What Are The Treatment Options for Prostate Cancer?

(Read time: 8 minutes) 

This article is not intended to replace professional medical care or advice. If you have any questions or need additional information, please talk with your doctor. 

Receiving a prostate cancer diagnosis can be overwhelming and frightening. Fortunately, prostate cancer is treatable if caught early enough.  

If you or a loved one has been diagnosed, it’s important to discuss which treatment option has the best chance of eliminating the cancer and preserving your quality of life in the years following treatment.  

It’s very important to get a second opinion in order to assess all available treatment options and potential outcomes.  

Newly diagnosed patients are encouraged to consult physicians with multiple specialties, such as radiation oncologists and urologists, who can provide unique perspectives and opinions that aid in the creation of a comprehensive treatment plan. 

What are the most common treatment options for prostate cancer? 

For most men diagnosed with prostate cancer, the most common treatment options are:  

• radiation therapy 
• active surveillance 
• surgery (a prostatectomy) 

Additional prostate cancer treatments include cryotherapy, hormone therapy, chemotherapy, and immunotherapy. 

Download a prostate cancer treatment discussion guide

Treatment decisions are based on a combination of clinical factors such as the stage and grade of cancer, your age, overall health, and the risks and benefits associated with each treatment option.  

It’s important to understand that different facilities will have different medical equipment. For example, some facilities may have proton centers, while others may be equipped with stereotactic body radiation therapy (SBRT). Regional availabilities should always be taken into consideration. 

With that in mind, let’s take a look at each of the three most common treatment options for prostate cancer, along with their potential side effects. 

What is radiation therapy treatment for prostate cancer? 

Radiation therapy is a common treatment for low-grade prostate cancer that remains within the prostate, according to the American Cancer Society. It can also be an effective treatment for more advanced types of prostate cancer. 

Radiation therapy is often used to treat stage 1 and stage 2 prostate cancer, and can often complement other treatment options (like hormone therapy or surgery) if the cancer has spread beyond the prostate and is stage 3 or above. 

There are two main types of radiation therapy: 

1. External beam radiation 

When undergoing external beam radiation, a machine shoots targeted, high-energy beams of radiation at your prostate gland (from outside your body). The advantages of this type of radiation are: 

• It’s non-invasive and the procedure itself is painless.
• The treatment should take less than 20 minutes and you come and go as an outpatient.
• Newer techniques and technologies allow more radiation to target the cancer, while limiting exposure to healthy tissues nearby. 
• Treatment success rates can be as high as 95% for intermediate-risk prostate cancer and 91% for high-risk prostate cancer, according to the Journal of Medical Imaging and Radiation Oncology.  

That being said, external beam radiation can lead to various side effects, including but not limited to: 

• Bowel dysfunction 
• Urinary dysfunction 
• Erectile dysfunction 
• Lethargy 
• Lymphedema 

2. Brachytherapy (internal radiation) 

There are two types of brachytherapy: low-dose rate (LDR) and high-dose rate (HDR). Which type of brachytherapy you may receive depends on your specific situation. 

With LDR brachytherapy, small seeds of radioactive pellets are placed into your prostate. Sometimes, the radioactive pellets are left in position permanently. Depending on the facility, a radiation oncologist and urologist will perform this procedure together and patients go home the same day. 

With HDR brachytherapy, multiple catheters attached to a single radioactive source is placed temporarily into the tumor for a few minutes and then removed. Tumors can be treated with very precise doses of localized radiation, which reduces the risk to surrounding healthy tissues.   

The advantage of brachytherapy is that it has relatively high precision because the pellets can be placed in a very targeted manner. It also has a rapid fall-off in dose, which helps spare adjacent organs from the effects of unwanted radiation. 

The side effects patients receiving brachytherapy may experience are similar to those from external beam radiation. 

Newer technologies reduce the risk of radiation therapy side effects

Although radiation therapy can be a very effective treatment option for many types of prostate cancer, the potential side effects can affect a patient’s quality of life. 

Fortunately, advanced techniques and innovative products are helping mitigate the side effects of prostate cancer treatments like radiation therapy.  

As an example, the rectum may be left vulnerable and exposed to radiation intended to target the prostate during external beam and brachytherapy radiation treatments. This exposure can lead to several side effects, including bowel, urinary, and sexual problems. 

SpaceOAR Hydrogel works to help combat these side effects by acting as a spacer between the rectum and prostate. The water based gel is a pre-treatment option that stays in place during radiation treatment and is absorbed by the body about 6 months after placement. 

