Best Treatment for Prostate Cancer

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.

Prostate cancer treatment options 

For people with localized prostate cancer, there are four main treatment options:

1. Active surveillance 

Active surveillance is a prostate cancer treatment that focuses on monitoring prostate cancer. It’s an option for low-risk prostate cancer. During active surveillance, you’ll need regular follow-up with your healthcare team. You’ll also need prostate biopsies or prostate MRIs every one or two years. The benefit of active surveillance is that you can avoid the side effects of more invasive types of treatment.

2. Surgery 

Radical prostatectomy is when a surgeon removes the prostate. Healthcare providers usually recommend surgery for prostate cancers that are intermediate and high risk. Prostate removal is an effective treatment for some types of prostate cancer. But all surgery comes with risks including infection 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: external beam radiation therapy and brachytherapy. Healthcare providers recommend it for prostate cancers that are intermediate and high risk. 

4. Hormone therapy

Hormone therapy is also called “androgen deprivation therapy.” These medications block the activity of testosterone in the body. Providers may recommend hormone therapy for unfavorable, intermediate-risk and high-risk prostate cancer. It isn’t recommended for low-risk prostate cancer. 

Alternative treatment for prostate cancer

There are some additional treatments available for prostate cancer. Some of these are experimental, which means that researchers are still studying how well they work. And all these treatments are meant for more advanced prostate cancer. You’ll not be offered these treatments if you have localized prostate cancer. But it can be helpful to know that they exist.

Cryotherapy

Cryotherapy is a “freezing therapy” in which probes are placed into the prostate. Liquid nitrogen goes through these probes and freezes the cancer cells to death. This type of therapy is still experimental and is not typically used outside of clinical trials. Cryotherapy can lead to side effects like urinary incontinence and erectile dysfunction. 

High-intensity focused ultrasound

High-intensity focused ultrasound is another experimental therapy. Like cryotherapy, it’s not part of treatment guidelines and is used within clinical trials. High-intensity focused ultrasound uses sound waves to destroy cancer cells.

Chemotherapy

Chemotherapy is sometimes used to treat advanced prostate cancer. Chemotherapy for prostate cancer isn’t curative, but it can improve quality of life, reduce pain, and help some people live longer. Chemotherapy is given with other treatments for prostate cancer like androgen deprivation therapy or steroids.

Prostate cancer vaccines

Prostate cancer vaccines aren’t like other vaccines. They don’t prevent illnesses. They’re a type of immunotherapy that uses the body’s own immune cells to fight prostate cancer. Prostate cancer vaccines can’t cure prostate cancer, but they may help people with advanced prostate cancer live longer.

Is it normal to combine different 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.  

• High-risk prostate cancer: If you have high-risk prostate cancer and you had surgery, you may need radiation therapy, too. Your team may wait and see if your prostate-specific antigen (PSA) levels go up before starting radiation therapy. Or you might start radiation about 4 to 6 months after your surgery, regardless of your PSA level. Many times, people with high-risk prostate cancer will also start hormone therapy.

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 radiation treatments. Evidence shows they 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 cure 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. 

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Written by:

Jennifer Clements, MD, MSEd, NBHWC

Jennifer Clements, MD, MSEd, NBHWC, is a board-certified physician and health coach who is passionate about achieving optimal health through healthy lifestyles. Clements is a diplomate of the American Board of Obesity Medicine and the American Board of Integrative Medicine.

Edited by:

Patricia Pinto-Garcia, MD, MPH

Patricia Pinto-Garcia, MD, MPH, is a medical editor at GoodRx. She is a licensed, board-certified pediatrician with more than a decade of experience in academic medicine.

Reviewed by:

Brandon R. Mancini, MD, MBA, FACRO

Brandon R. Mancini, MD, MBA, FACRO, serves as medical director at BAMF Health in Grand Rapids, Michigan in the emerging field of theranostics. His primary clinical focus is on the treatment of people with metastatic prostate and neuroendocrine cancers.

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