Key takeaways:
Treatment for localized prostate cancer may include surgery, radiation, hormone therapy, and active surveillance.
It’s common to receive more than one treatment option.
The most effective treatment depends on your cancer risk group and your overall health. Intermediate- and high-risk prostate cancers need more intensive treatments.
Prostate cancer affects the prostate, a small gland that plays a role in male fertility. Sometimes, prostate cancer grows slowly, but it can also be aggressive. Because prostate cancer acts in different ways, there are many ways to treat it. The best treatment options depend on your health, treatment goals, and the prostate cancer’s risk group and stage.
If you have localized prostate cancer, it’s important to talk with your healthcare team about your treatment options. Learning the side effects of treatments can help you balance the risks and benefits. Let’s take a look at prostate cancer treatment options for localized prostate cancer.
4 common treatments for localized prostate cancer
For people with localized prostate cancer, there are four main treatment options.
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1. Active surveillance
Active surveillance is a prostate cancer treatment that focuses on monitoring how prostate cancer behaves over time. It’s an option for some types of prostate cancer.
During active surveillance, you’ll need regular follow-up with your healthcare team. You’ll also need prostate-specific antigen (PSA) measurements, prostate biopsies, and prostate MRIs on a regular schedule. Active surveillance may allow you to delay or avoid more invasive treatments, depending on how the cancer behaves over time. Some people never need additional treatment, while others may eventually need it if the cancer shows signs of progression.
2. Surgery
Radical prostatectomy is a surgery that removes the prostate. Prostate removal is an effective treatment for some types of prostate cancer. But all surgery comes with risks including infection, erectile dysfunction (ED), and urinary incontinence.
3. Radiation therapy
Radiation therapy uses beams of energy (radiation) to destroy cancer cells. There are two main types of radiation therapy for prostate cancer: external beam radiation therapy and brachytherapy. Your healthcare team may recommend one type of radiation therapy over another, depending on your specific situation and overall health.
4. Hormone therapy
Hormone therapy is also called “androgen deprivation therapy.” These medications block the activity of testosterone in the body. Healthcare professionals may recommend hormone therapy for the following types of prostate cancer:
Favorable/unfavorable intermediate risk
High risk
Very high risk
Hormone therapy isn’t recommended for low-risk prostate cancer. It’s usually combined with radiation therapy.
Can you combine different prostate cancer treatment methods?
It’s common to combine different treatment methods to treat prostate cancer. In fact, sometimes combination therapy is the “standard of care.” This means the treatments should always be combined to provide the best possible outcomes in these situations:
Positive surgical margins: When you have surgery to remove cancer, a pathologist will use a microscope to look at removed tissue to make sure there are no cancer cells at the edges of the removed tissue. If there are cancer cells at the edges, it can mean that some of the cancer is still in the body. These are “positive surgical margins.” If you have them, you may need radiation, hormone therapy, or both.
Adverse features: Under a microscope, some cancers have features that make them more likely to be aggressive. These are “adverse features.” If your cancer has adverse features, you might need radiation, hormone therapy, or both.
Best treatment for prostate cancer in early stages
The most effective treatment depends on your specific situation. Here are some tips to keep in mind:
Find the right cancer center. It’s important to find the right cancer center and a highly skilled, experienced team to do your surgery and/or radiation treatments. This can lead to better outcomes and fewer side effects.
Active surveillance is safe. Some people are hesitant to try active surveillance. But a landmark study showed that people using active surveillance, when done correctly, don’t develop metastatic prostate cancer more often than people who chose radiation or surgery.
Radiation is effective. Some people are also more hesitant to try radiation instead of surgery. But in cases of localized or locally advanced prostate cancer, evidence shows that radiation therapy has the same long-term success rate as surgery.
Hormone therapy can be lifesaving. Hormone therapy can improve cure rates for people with unfavorable intermediate-risk and high-risk prostate cancer when added to radiation therapy.
Common side effects of prostate cancer treatments
Prostate cancer treatments can cause side effects. Some side effects may be temporary, but others may last for months, years, or even a lifetime. The side effects depend on the treatment type.
Surgical side effects
Radical prostatectomy (surgery) can cause:
Urinary incontinence
ED
Urethral strictures (rare)
Urinary incontinence and ED often improve over time, but some people continue to have symptoms long term.
Radiation therapy side effects
Radiation therapy can cause:
Bloody stools
Diarrhea
Fecal urgency
Urinary irritation
Urethral strictures
ED
Increased risk of bladder cancer
Most of these side effects improve after treatment ends.
Hormone therapy side effects
Hormone therapy can cause:
Lower sex drive
ED
Hot flashes
Night sweats
Weight gain
Decreased muscle mass
Osteopenia and osteoporosis
Mood changes
These side effects get better and many go away after treatment ends.
Frequently asked questions
Stage 1 prostate cancer is called low-risk localized prostate cancer. Stage 1 prostate cancer is usually treated with active surveillance, though some people may also receive other treatment.
The survival rate for prostate cancer varies from person to person, depending on how aggressive the cancer is and your overall health. People have very high survival rates, with 5-year survival above 99%, if they have:
Localized prostate cancer (cancer that hasn’t spread beyond the prostate)
Regional disease (spread to nearby areas like lymph nodes)
Survival rates are lower for people with distant prostate cancer, where the cancer has spread to other parts of the body.
It’s also important to remember that these numbers are based on past data. These numbers continue to improve as new treatments become available.
Prostate cancer is very treatable, especially if it’s found early before it has spread to other parts of the body. Some types of prostate cancer can be cured with treatment. Working with a healthcare team that specializes in prostate cancer can help you get the best treatment for your situation.
Stage 1 prostate cancer is called low-risk localized prostate cancer. Stage 1 prostate cancer is usually treated with active surveillance, though some people may also receive other treatment.
The survival rate for prostate cancer varies from person to person, depending on how aggressive the cancer is and your overall health. People have very high survival rates, with 5-year survival above 99%, if they have:
Localized prostate cancer (cancer that hasn’t spread beyond the prostate)
Regional disease (spread to nearby areas like lymph nodes)
Survival rates are lower for people with distant prostate cancer, where the cancer has spread to other parts of the body.
It’s also important to remember that these numbers are based on past data. These numbers continue to improve as new treatments become available.
Prostate cancer is very treatable, especially if it’s found early before it has spread to other parts of the body. Some types of prostate cancer can be cured with treatment. Working with a healthcare team that specializes in prostate cancer can help you get the best treatment for your situation.
The bottom line
There are many treatments for prostate cancer. Treatment options for localized prostate cancer include surgery, radiation, hormone therapy, and active surveillance. Healthcare teams may use some of these treatments together for the best outcomes. The therapy that’s right for you depends on your prostate cancer’s risk group and your own treatment goals. Working with a skilled cancer center gives you access to the most up-to-date treatment options.
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References
American Cancer Society. (2025). Radiation therapy for prostate cancer.
American Cancer Society. (2026). Survival rates for prostate cancer.
National Cancer Institute. (2026). Find a cancer center.
Prostate Cancer Foundation. (n.d.). Understanding prostate cancer.
Raychaudhuri, R., et al. (2025). Prostate cancer: A review. JAMA.
Tosoian, J., et al. (2015). Intermediate and longer-term outcomes from a prospective active-surveillance program for favorable-risk prostate cancer. Journal of Clinical Oncology: The Official Journal of the American Society of Clinical Oncology.
Wenzel, M., et al. (2025). Radical prostatectomy versus radiation therapy for locally advanced and clinically nodal positive prostate cancer. Clinical Genitourinary Cancer.
