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The information on this page was reviewed and approved by
Maurie Markman, MD, President, Medicine & Science at CTCA.

This page was updated on September 28, 2021.

Prostate cancer treatment options

Prostate cancer experts develop a comprehensive treatment plan specifically tailored for each patient. This individualized plan typically includes evidence-based medical treatments and technologies, combined with supportive care services to help reduce side effects and keep the patient strong in body, mind and spirit.

This guide provides an overview of the most common treatments for both localized and advanced prostate cancers.

  • Localized prostate cancer means that the cancer cells are contained within the prostate gland.
  • Advanced, or metastatic, prostate cancer means the cancer has spread to other parts of the body, such as the lymph nodes and bones.

Localized prostate cancer is the most commonly diagnosed, accounting for 77 percent of new cases, according to the Centers for Disease Control and Prevention. Understanding the type of cancer is critical to understanding the treatment options available.

Learn about prostate cancer survival statistics and results

Five things I've learned as a caregiver and daughter

Samantha B. is a caregiver for her father, David, who was diagnosed with prostate cancer in 2014. He underwent surgeries and other treatments at Cancer Treatment Centers of America® (CTCA), Atlanta. Now, Samantha shares some of what she’s learned since her dad's diagnosis and how it may help other caregivers like herself. 

    Sam-B-Caregiver

    Deciding on a treatment option

    It may be challenging to decide on a treatment option, but remember: Everyone’s situation is unique. Prostate cancer behaves differently in different people—sometimes it’s slow-growing, while other times it’s aggressive—so treatment is not one-size-fits-all.

    Options also depend on the patient’s stage of prostate cancer. Below are some factors to consider when speaking with your doctor about treatment options:

    • Age
    • Health history and medical conditions
    • Potential side effects
    • Travel plans and recovery time from treatments

    Treatment for localized prostate cancer

    If you’ve been diagnosed with localized prostate cancer, the following treatments may be an option:

    Active surveillance

    Active surveillance is sometimes recommended for small, slow-growing cancers with a low prostate-specific antigen (PSA) score. The doctor will closely monitor the cancer with a PSA blood test. A digital rectal exam (DRE) may also be performed regularly, along with imaging tests and biopsies.

    Older men are more likely to be candidates for active surveillance because treating them with surgery or radiation has not been shown to help them live longer. The decision to monitor prostate cancer, instead of treating it, is made between a patient and his doctor.

    In general, active surveillance may be an option for patients whose prostate cancer is:

    • Not causing symptoms
    • Expected to grow slowly
    • Small and contained within the prostate

    Patients under active surveillance at Cancer Treatment Centers of America® (CTCA) may receive regular PSA tests and biopsies every one to two years. Other treatment options would be considered if a patient’s PSA levels were to rapidly increase, he developed new symptoms, or his doctor found changes during a DRE.

    Watchful waiting

    Watchful waiting, also called observance, is similar to active surveillance, but it involves even fewer check-ins. It’s most commonly recommended for older men or those who have other health conditions that need to take priority.

    Surgery

    A radical prostatectomy is a surgical procedure in which the prostate is removed, along with any nearby tissue that contains prostate cancer cells. This is a common treatment for localized prostate cancer. The da Vinci® Surgical System allows the surgeon to offer this procedure using a minimally invasive approach.

    There are two options, open or laparoscopic surgery:

    • In an open radical prostatectomy, a surgeon makes a single long incision to remove the prostate.
    • In a laparoscopic prostatectomy, which may be performed using robotic assistance, the surgeon uses a mechanical device to remove the prostate via several small incisions. This may sometimes result in a quicker recovery time.

    Some advantages of surgery for prostate cancer may include:

    • Patients with localized cancer may need no further treatment.
    • Simultaneous biopsy allows for more accurate staging.
    • Post-surgical PSA levels may more reliably predict recurrence of cancer.
    • Patients tend to experience fewer bowel or rectal side effects than with radiation treatments.
    • There’s a lower risk of urinary urgency and frequency than with radiation treatments.

