Prostate cancer treatment often begins with careful monitoring — active surveillance or watchful waiting — and may move to surgery, radiation, hormone therapy, or other treatments as needed. Because many prostate cancers are slow growing, immediate intervention isn’t always necessary for men who have no symptoms and good overall health. Which treatment your care team may recommend depends on your age, general health, the stage and grade of the cancer, and your personal preferences. This guide explains common prostate cancer treatment options, when they are typically used, and what to discuss with your doctor.

Active Surveillance and Watchful Waiting

Active surveillance and watchful waiting are strategies for managing prostate cancer when immediate treatment may not be necessary. Active surveillance is an organized program of tests to monitor low-risk disease closely; watchful waiting focuses on managing symptoms in men who are unlikely to benefit from curative treatment because of limited life expectancy or other health problems.

Typical monitoring in active surveillance includes regular exams and tests to detect changes in the cancer so treatment can start if needed. Common tests include:

  • Digital rectal exams (DRE) at regular intervals
  • Transrectal ultrasounds when indicated
  • Prostate-specific antigen (PSA) tests — often every 3–6 months at first
  • Prostate biopsies on a schedule determined by your team (and MRI‑targeted biopsies when available)

Many clinics now also use multiparametric MRI and, in some cases, genomic tests to refine monitoring and help decide whether treatment is needed. Discuss availability of these tests with your team. In watchful waiting, the focus is on tracking prostate cancer symptoms rather than routine testing. The goal is to treat symptoms (for example pain or urinary blockage) if and when they occur, rather than to cure the disease.

When might monitoring change to active treatment? Common triggers include:

  • New or worsening prostate cancer symptoms such as blood in the urine, worsening urinary obstruction, or bone pain
  • Evidence of cancer growth on repeat biopsy (higher Gleason/grade)
  • Sustained rise in PSA or a rapid PSA velocity

Example scenarios:

  • A man in his 70s with low‑grade, localized prostate cancer and other health problems may choose watchful waiting to avoid repeated tests and invasive treatments.
  • A younger man with low‑risk cancer might choose active surveillance (regular PSA, MRI, and periodic biopsy) to delay or avoid surgery or radiation while keeping curative options open.

Talk with your care team about the monitoring schedule that fits your situation. Ask whether multiparametric MRI or genomic testing could improve your diagnosis and help refine treatment decisions, and whether a clinical trial is an option for you.

You and your doctor will decide which of the following treatments are best for you.

How Is Prostate Cancer Treated?

Surgery for Prostate Cancer

If prostate cancer is confined to the prostate gland, surgical removal (a prostatectomy) is a common curative option. Surgery aims to remove the tumor and any nearby tissue that might harbor cancer, including lymph nodes when indicated.

  • Radical prostatectomy — removal of the prostate through an abdominal incision; lymph nodes may be sampled or removed to check for spread in the lymphatic system.
  • Radical retropubic prostatectomy — prostate plus surrounding tissues and seminal vesicles are removed via a lower abdominal incision.
  • Radical perineal prostatectomy — done through an incision between the scrotum and anus; shorter operation but less often used because of potentially higher risk of erectile dysfunction.
  • Laparoscopic (including robotic) prostatectomy — minimally invasive approach using small incisions and fiber-optic instruments; often associated with less pain, shorter hospital stays, and faster recovery for many patients.

When surgery is recommended:

  • Localized cancer (confined to the prostate) in men who are healthy enough for an operation.
  • Intermediate- or high-risk disease where removing the prostate offers a chance for cure.

Recovery and common side effects: Recovery timelines vary, but many men leave the hospital within 1–3 days for minimally invasive procedures and a bit longer for open surgery. Major possible side effects include erectile dysfunction, urinary incontinence, and loss of fertility. Ask about nerve-sparing techniques, pelvic-floor therapy, and sexual-rehabilitation options to reduce and manage these risks.

Radiation Therapy for Prostate Cancer

Radiation therapy uses focused high-energy rays or radioactive substances to destroy cancer cells and is a common curative or palliative option. Methods include:

  • External beam radiation — a machine outside the body directs beams at the prostate; schedules range from daily sessions over several weeks to shorter, higher-dose regimens (hypofractionation) depending on clinical factors.
  • Internal radiation (brachytherapy) — radioactive seeds or pellets are placed in or near the prostate to deliver a high, localized dose while sparing surrounding tissue.
  • Radiopharmaceuticals (systemic) — radioactive drugs injected into the bloodstream that target cancer cells in bones or other sites; these are often used for metastatic disease to reduce pain and tumor burden.

Radiation is frequently chosen when the cancer is isolated to the prostate, when cancer remains after surgery, or as part of combined therapy for higher‑risk disease. Hormone therapy is often given alongside radiation when the cancer has higher risk features.

Side effects from radiation can include fatigue, skin irritation, erectile dysfunction, and urinary or bowel problems. There is some evidence of a small increased long-term risk of secondary cancers in nearby tissues; discuss absolute risk with your radiation oncologist.

Hormone Therapy for Prostate Cancer

Hormone therapy reduces or blocks male sex hormones (androgens) such as testosterone that fuel prostate cancer cells. It is used to shrink tumors before other treatments, to treat cancer that has spread beyond the prostate, and to control disease that has recurred.

Hormone therapy is commonly combined with radiation for intermediate- and high-risk disease and is a mainstay of treatment for metastatic prostate cancer. Discuss timing and expected duration with your oncologist because side effects and bone health implications vary with length of treatment.

