Prostate cancer treatment options will vary based on the stage of the cancer, as well as other factors. Options may include active surveillance, radiation, and surgery.

About 1 in 8 men in the United States will receive a diagnosis of prostate cancer in their lifetime. Many treatments are available for prostate cancer, but the best treatment for you will depend on what stage of cancer you have, how aggressive it is, and other factors, such as your age.

Prostate cancer is very treatable and has a 5-year relative survival rate of almost 98%, which means that someone with prostate cancer is 98% as likely to survive for 5 years as someone without the disease.

Before starting treatment, it’s important to discuss your options with your doctor. Some treatments are more aggressive than others, and most will have side effects.

Let’s learn more about your treatment options and how you can best weigh the pros and cons of each.

Each prostate cancer treatment option comes with benefits and risks. There’s rarely only one correct option.

When recommending treatments, doctors will consider factors such as:

  • the stage of prostate cancer you have
  • your age
  • how quickly the cancer is predicted to grow
  • whether you have other health conditions, such as diabetes or heart disease
  • whether you’ve previously had surgery for an enlarged prostate
  • the resources available in your local area
  • the preferences of you and your loved ones
  • the possible side effects and complications of treatment

The stage of the cancer is one of the most important factors in treatment decisions. The most common staging system is the American Joint Committee on Cancer (AJCC) tumor-node-metastasis (TNM) system, which divides cancer into stages 1 through 4.

The TNM system considers the following elements:

  • Tumor: the size of the cancer
  • Node: whether the cancer has spread to nearby lymph nodes
  • Metastasis: whether the cancer has spread to distant parts of your body
  • Your levels of prostate-specific antigen (PSA): a protein that, at high levels, can indicate cancer or other conditions that affect your prostate, such as prostatitis or a urinary tract infection
  • The cancer’s grade group: a measurement, based on the cancer’s Gleason score, that indicates how likely it is to grow or spread quickly

The stages of treatment

Because the stage of cancer you have is the most influential factor in how your treatment will progress, we’ve divided the rest of this article into sections based on the stages of prostate cancer:

Stage 1 is the least advanced stage of prostate cancer. This means the cancer is small and has not spread beyond your prostate.

At this stage, PSA levels and grade group ratings are low. More than 99% of people with prostate cancer caught in stage 1 survive for at least 5 years. This means you have less than a 1% chance of dying from prostate cancer complications within 5 years.

Treatment for stage 1 prostate cancer usually consists of some combination of active surveillance, surgery, and radiation therapy. You may also be eligible for clinical trials that offer newer treatment methods.

Active surveillance and watchful waiting

During active surveillance, you will not receive any treatment. Instead, you’ll have routine tests to monitor how the cancer changes over time.

Doctors will usually recommend active surveillance if cancer is unlikely to spread to organs far from your prostate. Active surveillance typically involves regular PSA screenings and visits with a doctor.

You might also undergo a prostate biopsy every few years. During this procedure, a doctor takes a tissue sample from your prostate and sends it to a laboratory to be checked for cancerous cells.

If you’re older or have any other serious health conditions, your doctor might instead recommend watchful waiting. You won’t receive cancer treatment or routine tests during watchful waiting, but you may receive treatment to help relieve symptoms and improve your quality of life.

Surgery

Your doctor might recommend a type of surgery called a radical prostatectomy, which involves removing your prostate and seminal vesicles (glands that help produce semen for ejaculation). This procedure is usually combined with a pelvic lymphadenectomy to remove your lymph nodes and check for cancer.

You might also undergo radiation therapy after surgery.

Radiation therapy

Radiation therapy uses high energy rays to kill cancer cells. It may be combined with androgen deprivation therapy (ADT), a type of hormone therapy that lowers the levels of hormones called androgens that can fuel the cancer.

Your treatment team may recommend one or both of the following types of radiation therapy:

  • External radiation therapy: A machine outside your body focuses a beam of high energy rays on the area where the cancer is located. This is the more common type of radiation therapy.
  • Internal radiation therapy: Small pieces of radioactive material are placed in your prostate.

Clinical trials

You may be eligible for clinical trials that use newer treatments. If researchers find that those newer methods are more effective than the current standard treatments, those might become the new standard treatments in the future.

A doctor can help you find clinical trials in your area that you may be eligible for. You can also search on ClinicalTrials.gov. Clinical trials may involve treatments such as:

  • Cryosurgery: An extremely cold liquid is used to freeze and destroy cancerous tissue.
  • Photodynamic therapy: The cancer cells are destroyed with drugs that are activated by light exposure.
  • High intensity focused ultrasound therapy: High energy sound waves are used to create heat and destroy cancer cells.

Keep in mind that clinical trials are experimental and will not necessarily be more effective than any established treatments. You can talk with your doctor about what you can realistically expect when joining a clinical trial for prostate cancer.

Your doctor will also make sure the trial doesn’t interfere with treatments for any other health conditions you have.

Stage 2 prostate cancer is still limited to your prostate gland, but your PSA levels and grade group are higher. A doctor might be able to feel the tumor during a digital rectal exam at this stage.

More than 99% of people with stage 2 prostate cancer are expected to survive the effects of the cancer for at least 5 years (although this figure does not account for any other possible causes of death).

The AJCC staging system divides stage 2 into substages 2A, 2B, and 2C depending on how big the tumor is and how the cells look under a microscope. Your doctor may factor in these distinctions when identifying the best prostate cancer treatment options for you.

