MSK Advances Prostate Cancer Care With HIFU, Radiopharmaceuticals, and Precision Surgery to Reduce Deaths and Preserve Function
核心洞察
Memorial Sloan Kettering Cancer Center (MSK) has led clinical development of multiple prostate cancer (搜索) advances, including high-intensity focused ultrasound (HIFU) for intermediate-risk tumors and the FDA-approved radiopharmaceutical Pluvicto® for metastatic disease.
A phase 2 trial led by MSK surgeon Behfar Ehdaie, MD, MPH, and reported in Lancet Oncology in 2022 showed HIFU works well for controlling prostate cancer (搜索) in many patients.
MSK offers active surveillance for low-risk disease, focal therapy for localized tumors, and advanced radiation approaches such as SBRT, IMRT, proton therapy, and MRI-guided adaptive radiation therapy.
The outlook for people with prostate cancer (搜索) has greatly improved in recent years, with a 10-year survival rate for all stages combined of 98%, according to the American Cancer Society. Memorial Sloan Kettering Cancer Center (MSK) has led clinical development of some of the latest improvements in prostate cancer treatment, including high-intensity focused ultrasound (HIFU) for intermediate-risk tumors, genetic sequencing to guide checkpoint inhibitor immunotherapy, and a radiopharmaceutical therapy for metastatic prostate cancer (Pluvicto®) that was recently approved by the U.S. Food and Drug Administration (FDA).
"At MSK, we've made many advances in prostate cancer (搜索) treatment — but just as important, we developed more personalized evaluations to better understand each person's disease," says urologic surgeon Massimiliano Spaliviero, MD, FACS. "This helps us determine the true level of risk and whether treatment is needed, so we can recommend the most appropriate care for each patient."
MSK's prostate cancer (搜索) specialists are part of a team that was ranked #1 in the nation for urology care by U.S. News & World Report in 2025 for the third consecutive year.
Active Surveillance for Low-Risk Disease
For men whose prostate cancer (搜索) is considered low-risk, MSK offers active surveillance, which involves very close monitoring and helps people avoid the possible side effects of surgery and radiation therapy. Dr. Spaliviero emphasizes that active surveillance does not mean doing nothing: "It's called active surveillance because it is active — with regular scans, bloodwork, and other tests." The schedules for these tests are based on scientific studies of how low-risk cancers are most likely to behave, and treatment is only initiated if the cancer begins to grow.
"Many men with prostate cancer (搜索) don't need treatment right away because this type of cancer grows slowly," Dr. Spaliviero explains. "At MSK, we have the expertise to carefully identify who can safely monitor their condition over time or delay treatment without added risk."
Focal Therapy and HIFU for Localized Tumors
Focal therapy, also called partial gland ablation, is a prostate cancer (搜索) treatment for small tumors limited to one area of the prostate. It is less invasive and does less harm to healthy tissue. MSK uses focal therapy to treat the area of the prostate gland with higher-grade cancer, while using active surveillance for parts of the prostate with low-grade tumors.
Among the focal therapy approaches, prostate cancer (搜索) high-intensity focused ultrasound (HIFU) uses focused ultrasound waves to kill tumor cells with high heat. MSK has been using HIFU increasingly for prostate cancers considered "intermediate risk." A phase 2 clinical trial led by MSK urological cancer surgeon Behfar Ehdaie, MD, MPH, and reported in Lancet Oncology in 2022 demonstrated this less-invasive method works well for controlling prostate cancer in many people.
Other focal therapy techniques include cryoablation (freezing cancer cells), irreversible electroporation using the NanoKnife® to generate short electrical pulses that create tiny pores in tumor cells, and a photodynamic therapy (PDT) currently under investigation in a clinical trial.
Advanced Radiation Approaches
MSK delivers radiation therapy using advanced tools to target tumors with precision while minimizing side effects. Stereotactic body radiation therapy (SBRT), branded as MSK Precise®, delivers higher, more precise doses of radiation and can be given in just five short visits over about 10 days. Multiple randomized clinical trials have shown SBRT is very effective at controlling cancer, with low rates of urinary and bowel problems.
Additional approaches include Intensity-Modulated Radiation Therapy (IMRT), which uses advanced computer programs to deliver radiation directly to cancer cells from different angles, and proton therapy, which uses charged particles called protons to kill cancer cells. MSK also offers real-time, MRI-guided radiation therapy and CT-based adaptive radiation therapy, which allows doctors to adjust the treatment plan every day based on daily changes in anatomy.
Treatments for Metastatic Prostate Cancer
For men whose prostate cancer (搜索) has metastasized, MSK offers systemic treatments including hormone therapy, theranostics, targeted therapy, chemotherapy, and immunotherapy. MSK led clinical trials testing more effective hormone therapies now commonly used for metastatic prostate cancer, including abiraterone acetate (Zytiga™) and enzalutamide (Xtandi®).
In theranostics, targeted imaging molecules find cancer cells and then deliver radiation directly to those cells. Pluvicto® selectively seeks out and attaches to a specific protein on the cancer cell surface called PSMA (搜索) (prostate-specific membrane antigen). MSK medical oncologist and Prostate Cancer (搜索) Section Head Michael Morris, MD, led clinical trials that resulted in FDA approval of this therapy to treat patients after chemotherapy had failed.
For targeted therapy, PARP (搜索) inhibitors block the PARP protein inside cells that helps repair cell DNA, treating prostate cancer (搜索) with a mutation in the BRCA (搜索) gene. PARP inhibitors for prostate cancer include olaparib (Lynparza®) and rucaparib (Rubraca®). Chemotherapy options include docetaxel (Taxotere®) as the standard for hormone-resistant prostate cancer, and cabazitaxel (Jevtana®) for metastatic disease that has grown while on docetaxel.
Neuroendocrine Prostate Cancer and the DLL3 Target
Neuroendocrine prostate cancer (搜索) (NEPC) is a deadlier form of prostate cancer (搜索) that usually arises when common prostate adenocarcinoma develops resistance to certain hormonal therapies, and it is becoming more common. This urgent need spurred MSK to create a new program focused on NEPC, with multiple research projects and clinical trials investigating new treatments.
MSK researchers identified a new target: a ligand (molecule) called DLL3 (搜索) that is especially prominent in NEPC. They have developed radioactive agents that selectively target DLL3-expressing cancer cells while sparing normal tissue, and they are working toward translating the technology into a clinical trial.
Surgical Innovation and Ongoing Research
Surgery for prostate cancer (搜索) is very effective at controlling or curing the disease when it has not yet spread outside the prostate gland. The most common type is radical prostatectomy, which involves removing the prostate gland and some surrounding tissue. At MSK, robot-assisted laparoscopic surgery is the most common way to perform a radical prostatectomy, and open surgery remains an effective option for locally spread or high-risk cancers.
MSK is developing advanced imaging tests to plan surgery with greater precision, potentially protecting important nerves and surrounding structures to reduce the risk of incontinence and improve the chances of preserving sexual function. Clinical trials are investigating a new method for lighting up nerves during surgery and whether exercising pelvic muscles before and after radical prostatectomy can minimize loss of urinary control.
One intriguing recent finding is that exercise before surgery might reduce the chance of prostate cancer (搜索) progressing. A clinical trial showed that exercise had a beneficial effect on two biomarkers linked to prostate cancer growth, though determining whether exercise leads to better outcomes and survival rates will require longer and larger clinical trials.