There are many different ways to treat prostate cancer. The treatment is determined by how advanced the cancer is, whether it has spread outside the prostate, and your overall health.

Active surveillance

Prostate cancer grows very slowly. This means that you can live a full life without ever needing treatment or experiencing symptoms. If your doctor believes the risks and side effects of treatment outweigh the benefits, they may recommend active surveillance. This is also called watchful waiting or expectant management. Your doctor will closely monitor the cancer’s progress with blood tests, biopsies, and other tests. If its growth remains slow and doesn’t spread or cause symptoms, it will not be treated.

Surgery

Surgical treatments for prostate cancer include the following:

Radical prostatectomy

If cancer is confined to the prostate, one treatment option is radical prostatectomy. During this procedure, the prostate gland is completely removed. This can be performed in several ways:

  • Open surgery: The surgeon makes a large incision in the abdomen or perineum to access the prostate. The perineum is the area between the rectum and the scrotum.
  • Laparoscopic surgery: The surgeon uses several specialized cameras and tools to see inside the body through small incisions.
  • Robotic-assisted laparoscopic surgery: The surgeon controls very precise robotic arms to perform laparoscopic surgery. 

Laparoscopic surgery is less invasive. However, open surgery allows doctors to examine nearby lymph nodes and other tissues for evidence of cancer.

Loss of the prostate will decrease the amount of fluid in male ejaculate. Men who undergo prostatectomy may experience “dry orgasm” with no emission. However, sperm are still produced in the seminal vesicles.

Cryosurgery

In this procedure, your doctor will insert probes into the prostate. The probes are then filled with very cold gases to freeze and kill cancerous tissue.

Both cryosurgery and radical prostatectomy are usually done under general anesthesia or epidural anesthesia. General anesthesia puts you to sleep during the surgery. Epidural anesthesia numbs a large area of your body with drugs injected into the spinal canal.

Possible side effects of cryosurgery and prostatectomy are urinary incontinence and impotence. The nerves that affect the ability to control urine and get an erection are close to the prostate. These nerves can be damaged during surgery.

Transurethral resection of the prostate (TURP)

During this surgical procedure, your doctor will insert a long, thin scope with a cutting tool on the end into the urethra. They will use this tool to cut away prostate tissue that’s blocking the flow of urine. TURP cannot remove the entire prostate. However, it can be used to relieve urinary symptoms in men with prostate cancer.

Radiation therapy

Radiation therapy kills cancer cells by exposing them to controlled doses of radioactivity. Radiation is often used instead of surgery in men with early-stage prostate cancer that has not spread to other parts of the body. Doctors can also use radiation in combination with surgery. This helps ensure all cancerous tissue has been removed. In advanced prostate cancer, radiation can help shrink tumors and reduce symptoms.

There are two main forms of radiation therapy:

External radiation

External radiation is delivered from outside the body during a series of treatment sessions. There are many different kinds of external radiation therapy. They may use different sources of radiation or different treatment methods. The goal is to target only the cancerous area and spare healthy tissue.

Internal radiation (also called brachytherapy)

Internal radiation involves surgically implanting tiny packets of radioactive material called seeds into the cancerous prostate tissue. The seeds give off radiation for several months, killing the cancer cells.

The most common side effects of all radiation therapy are fatigue and bowel or urinary problems like diarrhea and painful urination. Damage to the tissues surrounding the prostate can also cause bleeding. Impotence is less common and usually temporary. Internal radiation therapy can also cause temporary urinary incontinence.

Hormone therapy

Androgens, or male hormones such as testosterone, cause prostate tissue to grow. Reducing the body’s production of androgens can slow the growth and spread of prostate cancer or even shrink tumors.

Hormone therapy is commonly used when:

  • prostate cancer has spread beyond the prostate
  • radiation or surgery aren’t possible
  • prostate cancer recurs after being treated another way

Hormone therapy cannot cure prostate cancer. But it can significantly slow or reverse its progress.

The most common type of hormone therapy is a drug or combination of drugs that affects androgens in the body. The classes of drugs used in prostate cancer hormone therapy include:

  • Luteinizing hormone-releasing hormone (LHRH) analogs, LHRH agonists, and LHRH antagonists, which prevent the testicles from making testosterone.
  • Antiandrogens, which block the action of androgens in the body.
  • Other androgen-suppressing drugs, which prevent the adrenal glands from making testosterone.

Another hormone therapy option is the surgical removal of the testicles, called orchiectomy. This procedure is permanent and irreversible, so drug therapy is much more common.

Possible side effects of hormone therapy include:

  • loss of sex drive
  • impotence
  • hot flashes
  • anemia
  • osteoporosis
  • weight gain
  • fatigue

Chemotherapy

Chemotherapy is the use of strong drugs to kill cancer cells. It’s not a common treatment for prostate cancer. However, it can be used if cancer has spread throughout the body and hormone therapy has been unsuccessful.

Chemotherapy drugs for prostate cancer are usually given intravenously. They can be administered at home, at a doctor’s office, or in a hospital. Like hormone therapy, chemotherapy cannot cure prostate cancer at this stage. Rather, it can shrink tumors, reduce symptoms, and prolong life.

Possible side effects of chemotherapy include:

  • fatigue
  • hair loss
  • loss of appetite
  • nausea
  • vomiting
  • diarrhea
  • reduced immune system function

Immunotherapy

Immunotherapy is one of the newer forms of cancer treatment. It uses your own immune system to fight tumor cells. Samples of your white blood cells are exposed to proteins that are present in prostate tissue. The white cells remember the protein and are able to react to it and destroy cells that contain that protein. These white cells are then injected into the body and are able to target the tumor tissue and attack it.

High-intensity focused ultrasound (HIFU)

High-intensity focused ultrasound (HIFU) is a new cancer treatment that’s being studied in the United States. It uses focused beams of high-frequency sound waves to heat up and kill cancer cells. This method is similar to radiation therapy, but doesn’t use radioactive materials.

Your doctor and healthcare team will help you determine which of these prostate cancer treatments is right for you. Factors include the stage of your cancer, the extent of the cancer, the risk of recurrence, as well as your age and overall health.