Prostate cancer treatment options include active surveillance, surgery, radiation, hormone therapy, and more. Cancer begins when prostate cells mutate and grow uncontrollably, forming a tumor. Treatment is based on the cancer stage, your age, health, and personal preferences.

The goal is to either cure the disease or manage symptoms and extend life. A cancer care team, including urologists, oncologists, and nurses, will help guide your treatment plan.

Active Surveillance

monitoring low-risk cancer
Active surveillance delays treatment until signs of cancer progression appear. Since some prostate cancers grow slowly, treatment side effects may outweigh benefits initially.

This approach is often used when tumors are small, confined to the prostate, symptom-free, and PSA levels are under 10. Regular monitoring includes:

  • PSA blood tests and digital rectal exams every 6 months

  • Imaging tests every 1–3 years

  • Prostate biopsy every 1–3 years

watchful waiting vs. surveillance
Watchful waiting is a less intensive approach, often for older adults or those with other health concerns. It typically involves fewer follow-ups, focusing on symptom management rather than monitoring tumor growth.

Surgery

removing the prostate
Surgery is used for cancers confined to the prostate. It usually involves removing the prostate gland, sometimes along with the seminal vesicles and pelvic lymph nodes.

possible side effects
Not everyone experiences complications, but some may include:

  • Erectile dysfunction

  • Orgasm changes

  • Urinary incontinence

  • Loss of fertility

  • Change in penis length

radical (open) prostatectomy
Involves an incision from belly button to pubic bone under anesthesia to remove the prostate and nearby tissues.

laparoscopic or robotic prostatectomy
Minimally invasive surgery using small incisions and special instruments (robotic-assisted or camera-guided) to remove the prostate.

TURP (transurethral resection of the prostate)
Used to relieve symptoms, not to cure cancer. A resectoscope is inserted through the urethra to cut or burn away prostate tissue.

Radiation Therapy

killing cancer cells with X-rays
Radiation may be used alone or with hormone therapy. Options include external-beam radiation and brachytherapy (internal radiation).

side effects

  • Bowel issues: rectal pain, bleeding, diarrhea

  • Erectile problems

  • Fatigue

  • Urinary discomfort

external-beam radiation therapy
Uses a machine to deliver radiation to the prostate. Often used in early-stage cancer or to relieve bone pain from metastasis. Treatments are typically five days per week over several weeks.

brachytherapy
Involves implanting radioactive seeds in the prostate. Low-dose seeds stay in place long-term; high-dose seeds are removed after ~30 minutes, sometimes repeated multiple times.

Other Focal Therapies

less invasive treatments for localized cancer

cryotherapy
Freezes cancer cells using cold gases delivered via probes. Side effects may include blood in urine, urinary symptoms, and possible erectile dysfunction.

HIFU (high-intensity focused ultrasound)
Uses ultrasound to heat and destroy cancer cells. May be chosen before other major treatments due to being minimally invasive.

Hormone Therapy

reducing testosterone to slow cancer
Prostate cancer cells depend on testosterone to grow. Hormone therapy deprives them of this fuel using drugs or surgery.

types of hormone therapy

  • LHRH agonists: injected implants that reduce testosterone

  • LHRH antagonists: rapid testosterone reduction, oral or injection

  • Orchiectomy: surgical removal of testicles for permanent hormone suppression

side effects
Temporary effects: low libido, hot flashes, fatigue, weight gain
Long-term risks: bone thinning, heart disease, diabetes

Chemotherapy

targeting cancer cells throughout the body
Chemo may be used if prostate cancer has spread. It’s not curative but can slow progression and extend life.

common chemo drugs

  • Docetaxel (Taxotere)

  • Cabazitaxel (Jevtana)

  • Estramustine (Emcyt)

  • Mitoxantrone (Novantrone)

Side effects vary but may include fatigue, nausea, bruising, and mouth sores. Most symptoms subside after treatment.

Immunotherapy

stimulating the immune system
Provenge (sipuleucel-T) is a vaccine used for advanced prostate cancer not responding to hormone therapy. It prolongs life but does not reduce tumor size or PSA.

treatment process
Your white blood cells are combined with prostate enzyme PAP and re-infused into your body across three IV treatments every two weeks.

Targeted Therapy

attacking cancer cells specifically
PARP inhibitors block DNA-repair enzymes in cancer cells, useful for BRCA mutation carriers.

examples

  • Olaparib (Lynparza)

  • Rucaparib (Rubraca)

Side effects may include joint pain, nausea, and anemia.

Clinical Trials

exploring new treatments
Clinical trials test innovative therapies. They may offer early access to new drugs or help those whose cancer hasn’t responded to standard care.

Living With and Managing Prostate Cancer

coping and support
A prostate cancer diagnosis brings emotional, physical, and financial stress. Support from loved ones and healthcare teams is crucial. Resources are available for emotional, financial, and symptom management.

survival rates
The five-year survival rate is around 97%, and rises to 100% for early-stage prostate cancer. Early diagnosis and proactive care make a major difference.

A Quick Review

Prostate cancer treatments vary based on disease stage, health, and patient preference. Options include active surveillance, surgery, radiation, hormone therapy, chemotherapy, targeted therapy, and immunotherapy.

Your care team will recommend the best options to cure the cancer or manage it effectively. Support resources are essential throughout the journey.