Prostate Cancer Treatment Options: Active Surveillance, Surgery, Radiation, and More
By Dr. Christopher Vendryes, MD · Board-Certified Urologist · · 5 min read
Quick answer: Prostate cancer treatment depends on risk level, which is based on PSA, Gleason score (Grade Group), and the cancer's extent. Low-risk cancer is often managed with active surveillance, regular monitoring without immediate treatment. Intermediate and high-risk cancer is usually treated with surgery (radical prostatectomy) or radiation, sometimes combined with hormone therapy. Focal therapies are options for select men. Many prostate cancers grow slowly, so there's usually time to get a second opinion and make an informed choice.
How is prostate cancer risk determined?
- PSA level
- Grade Group (Gleason score): how aggressive the cells look under a microscope, from Grade Group 1 (least aggressive) to 5
- Stage: whether the cancer is confined to the prostate or has spread
- MRI and biopsy findings, including how much of the prostate is involved
What is active surveillance?
For low-risk cancer, the risks of treatment can outweigh the benefits. Active surveillance means regular PSA tests, MRIs, and repeat biopsies, with treatment started only if the cancer shows signs of growing. It avoids or delays side effects like incontinence and erectile dysfunction. Active surveillance is now the preferred approach for most men with low-risk prostate cancer.
How do the main treatments compare?
| Active Surveillance | Radical Prostatectomy | Radiation Therapy | |
|---|---|---|---|
| Best for | Low-risk cancer | Localized intermediate and high-risk cancer | Localized intermediate and high-risk cancer |
| What it involves | Regular PSA, MRI, biopsies | Surgical removal of the prostate, often robotic | External beam or seed implants |
| Main side effects | Anxiety of monitoring | Incontinence, erectile dysfunction | Bowel and urinary irritation, erectile dysfunction |
| Recovery | None | Catheter about a week; continence improves over months | Treatments over weeks |
What about focal therapy?
Focal therapies, such as high-intensity focused ultrasound (HIFU) and cryotherapy, treat only the part of the prostate with cancer. They may reduce side effects for carefully selected men with localized disease, but long-term data is still developing.
What about hormone therapy?
Androgen deprivation therapy lowers testosterone, which fuels prostate cancer. It's often combined with radiation for higher-risk disease and is a mainstay for advanced cancer.
How do I choose?
Consider your cancer's risk, your age and health, your priorities around urinary and sexual function, and how you feel about monitoring versus treatment. Meeting with both a urologist and a radiation oncologist gives you a full picture.
What about side effects after treatment?
Incontinence and ED after treatment are treatable. Read Erectile Dysfunction Treatment Options and Urinary Incontinence Treatment.
Frequently Asked Questions
Talk to a Board-Certified Urologist
Dr. Vendryes sees patients in Plantation and across Broward and Palm Beach Counties for men's health, fertility, kidney stones, urologic cancers, and bladder problems.
References
- American Urological Association / ASTRO / SUO. Clinically Localized Prostate Cancer Guideline. 2022.
- National Cancer Institute. Prostate Cancer Treatment (PDQ).
- American Cancer Society. Treating Prostate Cancer.