Prostate Cancer Treatment Options

This page is for people with prostate cancer and their families. It gives an overview of the main treatments, from close monitoring to surgery, radiation, and hormone therapy.

Prostate cancer treatment covers a wide range. It can mean close monitoring with no active treatment. It can mean surgery. It can mean radiation or hormone therapy.

The right choice depends on your cancer's stage and grade, your age, and your own priorities. For many men, especially with lower-risk disease, more than one reasonable option exists. This decision involves your values as much as the medical facts.

For some prostate cancers, active surveillance may be an option. NCI describes it as closely following your condition without giving treatment unless test results change. Your team will tell you what monitoring involves.

Active surveillance avoids the side effects of surgery or radiation, unless there's a real reason to treat. This is not the same as doing nothing. It's a plan with regular follow-up.

Radical prostatectomy is surgery that removes the whole prostate gland. Surgeons may remove nearby lymph nodes (small glands that filter fluid) at the same time. Ask your team whether surgery is an option for your stage.

Side effects can include leaking urine and trouble with erections. Talk about this in detail before surgery. Ask what recovery looks like. Ask what support is available, like pelvic floor therapy.

External beam radiation aims high-energy beams at the prostate from outside your body. External radiation uses a machine outside the body to send radiation toward the cancer.

Brachytherapy (internal radiation) places small radioactive seeds right inside the prostate. Ask your team whether it is an option for you.

Radiation has its own possible side effects too, such as urinary and bowel changes and trouble with erections. That's another reason to have a detailed talk about what matters most to you.

Prostate cancer is often fueled by male hormones such as testosterone. Androgen deprivation therapy, or ADT, works by lowering testosterone or blocking its effects.

Doctors can do this with surgery, by removing the testicles (an orchiectomy), or with medicine. Medicines include:

• LHRH agonists stop the testicles from making testosterone.
• Antiandrogens block the action of androgens.
• Other hormone-blocking medicines are used in some cases. Ask your team which apply to you.

Hormone therapy is used for some higher-risk cancers and for cancer that has spread. Your team will explain where it fits for you.

Side effects matter here too. NCI lists hot flashes, impaired sexual function, loss of desire for sex, and weakened bones. Ask your team how they will watch for and manage them.

Sometimes prostate cancer keeps growing despite hormone therapy. Chemotherapy, which uses drugs to stop the growth of cancer cells, is one option for advanced disease.

NCI says olaparib, a PARP inhibitor, is used for prostate cancer that has spread to other parts of the body and has mutations in certain genes, such as BRCA1 or BRCA2. If your cancer is advanced, ask whether testing for these mutations is right for you.

• Is active surveillance reasonable for me? What would trigger a switch to treatment?
• If I have surgery or radiation, how long do side effects usually take to improve?
• What support is there during recovery?
• If I have hormone therapy, how long is it likely to last?
• How will you watch for and manage the longer-term effects of hormone therapy, such as weakened bones?

• National Cancer Institute — Prostate Cancer Treatment (PDQ) Patient Version.