Treatment for stage 2 prostate cancer is similar to the treatment for stage 1 and may involve some combination of the following options:

  • Active surveillance: Doctors will check your PSA levels and take an occasional tissue sample to look for cancerous cells.
  • Watchful waiting: If you’re older or have other health issues, your doctor may recommend this approach. You will not receive treatment for cancer but will receive treatment to relieve symptoms and maintain your quality of life.
  • Radiation therapy: This treatment kills cancerous cells.
  • Radical prostatectomy surgery: A doctor removes your prostate and some tissue around it. You might also receive radiation therapy.
  • Clinical trials: By enrolling in a clinical trial, you might be able to receive a newer treatment that is still being studied.

Active surveillance is usually recommended only in stages 2A and 2B.

People with stage 3 prostate cancer still have more than a 99% chance of surviving the effects of cancer for at least 5 years (without factoring in other possible causes of death).

Stage 3 is divided into substages 3A, 3B, and 3C. In stage 3B or 3C, cancer might have spread beyond your prostate to nearby tissues, such as your seminal vesicles or the lymph nodes that carry lymph fluid throughout your body. Prostate cancer in these stages is harder to treat effectively.

Standard treatments for stage 3 prostate cancer include:

  • External radiation therapy: This treatment helps kill cancerous cells.
  • ADT: This treatment lowers your levels of androgens such as testosterone. Lowering androgen levels can help slow the growth of cancerous tumors.
  • Radical prostatectomy: A surgeon removes your prostate and the tissue around it.
  • Active surveillance: Healthcare professionals monitor your PSA levels and check the tumor tissues for cancerous cells.
  • Watchful waiting: If you’re older and have a high risk of side effects from other treatments, healthcare professionals may treat your symptoms but not treat the cancer itself.

Treatment might include a transurethral resection of the prostate (TURP), a procedure in which a surgeon cuts away part of your prostate. This surgery can help manage symptoms such as frequent urination and sudden urges to urinate, which are caused by your prostate putting pressure on your urethra.

Your doctor might also recommend internal radiation or clinical trials. But keep in mind that clinical trials are experimental and may not be more effective than the currently available treatments.

Talk with your doctor about the possible side effects of these treatments, which may include:

Stage 4 prostate cancer is the most advanced stage, so the survival rate is lower.

It’s divided into substages 4A and 4B:

  • Stage 4A: The cancer has spread to nearby lymph nodes and possibly to other nearby tissues, such as your rectum, bladder, or pelvic wall.
  • Stage 4B: The cancer has spread to distant parts of your body, such as your bones or distant lymph nodes.

The 5-year relative survival rate drops to 37% if prostate cancer reaches these distant parts of your body.

If you are healthy enough to receive treatment, possible treatments for stage 4A cancer include:

  • External beam radiation treatment with ADT: This treatment kills cancerous cells and stops androgens such as testosterone from causing the tumors to grow more quickly.
  • Abiraterone: This medication helps lower your levels of androgens that can promote tumor growth.
  • Radical prostatectomy with pelvic lymph node dissection: This surgical procedure involves removing your prostate, the affected tissue around your prostate, and the cancerous tissue in your nearby lymph nodes.

If you don’t have symptoms or other serious health problems, your doctor may recommend:

  • Watchful waiting: If other treatments are too risky, you’ll receive treatment only to relieve your symptoms and maintain your quality of life.
  • Active surveillance: Healthcare professionals will monitor your PSA levels and check your prostate tissue for cancerous cells.
  • Hormone therapy: This treatment lowers your androgen levels and slows down tumor growth.

In stage 4B, most cancers cannot be completely eliminated, but treatment can help manage the cancer and improve your quality of life. Treatment could include:

  • ADT: This treatment can be given alone or combined with:
    • abiraterone to lower your androgen levels and slow down tumor growth
    • apalutamide in combination with other ADT options to improve your outlook
    • chemotherapy (usually with docetaxel) to kill cancerous cells
    • enzalutamide to slow down tumor growth
    • external beam radiation therapy, which uses X-rays or proton beams to break down cancerous tissue
  • TURP: This procedure treats symptoms such as urinary blockage.
  • External radiation: This treatment kills cancerous cells.
  • Watchful waiting: If other treatments are too risky, healthcare professionals will provide treatment to minimize your symptoms.
  • Active surveillance: Healthcare professionals monitor your PSA levels and check your prostate tissue for cancerous cells.
  • Bisphosphonate therapy: This treatment reduces bone pain and can help strengthen your bones and prevent fractures.
  • Alpha emitter radiation therapy: This treatment targets prostate cancer that has spread to your bones.
  • Radical prostatectomy with testicle removal: This surgical procedure, also called an orchiectomy, involves removing your prostate and one or both testicles.

Many of these treatments can slow down tumor growth and help you live longer. But they might also have painful or disruptive side effects that can decrease your quality of life, such as:

The risk of side effects or problems from some treatments may be greater than the possible benefits. You can talk with your doctor about your options.

For some people, especially those who are older or have other serious health issues, active surveillance and watchful waiting may the best ways to reduce pain and discomfort if other treatments could be ineffective or too risky to try.

Living with prostate cancer

Receiving a prostate cancer diagnosis can be stressful. Even though most people who receive a diagnosis of prostate cancer live for many years afterward, treatment can be exhausting and cause side effects that affect your quality of life.

Many resources are available to help you get through these difficult times:

Many treatment options are available for prostate cancer. Common options include watchful waiting or active surveillance, radiation therapy, surgery, and hormone therapy.

It’s important to talk with your doctor about prostate cancer treatments that may fit your specific needs. Often, there is not one specific best treatment but instead a variety of options. Your doctor can let you know what your options are and inform you about the pros and cons of each.

No matter what type of treatment you choose, consider looking into mental health support as well. Prioritizing your mental health can help you continue to live as healthy and happy a life as possible after receiving a cancer diagnosis and during treatment.