Deciding between surgery and radiation often depends on cancer stage and grade, patient age and comorbidities, and priorities around urinary, sexual, and fertility outcomes. For example, a man with localized intermediate‑risk prostate cancer may choose surgery, radiation plus hormone therapy, or enrollment in a clinical trial — each option has different tradeoffs in terms of cure probability and side effects.

Ask your provider about second opinions, fertility preservation (if relevant), and rehabilitation services such as pelvic-floor exercises and sexual-medicine referrals to help manage life-changing side effects. Hormone therapy treatments reduce or block the male hormones that help prostate cancer cells grow. These approaches can shrink tumors before other treatments, control disease that has spread outside the prostate, or manage recurring cancer.

  • Drugs that reduce androgen production in the testicles (medical castration)
  • Drugs that block the action of testosterone and other androgens throughout the body (androgen receptor blockers)
  • Drugs that prevent the adrenal glands from making androgens

Medications used in hormone therapy for prostate cancer (medical castration) act on the pituitary–testicle axis to lower androgen production. Commonly used luteinizing hormone–releasing hormone (LHRH) agonists and antagonists approved in the United States include:

  • goserelin (Zoladex)
  • histrelin (Vantas)
  • leuprolide (Lupron)
  • triptorelin (Trelstar)

Androgen receptor blockers (which prevent testosterone from stimulating cancer cell growth) and newer oral agents are used for many stages of prostate cancer. Examples include:

  • apalutamide (Erleanda)
  • bicalutamide (Casodex)
  • darolutamide (Nubega)
  • enzalutamide (Xtandi)
  • flutamide
  • nilutamide (Nilandron)

Androgen synthesis inhibitors block androgen production throughout the body. Examples include:

  • abiraterone (Yonsa, Zytiga)
  • aminoglutethimide
  • ketoconazole

Surgical castration (orchiectomy) is another hormone‑lowering option that removes one or both testicles and rapidly reduces testosterone levels.

Hormone therapy side effects can significantly affect quality of life and include lower libido and erectile dysfunction, weakened bones, loss of muscle mass, hot flashes, gastrointestinal issues, and breast growth. Discuss bone‑protecting strategies (calcium, vitamin D, bisphosphonates or denosumab) and regular monitoring with your provider.

Other Prostate Cancer Treatments

When cancer progresses despite hormone therapy or when disease is metastatic, several additional cancer treatment options are available. Each has different goals, from symptom control to extending life.

Chemotherapy uses drugs that travel through the bloodstream to kill cancer cells. Common agents for advanced prostate cancers include docetaxel (Taxotere) and cabazitaxel (Jevtana), typically given intravenously on scheduled cycles. Side effects can include hair loss, digestive issues, fatigue, and increased infection risk. Discuss expected schedules and supportive care (anti-nausea, growth factors) with your oncologist.

Immunotherapy aims to harness the body’s immune system to attack cancer cells. Sipuleucel‑T (Provenge) is an FDA‑approved vaccine for certain advanced prostate cancers; checkpoint inhibitors such as pembrolizumab (Keytruda) may be effective in selected patients with specific biomarkers. Immunotherapy is an active area of clinical trials — ask whether a trial is appropriate for you.

Cryotherapy and high‑intensity focused ultrasound (HIFU) are less invasive local treatments that destroy prostate tissue with cold or focused energy, respectively. They may be options for localized recurrences or in centers offering these therapies, but are generally not first‑line for most newly diagnosed prostate cancer.

Targeted drug therapy includes PARP inhibitors (olaparib/Lynparza, rucaparib/Rubraca, talazoparib/Talzenna) that may work for men whose tumors have certain DNA‑repair gene changes (for example BRCA1/2). Genetic testing of the tumor or blood can identify eligibility for these agents or for relevant clinical trials.

Bone‑directed therapy is important for men with prostate cancer that has spread to the bones. Bisphosphonates such as zoledronic acid (Zometa) and the RANKL inhibitor denosumab (Xgeva) can reduce bone loss, relieve pain, and lower fracture risk. Your team may recommend these drugs when metastatic prostate cancer involves bone or when long‑term hormone therapy weakens bones.

Because treatments and indications change, ask your provider about current clinical trials and whether molecular testing or trial enrollment could improve your prognosis or access to newer targeted therapies. Clinical trials are an important option for men with advanced or treatment‑resistant disease.

Choosing the Right Prostate Cancer Treatment

Deciding among treatment prostate cancer options involves weighing the cancer’s stage and grade, your age and overall health, and your priorities about urinary, sexual, and long‑term quality of life. Your doctor may recommend a single approach or a combination of surgery, radiation therapy, hormone therapy, or other treatments depending on risk and goals of care.

  • For low‑risk disease, active surveillance is often appropriate to avoid overtreatment.
  • For localized intermediate‑ or high‑risk disease, surgery or radiation (often with hormone therapy) are common curative options.
  • For metastatic prostate cancer or disease that has spread outside the prostate, systemic treatments (hormone therapy, chemotherapy, targeted drugs, or radiopharmaceuticals) and clinical trials may be recommended.

Practical next steps: discuss risks and expected changes in function with your care team, consider a second opinion for major decisions, ask about fertility preservation if relevant, and inquire about clinical trials and supportive care resources to help maintain quality of life.

Talk with your care team — they can help match treatment options to your stage prostate findings and life goals, explain potential side effects, and connect you with trials or supportive services.