    Some disadvantages may include:

    • Surgery-related risks are possible, including side effects from general anesthesia.
    • It requires an overnight hospitalization.
    • A catheter is required for one or two weeks.
    • Long-term sexual changes, including dry orgasms, pain during orgasm and shortened penis, may result.

    Radiation therapy

    Radiation therapy is administered externally or internally, killing cancer cells with high-energy rays or particles.

    External beam radiation therapy (EBRT) is used to treat both localized and advanced cancer. A machine outside the body directs radiation beams directly to the prostate for five days a week throughout several weeks. Unlike surgery, EBRT is a noninvasive treatment, which appeals to some men.  

    Internal radiation therapy delivers radioactive material via catheter or another implantable device into the prostate. Examples of internal radiation therapy include high-dose rate (HDR) brachytherapy, which delivers a high dose of radiation to the prostate in short bursts over a few minutes, and low-dose rate (LDR) brachytherapy, in which small, radioactive pellets, or seeds, are implanted in the prostate and emit low levels of radiation over several weeks.

    Some prostate cancer patients may also undergo stereotactic body radiation therapy (SBRT), which uses innovative imaging technologies to deliver high doses of radiation. Because the dose rate is high, patients typically require fewer treatments.

    Learn more about radiation therapy for prostate cancer

    Treatment options for advanced prostate cancer

    It’s rare for prostate cancer to metastasize, or spread to other parts of the body. In about 90 percent of all cases, this type of cancer is diagnosed in its early stages, when the disease is confined to the prostate. However, when the disease metastasizes, prostate cancer cells tend to spread to the brain, bones, lungs and liver. Metastatic prostate cancer cells may also be found in lymph nodes outside the pelvis.

    In some cases, the treatment options for advanced prostate cancer may be considered palliative, used to relieve symptoms and improve quality of life. Treatment options include:

    Hormone therapy

    One of the most common types of treatment for advanced cancer is hormone therapy. It’s also known as androgen suppression therapy. Many prostate cancers are fueled by male hormones, or androgens, so lowering a patient’s androgen levels may help shrink the cancer. Another form of hormone therapy requires removing the testicles, because the testicles produce testosterone—but this isn’t as common. Now, hormone therapy most commonly involves medications that lower the amount of testosterone in the body.

    Hormone therapy may cause side effects associated with low testosterone, such as hot flashes, weight gain, reduced sexual desire and depression. Eventually, the cancer may become resistant to hormone therapy. If that happens, doctors may switch the patient’s treatment type.

    Chemotherapy

    When treating prostate cancer with chemotherapy, anti-cancer drugs are either injected or taken as a pill, and they travel through the bloodstream to the cancer cells. Chemotherapy is usually given to treat cancer after hormone therapy stops working, and generally isn’t a standalone treatment.

    During chemotherapy, doctors may also offer supportive care services to help ease side effects. For example, naturopathic providers may suggest supplements to reduce nausea. Also, a mind-body therapist may recommend techniques to help the patient relax and feel less anxious during prostate cancer chemotherapy treatments.

    Learn more about side-effect management

    Targeted therapy

    Targeted therapy cancer treatments are drugs that may identify cancer cells without harming normal cells. Essentially, these new treatments change the way cancer cells function during their life cycle, while having less of an impact on a patient’s overall health and well-being than chemotherapy. These treatments for prostate cancer are oral medications, and are also known as PARP inhibitors. Some men may experience side effects such as diarrhea, nausea and low red blood cell counts.

    Immunotherapy

    Immunotherapy is a unique treatment that uses the body’s immune system to fight off cancer cells. It’s a promising treatment for prostate cancer, including advanced or recurrent forms of the disease. This treatment method may be used alone or in conjunction with other treatments such as radiation therapy and hormone therapy.