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Prostate cancer treatment options

This page was reviewed under our medical and editorial policy by
Maurie Markman, MD, President, Medicine & Science at CTCA.

This page was updated on June 21, 2022.

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

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.

Common side effects of radiation therapy for prostate cancer include:

  • Increased urge to urinate or more frequent need to urinate
  • Sexual function problems such as loss of desire, erectile dysfunction, dry orgasm and penis shrinkage
  • Bowel problems such as diarrhea, rectal discomfort or rectal bleeding
  • Fatigue

Most patients find their side effects ease or stop after treatment.

Prostate cancer treatments by stage

Stage 1 prostate cancer

Stage 1 is the lowest prostate cancer stage. In this stage, prostate cancer is most likely slow growing. The patient may have a small tumor that can’t be felt by touch and that involves half or less than half of one side of the prostate. The prostate cancer cells don’t look very different from healthy cells. PSA levels are on the low side. If there are no other serious health issues that could limit lifespan, the doctor may recommend active surveillance or watchful waiting for low-risk prostate cancer. PSA testing may be needed about every six months, and digital rectal exams (DREs) may be recommended at least annually. Radiation therapy (external beam or brachytherapy) or surgery to remove the prostate may also be options, but these treatments typically cause side effects.

Stage 2 prostate cancer

Stage 2 prostate cancer is confined to the prostate gland. PSA levels are in the low-to-medium range. While the cancer is small, it’s at increased risk of growing larger and spreading outside the prostate. Stage 2 is divided into three stages: 2A, 2B and 2C. The higher the stage (stage 2C is higher than 2B, for example), the more differentiated (abnormal) the cancer cells and the more easily it can be felt during a digital rectal exam. Stage 2 is low risk, and men in the low-risk group also have a choice of active surveillance (also known as watchful waiting) or a more aggressive treatment, including radiation therapy and surgery to remove the prostate. Observation may be recommended for those whose cancer isn’t causing symptoms or who don’t have any other serious health issues.

Stage 3 prostate cancer

Stage 3 prostate cancer involves a tumor that’s grown and is locally advanced. Stage 3 is also divided into 3A, 3B and 3C. The higher the stage, the more it’s spread to nearby structures such as the seminal vesicles, the bladder and rectum. In stage 3, cancer cells look different from healthy prostate cells. Stage 3 is intermediate risk, and those with intermediate risk are typically offered radiation therapy or a radical prostatectomy with a pelvic lymph node dissection. Some in this group may be given the option of active surveillance, but there is a slightly higher risk of the cancer spreading without radiation therapy or surgery. If the patient has other life-threatening health issues, he may choose observation instead of an aggressive treatment.

Stage 4 prostate cancer

Stage 4 is the most advanced stage, when the cancer is no longer confined to the prostate. In stage 4A, the cancer has spread to lymph nodes in the region. In stage 4B, it’s spread to distant lymph nodes and elsewhere in the body, and possibly to the bones. Men with stage 4 prostate cancer are in a high-risk group and likely require more aggressive treatment.

Treatment options for advanced prostate cancer (stage 4)

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 prostate 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 be given to men with locally advanced prostate cancer for up to six months before radiation therapy. They may be given hormone therapy along with radiation therapy and afterward for up to 36 months.

Some studies show that hormone therapy may be more helpful in preventing death from locally advanced prostate cancer when it’s given for 18 months instead of six months. Other research found that life expectancy was the same whether men were given hormone therapy for 18 or 36 months, but some who were given therapy for 18 months reported a better quality of life.

Prostate cancer is usually more responsive to hormone therapy in its earlier stages, when hormones are needed for it to grow.

Side effects of hormone therapy

Hormone therapy may cause side effects associated with low testosterone, such as hot flashes, sweating, weight gain, reduced sexual desire and depression. Some men also may experience swollen breasts, depression, memory loss and heart problems. Eventually, the cancer may become resistant to hormone therapy. If  hormone therapy stops working, doctors may switch treatments.

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.

Side effects of chemotherapy

Side effects of chemotherapy are common and may include:

  • Hair loss
  • Mouth sores
  • Decreased appetite
  • Digestive issues such as nausea, vomiting and diarrhea

While on chemotherapy, patients are also susceptible to infections because their white blood cell counts are lower. Other common side effects include bruising or bleeding due to fewer blood platelets and fatigue due to the lowered red blood cell count.

It’s also possible to experience a severe allergic reaction to some of the drugs used to treat prostate cancer, especially Taxotere® (docetaxel) and Jevtana® (cabazitaxel). The patient’s care team may recommend medicines before each session to help prevent a reaction.

The prostate chemotherapy drug mitoxantrone may cause leukemia later in life, but this is rare. The prostate chemotherapy drug Emcyt® (estramustine) may increase the risk for blood clots.

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.

Side effects of targeted therapy

Some men may experience side effects such as diarrhea, nausea and low red blood cell counts. Other possible side effects include:

  • Fatigue
  • Loss of appetite
  • Constipation
  • Cough
  • Shortness of breath
  • Skin rash

Liver blood tests may also be abnormal.

One of the targeted therapies for prostate cancer, Lynparza® (olaparib), may increase the risk for blood clots in the lungs and legs. These drugs may also cause a blood cancer such as myelodysplastic syndrome or acute myeloid leukemia, but this is rare.

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.

A cancer vaccine and immune checkpoint inhibitors have also been used when men with advanced prostate cancer no longer respond to hormone therapy, but show few or no symptoms.

Each vaccine is made specifically for the patient. A special machine is used to remove white blood cells (which are part of the immune system) from the blood. This procedure may take several hours. White blood cells are sent to a lab to be mixed with a protein (prostatic acid phosphatase) that protects the body against prostate cancer. The vaccine is then given to the patient by infusion. The process is repeated twice, two weeks apart for a total of three doses. This vaccine may help the immune system attack the prostate cancer. The vaccine may help men live longer, but it hasn’t been shown to stop the growth of cancer.

Immune checkpoint inhibitors are another way of using the immune system to prevent prostate cancer from growing. Checkpoint inhibitors may be used in men whose prostate cancer cells have tested positive for specific gene mutations and whose cancer recurs after being treated with chemotherapy or has spread throughout the body. They are called “checkpoints” because they act like switches that turn on a signal allowing an immune response in cells. They also may be designed to turn off an immune response.

Side effects of immunotherapy

Side effects of immunotherapy may include:

  • Fatigue
  • Nausea
  • Loss of appetite
  • Joint pain

Diarrhea, skin rash and itching are also possible.

When the immune system attacks other parts of the body, rare serious side effects may develop, such as problems in the lungs, gastrointestinal tract, kidneys and hormone-producing glands.

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