What Are the Most Effective Treatment Options for Prostate Cancer?

People with prostate cancer have many treatment options available — including radiation therapy and surgery — and often have time to decide their best option. Treatment may not even be needed right away as the tumor is often slow growing.

“Healthy men diagnosed with early-stage prostate cancer have a long natural life expectancy. For many patients, a prostate cancer diagnosis does not require urgent, immediate treatment decisions,” says Ramsey Chichakli, MD, a urologist at Scripps Cancer Center and Scripps Clinic.

“Men who have just been diagnosed can often take time to make thoughtful decisions about how to proceed, based on factors like their age and overall health, lifestyle and goals. This is not a one-size-fits-all diagnosis,” Dr. Chichakli says.

A physician will help patients weigh the risks and benefits of any prostate cancer treatment approach.

For men diagnosed at an early stage, options include active surveillance, traditional or minimally invasive surgery and radiation treatment.

All curative treatment options are similarly effective, according to Dr. Chichakli. A patient's choice often comes down to which potential treatment side effects he may be most willing to risk.

Sometimes called “watchful waiting,” active surveillance involves several visits per year to the physician for blood tests and examinations that monitor the growth of prostate cancer.

PSAs, imaging, and occasional biopsies are used to monitor the tumor. Each biopsy carries the low but real risks of any procedure, including discomfort, bleeding or infection.

Treatment is deferred until or unless the tumor changes from slow growing to more aggressive cancer.

Men who choose active surveillance may have underlying health issues that make treatment difficult, or may not want to risk the undesirable potential side effects of treatment.

If a prostate tumor’s growth rate is significantly driven by the hormone testosterone, drugs can be used to delay or slow its growth, or even shrink the tumor in some cases.

Hormone treatment is minimally invasive. It may be used in men who have health issues that preclude surgery or radiation or in cases where the cancer has spread outside the prostate. It is an active intervention, as opposed to mere surveillance.

Potential side effects are hot flashes, loss of libido and loss of bone mass. It is not curative; it only slows the progression of cancer.

Depending on the stage, size and nature of the tumor, a surgeon may remove the prostate through either a traditional open surgery, or more commonly now through a minimally invasive robotic approach.

Any surgery carries risks, including bleeding and infection, and risks from general anesthesia. Prostate surgery carries specific risks, including loss of continence and/or erectile function.

With minimally invasive or robotic-assisted surgery, recovery is quicker, hospital stay is shorter and surgical risks are lower.

Radiation treatment for prostate cancer takes many forms, including internal and external methods. It is best suited to men whose cancer is confined to the prostate and has not spread to the neighboring lymph nodes.

Though it is a noninvasive treatment, radiation therapy may cause side effects in some patients, usually depending on the location of the cancer, radiation dose and general health. For example, the bladder and rectum are near the prostate and could become irritated during radiation.

Other side effects may include fatigue. In a worst-case scenario, X-ray radiation may cause urinary or bowel irritation.

Advancements have made radiation therapy safer and more effective. At Scripps, radiation therapy treatments for prostate cancer target the cancer while minimizing radiation exposure to nearby areas.