Prostate cancer treatment

This page was reviewed under our medical and editorial policy by

Maurie Markman, MD, President, Medicine & Science

This page was updated on September 12, 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.

Localized prostate cancer means that the cancer cells are contained within the prostate gland, while 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 U.S. Centers for Disease Control and Prevention. Identifying the type of prostate cancer is critical to determining the treatment options available.

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.

Factors to consider when speaking with the care team about treatment options include:

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

Treatment for localized prostate cancer

After a patient has been diagnosed with localized prostate cancer, the following approaches and treatments may be options to consider.

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

Other treatment options may be considered if a patient’s PSA levels rapidly increase, he develops new symptoms, or his doctor finds 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.

Prostate cancer 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, a type of robot-assisted surgery, allows the surgeon to perform this procedure using a minimally invasive approach with greater precision.

The two options are 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 therapy.
  • It carries a lower risk of urinary urgency and frequency than radiation therapy.

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 may result, including dry orgasms, pain during orgasm and shortened penis.

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 localized and advanced cancer. A machine outside the body directs radiation beams directly to the prostate for five days a week over several weeks. Unlike surgery, EBRT is a noninvasive treatment.  

Internal radiation therapy delivers radioactive material via catheter or another implantable device into the prostate. One example of internal radiation therapy is high-dose rate (HDR) brachytherapy, which delivers a high dose of radiation to the prostate in short bursts over a few minutes. Another is 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.

Side effects of radiation therapy for prostate cancer

Radiation therapy may lead to side effects, including:

  • 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.

Learn more about radiation therapy for prostate cancer

Prostate cancer treatments by stage

Stage 1 prostate cancer treatment

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 care team 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 may also be options, but these treatments typically cause side effects.

Stage 2 prostate cancer treatment

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 may choose active surveillance (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 treatment

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 prostate cancer poses intermediate risks, and patients are typically offered radiation therapy or a radical prostatectomy with a pelvic lymph node dissection. Some men 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 treatment

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.

Learn more about treating metastatic prostate cancer

Expert cancer care

is one call away.
appointments in as little as 24 hrs.

Show references
  • American Society of Clinical Oncology (2021, September). Prostate Cancer: types of treatment.
  • American Society of Clinical Oncology (2021, September). Prostate Cancer: Coping with Treatment.
  • American Society of Clinical Oncology (2021, September). Prostate Cancer: Stages and Grades.
  • American Cancer Society (2022, January). Initial Treatment of Prostate Cancer, by Stage and Risk Group.
  • American Cancer Society (2019, August). Observation or active surveillance for prostate cancer.
  • Denham JW, Joseph D, Lamb DS, Spry NA, Duchesne G, Matthews J, et al. (2019). Short-term androgen suppression and radiotherapy versus intermediate-term androgen suppression and radiotherapy, with or without zoledronic acid, in men with locally advanced prostate cancer. The Lancet Oncology.
  • Nabid A, Carrier N, Martin AG, Bahary JP, Lemaire C, Vass S, et al. (2018). Duration of Androgen Deprivation Therapy in High-risk Prostate Cancer: A Randomized Phase III Trial. European Urology.
  • Prostate Cancer UK (2019, November). Treatments, Hormone therapy.
  • National Cancer Institute (2021, February). Hormone Therapy for Prostate Cancer.
  • American Society of Clinical Oncology (2021, September). Prostate Cancer: types of treatment.
  • American Cancer Society (2019, August). Chemotherapy for Prostate Cancer.
  • American Cancer Society (2020, June). Targeted Therapy for Prostate Cancer.
  • American Cancer Society (2019, August). Immunotherapy for Prostate Cancer.