Advanced prostate cancer care.

The spectrum of "advanced"

Advanced prostate cancer is not one diagnosis — it is a spectrum. Each point on it carries different treatment priorities:

• High-risk localized — confined to the prostate, but with features (Gleason 8–10, very high PSA, large tumor) that warrant multimodal therapy
• Locally advanced — extending beyond the prostate capsule, into seminal vesicles, or into pelvic lymph nodes
• Biochemically recurrent — a rising PSA after surgery or radiation, before any visible disease on imaging
• Oligometastatic — a small number of metastatic sites, where targeted treatment of those sites can change the trajectory
• Metastatic hormone-sensitive — widely metastatic but still responsive to hormonal therapy
• Castration-resistant — disease that has learned to grow despite hormonal therapy

The treatment of each looks meaningfully different in 2026 from how it looked even five years ago.

What has changed

PSMA PET imaging

Conventional CT and bone scans miss small-volume disease. PSMA PET — a scan using a tracer that binds to prostate-specific membrane antigen — sees disease as small as a few millimeters, often months or years before conventional imaging. This changes how high-risk disease is staged and how recurrence is found. Dr. Ursiny orders PSMA PET routinely — for both staging and for chasing down a rising PSA after primary treatment — with reliable access for patients throughout Maine and New Hampshire — including the Seacoast, central New Hampshire, and the Conway / White Mountains region.

Modern hormonal therapy — prescribed and managed here

The older approach — a single hormonal medication, started late — has been replaced by combination androgen-receptor pathway therapy started earlier. Adding agents like abiraterone, enzalutamide, apalutamide, or darolutamide to standard hormonal therapy has produced durable, real-world improvements in survival in multiple landmark trials.

Dr. Ursiny prescribes and manages these medications himself rather than handing patients off — the same physician who knows the cancer history follows the patient through hormonal therapy. The practice maintains an in-office dispensary stocked with these agents, so prescriptions can be filled at the visit instead of routed through a specialty pharmacy, which often saves weeks.

Treatment of the primary tumor in advanced disease

For selected men with oligometastatic disease, treating the prostate itself — not just the metastases — has been shown to improve outcomes. Dr. Ursiny offers this multimodal approach: typically referring to a radiation oncologist for radiation of the primary, while continuing to manage hormonal therapy and ongoing follow-up himself.

Genomic testing

Germline and tumor genomic testing identifies BRCA1, BRCA2, and other DNA-repair mutations that open the door to targeted therapies (PARP inhibitors). Anyone with metastatic, high-risk, or recurrent disease should have this testing.

How care is organized here

Advanced prostate cancer care is fundamentally multidisciplinary. Depending on the situation, the team may include medical oncology, radiation oncology, palliative care, and genetic counseling. Dr. Ursiny collaborates regularly with the local medical and radiation oncologists — coordinating cases directly with the specialists involved, rather than through a formal tumor board. That keeps decisions moving and the patient informed.

The urologist's role across advanced prostate cancer is often to be the constant face — the one doctor who follows a patient across years of treatment, who makes sure no step is missed, and who translates between specialists. That is the role Dr. Ursiny plays for the men in his practice.

What to bring to your first visit

• A timeline: when prostate cancer was diagnosed, PSA values over time, what treatments you have had
• Biopsy and surgical pathology reports
• Recent imaging reports (CT, MRI, bone scan, PSMA PET if available)
• Any genetic testing results
• A list of current medications

Part of prostate cancer care at this practice — diagnosis, treatment, and long-term management.