Treatment Options
Prostate cancer treatment is highly individualized – it depends on the stage and grade of the cancer, as well as the patient’s overall health and personal preferences. Fortunately, there are many treatment approaches available. Major treatment options include:
Active Surveillance (Watchful Waiting): For very low-risk or early-stage prostate cancers that appear small and slow-growing, doctors may recommend no immediate treatment. Active surveillance means the cancer is closely monitored with regular PSA tests, exams, and occasional biopsies, and treatment is only started if there are signs the cancer is growing. This strategy avoids or delays the side effects of active treatment. A similar approach, “watchful waiting,” involves less intensive monitoring and focuses on managing symptoms if they arise, and is usually considered for older men or those with other serious health issues. If the cancer shows signs of progression, active treatment (surgery or radiation) will be offered at that time.
Surgery (Radical Prostatectomy): Surgery aims to remove the prostate gland (and usually the nearby seminal vesicles) completely. This operation, called a radical prostatectomy, can be done through one large incision or with minimally invasive techniques (laparoscopic or robotic surgery). Removing the prostate is an effective treatment for cancers that are confined to the gland (Stages I and II, and some III). The surgery may also sample or remove nearby lymph nodes to check for spread. Potential side effects include urinary incontinence and erectile dysfunction (due to nerves around the prostate being affected), but many men recover bladder control within months and newer nerve-sparing techniques improve the chances of maintaining potency.
Radiation Therapy: This treatment uses high-energy rays to kill cancer cells in the prostate. Radiation can be delivered externally or internally.
External beam radiation therapy (EBRT) uses a machine to direct radiation at the prostate from outside the body, usually over several weeks.
Internal radiation therapy, or brachytherapy, involves implanting tiny radioactive “seeds” directly into the prostate, where they emit radiation over time. Radiation is a curative option for localized cancer (often equivalent to surgery in outcomes) and is also used for some locally advanced cases (sometimes combined with hormone therapy). Side effects can include fatigue, urinary frequency or burning, bowel habit changes, as well as longer-term risks of erectile dysfunction.
Hormone Therapy (Androgen Deprivation Therapy): Prostate cancer cells typically depend on male hormones (androgens) like testosterone to grow. Hormone therapy reduces the production of androgens or blocks their effect on cancer cells. This is often done with medications (LHRH agonists or antagonists, and/or anti-androgen pills) that either stop the testicles from making testosterone or block the hormone receptor. In some cases, surgical removal of the testicles (orchiectomy) is done, though most patients use the injectable or oral medicines. Hormone therapy is commonly used for advanced or metastatic prostate cancer, to shrink and slow the cancer. It is also used in combination with radiation for higher-risk localized cancers. While hormone therapy is very effective at initial control, the cancer can eventually become resistant. Side effects of androgen suppression include reduced libido, erectile dysfunction, hot flashes, weight gain, loss of muscle, and bone thinning.
Chemotherapy: Chemotherapy uses anti-cancer drugs that travel through the bloodstream to kill cancer cells. It is typically used for advanced prostate cancer that no longer responds to hormone therapy (castration-resistant prostate cancer). Common chemo drugs for prostate cancer (like docetaxel or cabazitaxel) can help men with metastatic disease live longer and reduce symptoms. Chemotherapy is usually given intravenously in cycles. Side effects can include hair loss, nausea, fatigue, lowered blood counts, and increased risk of infections, among others – but these side effects are manageable and often temporary.
Immunotherapy: Also known as biologic therapy, immunotherapy aims to boost the body’s own immune system to fight the cancer. One FDA-approved immunotherapy for prostate cancer is the sipuleucel-T (Provenge) vaccine for certain metastatic cases – it involves culturing a patient’s immune cells to recognize prostate cancer and infusing them back. Other immunotherapies (like checkpoint inhibitors) are being used in select cases, especially if the cancer has specific mutations (e.g., microsatellite instability). Immunotherapy can sometimes cause immune-related side effects (inflammation in various organs), but for most prostate cancer patients these treatments are well tolerated. This is an active area of research for future treatments.
Targeted Therapy: Targeted drugs block specific abnormalities in cancer cells. For example, PARP inhibitors (like olaparib or rucaparib) have been developed for prostate cancers that have certain DNA-repair gene mutations (such as BRCA mutations). These drugs specifically target the cancer cells’ ability to repair DNA, causing them to die. Targeted therapies are generally used for advanced prostate cancers that have a known targetable genetic feature and have progressed despite other treatments. They often come as pills. Side effects depend on the drug but may include nausea, anemia or other blood count changes, and fatigue.
Other/Newer Therapies: There are additional treatments for prostate cancer that may be recommended in special situations or are newer developments:
Cryotherapy (Cryoablation): This is a less common treatment that uses extreme cold to freeze and destroy prostate tumor tissue. A probe is inserted into the prostate, and argon gas is used to freeze the cells. Cryotherapy can be an option for early-stage cancers or when cancer comes back after radiation. It can cause side effects like ED or urinary symptoms and isn’t as long-term proven as surgery or radiation for initial treatment.
High-Intensity Focused Ultrasound (HIFU): Another less invasive approach, HIFU focuses high-energy sound waves on the prostate tumor to heat and kill cancer cells. Like cryotherapy, HIFU is typically used in certain localized cancer cases or clinical trials, and long-term outcomes are still being studied.
Radiopharmaceuticals: These are radioactive medicines that seek out bone metastases and deliver radiation directly to tumor sites. An example is Radium-223, used for prostate cancer that has spread to bones – it can reduce bone pain and improve survival in some cases. Newer targeted radioligand therapies (such as Lu-177–PSMA therapy) are also emerging for advanced prostate cancer, delivering radiation precisely to prostate cancer cells wherever they are in the body.
Doctors will help you decide which treatment is right for you, based on the cancer’s characteristics and your personal values. Often, multiple specialists (urologists, radiation oncologists, medical oncologists) will weigh in. Early-stage prostate cancer has several effective options (including surgery, radiation, or surveillance), each with different pros and cons. More advanced cancer might require a combination of treatments (for example, hormone therapy plus radiation, or chemo plus hormone therapy). It’s very reasonable to seek a second opinion, especially when facing a complex decision. Take the time to understand each option and its side effects so you can make an informed choice that fits your life and priorities.