tumor is needed, we explore all minimally invasive approaches. Our goal is to recommend options that are most beneficial to you and improve your quality of life.

Prostatectomy

There are two types of prostatectomy, a procedure that removes the entire prostate and some surrounding tissue.

Radical retropubic prostatectomy is performed through a single, small abdominal incision. It results in smaller scars and less pain.
During robotic 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 advanced prostatectomy techniques can help you regain urinary and sexual function quicker

Cryosurgery

During this outpatient procedure, doctors use ultrasound images as a guide as they precisely insert a needle into the prostate. Cool argon is injected to freeze and and kill cancerous prostate tissue.

Focal Therapy

This treatment is ideal for people with one or two low-grade tumors that are at low risk for growing or spreading. It targets a section of the prostate gland and kills the cancer with intense heat, cold, or electrical pulses while leaving healthy tissue intact. This treatment can minimize impacts to sexual and urinary function.

Radiation Treatments for Prostate Cancer

Radiation therapy is an equally effective option for people who want to avoid surgery or where surgery may not be possible. Modern radiation therapy uses advanced imaging technology that focuses radiation beams directly onto your prostate. When prostate cancer is advanced, radiation can reduce tumor size or relieve symptoms. 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.

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. All treatments are individualized so if you meet with a radiation oncologist for consultation, they will discuss which course of radiation they recommend for you.

Rectal Spacer

A rectal spacer is 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, meaning it will breakdown about six months after treatment. A radiation oncologist will discuss whether a spacer is a good option for the recommended treatment course.

Medication and Targeted Treatments for Prostate Cancer

If surgery or radiation are not options for treatment of your prostate cancer or you need additional treatments, your care team will include medical oncologists who specialize in systemic therapies for prostate cancer. Your oncologist will work with you to determine the best individualized treatment plan for your cancer.

Androgen Deprivation Therapy (Hormone Therapy)

Testosterone helps prostate cancers grow. Medications can be given to reduce how much testosterone your body produces. Androgen deprivation therapy (ADT) may help shrink tumors or slow the growth of cancer cells left behind after surgery. These medications are sometimes given to make radiation therapy more effective.

Novel Hormonal Agents

We have more insight regarding how testosterone promotes prostate cancer growth. Newer agents, which block the interaction between testosterone and prostate cancer cells have improved outcomes for our patients.

Chemotherapy

This treatment kills or slows the growth of cancers too advanced for treatment with surgery or radiation therapy alone. Chemotherapy works quickly and may also be used to help relieve your symptoms.

Radioligand Therapy

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

Immunotherapy

These drugs block cancer cells' ability to avoid our immune system, thus allowing our immune system to kill cancer cells. Immunotherapy can be a treatment option for certain prostate cancers.

Targeted Therapy

By analyzing the genetic make-up of your cancer, we can sometimes identify genetic mutations that can be targeted with specific cancer drugs.

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.

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.

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.

Imaging Abilities that Make a Difference
A prostate MRI can be one of the most important ways your care team can find tumors and determine a course of treatment. Every person who undergoes an MRI for prostate cancer will receive imaging from our 3-Telsa MRI machines which are twice as powerful as conventional scanners and just as safe. This advanced equipment allows us to provide the most specific diagnosis possible so radiologists and oncologists can collaborate on your course of treatment.

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.

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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This page was medically reviewed on 05/18/2023 by

Matthew Labriola, MD | Medical Oncologist