Consider the following results at median 3-year follow-up from patients who received SpaceOAR hydrogel in a clinical study:  

• Bowel dysfunction: Compared to the control group, 66% of patients were able to avoid clinically significant declines in bowel function. 

• Urinary dysfunction: Compared to the control group, 66% of patients were able to avoid clinically significant declines in urinary function. 

• Sexual dysfunction: SpaceOAR patients were 78% more likely to retain sexual function three years after treatment if they had erections sufficient for sex before treatment compared to control patients.  

If you’d like to learn more about how SpaceOAR Hydrogel works, click here. 

What is active surveillance for prostate cancer? 

Active surveillance for prostate cancer involves regular checkups and monitoring of low-grade prostate cancers that have Gleason scores of 6 or less. Active surveillance may be a good option* if you: 

• Are risk averse: Active surveillance is a low-risk treatment option for prostate cancer.  

• Want to avoid potential treatment side effects altogether: Since you aren’t actively treating the cancer, you won’t have to deal with treatment-related side effects. 

• Are older or have other serious health problems: In such cases, an invasive procedure such as surgery may not be as attractive a treatment option, especially with slow-growing cancer. 

*While active surveillance is usually discussed alongside treatment options for prostate cancer, it is technically just a monitoring method, not a treatment. 

If your healthcare team recommends active surveillance, then your doctor will closely monitor your prostate cancer with routine ultrasounds, digital rectal exams (DREs) and prostate-specific antigen (PSA) blood tests every few months. 

A repeat prostate biopsy may also be conducted after one year to ensure that the cancer is not spreading or becoming more aggressive. Notable developments, such as rising PSA levels, may warrant looking into other treatment options. 

Some patients who have decided to monitor their cancer and wait to see what happens have been able to enjoy life for decades without incident. That being said, active surveillance is not for everybody, so consider what the tradeoffs may be and talk to your doctor to see if it’s the right fit. 

What is surgery for prostate cancer (a prostatectomy)? 

A prostatectomy, or the surgical removal of the prostate, is a common treatment plan for low-grade prostate cancer that has not spread beyond the prostate because it involves physically removing as much of the cancer as possible. 

There are three major types of surgery for prostate cancer: 

1. Radical retropubic prostatectomy

In this type of prostatectomy, the surgeon makes an incision in the abdomen and removes the prostate gland directly. This is the more common option because the surgeon can remove nearby lymph nodes as well if there’s concern the cancer could spread. 

After surgery, you’ll stay in the hospital for a few days, and activity will be limited for a few weeks during recovery.  

2. Radical perineal prostatectomy

Radical perineal prostatectomy is typically the shorter and less painful of the two open procedures. This less common type of prostatectomy involves the surgeon making an incision between the scrotum and anus and removing the prostate gland. 

While this operation is faster, it’s used less often because the potential for erectile dysfunction is higher and lymph nodes cannot be removed in this manner.  

For this type of procedure, a hospital stay of a few days followed by limited activity for several weeks during recovery is standard. 

3. [Robot-assisted] Laparoscopic radical prostatectomy

A more advanced prostatectomy involves manually guiding telescopic surgical instruments and a camera through ports in the stomach to the surgical site. The surgeon is able to perform the prostatectomy without major incisions, compared to the other methods. There is also a robot-assisted version of this procedure (RALP). 

It’s important to note that, as with radiation therapy, all types of surgery can lead to side effects, including erectile dysfunction and urinary dysfunction. 

Other possible side effects of a prostatectomy include but are not limited to: 

• Not reacting well to anesthesia 
• Excessive bleeding as a result of surgery 
• Blood clots as a result of surgery 
• Nearby organs damaged 
• Surgery site infections 

No matter the treatment, consider getting a second opinion 

The importance of doing your own due diligence and getting a second and even third opinion cannot be overstated. 

It’s not so much that any one doctor could be wrong about their diagnosis and assessment. You simply need all the resources and expertise you can get to reach an unbiased and informed decision on how to best move forward with your treatment. 

That means forming a team of doctors—almost like a health panel—who are all looking out for your best interests. Patients are also advised to use outside resources, such as family, friends, and patient advocacy and support groups to assist in the decision-making process. 

It’s never easy making such life-changing decisions. But by educating yourself, assessing your situation, exploring all options (including new techniques and technologies), and talking with medical professionals and loved ones, you can make the right choice. 

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