There are many approaches to treating prostate cancer. Factors to consider include the severity and extent of the cancer, the man’s age and general health, and whether the patient wants to risk side effects of treatment for a possible cure. Some tumors spread quickly and need aggressive therapy. Many other prostate tumors are slow growing and may not need such aggressive treatment. 

Several measurements obtained during diagnostic tests may provide some guidelines for treatment. These include the level of prostate-specific antigen and the Gleason score, a measure of the cancer’s aggressiveness. In some cases, a combination of treatments, such as surgery followed by radiation therapy, may be used as therapy.

The cure rates for radiation treatments alone and surgical removal of the prostate are similar at 10 years after treatment (about 92 percent for each treatment). Risks of aggressive treatments include the possibility of incontinence or impotence. However, prostate cancer is usually slow to spread and in some cases does not need treatment, especially in the elderly or chronically ill.

The most common treatments are:

• “Watchful waiting” (expectant management). This involves regular monitoring of the cancer through tests such as the digital rectal exam and PSA test. Watchful waiting may be used if the cancer has been detected in an early stage or if it is slow growing and confined to a small area of the prostate. It is also used with elderly patients who may not be able to tolerate cancer treatments.
  
  
• Radical prostatectomy. Surgical removal of the prostate and nearby tissues. Typically, general anesthesia is used, and the patient is discharged from the hospital after a few days. The incision may be made through the lower abdomen or the perineum, the area between the scrotum and anus. Risks of surgery include blood loss and infection. Following surgery, a narrow flexible tube (catheter) is placed through the urethra into the bladder to move urine through the penis for a few weeks while the area heals. Men usually regain full bladder control within weeks or months. This treatment often cures early prostate cancer.
  
  The potential complications for prostatectomy, which include bladder control problems and sexual dysfunction, are a major concern for most men. According to the American Academy of Family Physicians:
  
  
• Patients under age 50 are more likely to retain sexual function afterward.
  
  
• Patients over 70 are more likely to become impotent.
  
  
• Impotence is less likely if the tumor is small and nerves do not have to be cut.
  
  
• Patients rarely have severe incontinence. About one-third have occasional leaking of urine during laughter, coughing or heavy lifting.
  
  
There are a number of variations to this surgery, as well as benefits, risks and lifestyle considerations. Several studies have indicated that surgery for certain prostate cancers does not need to be performed immediately. Men who are diagnosed with early stage, low grade tumors may not have a poorer outlook for survival if surgery is delayed. However, additional research is necessary to determine the effect of delayed surgical treatment on a patient’s survival.


• Partial prostatectomy. Surgical removal of part of the prostate. The most common type of partial prostatectomy is called transurethral resection of the prostate (TURP). It is more often a treatment for an enlarged prostate, but it may be performed to relieve pain and ease urination in men with cancer that radical prostatectomy cannot cure.
  
  
• Radiation therapy. Use of high-energy x-rays or radioactive seeds to kill or shrink malignant cells. Radiation therapy is a possible option for prostate cancer that has not spread outside of the prostate gland to distant sites in the body. External beam radiation therapy (EBRT) delivers radiation from an external machine in precise doses targeted at a specific area. Internal radiation (brachytherapy) uses implanted radioactive “seeds” to deliver the radiation to the prostate or nearby areas. Radiation may be used after prostatectomy.
  
  
• Hormone therapy. Reduces the level of male hormones to control the growth of cancer. Male hormones (androgens) such as testosterone encourage the growth of many prostate tumors. Hormonal therapy may be used for early stage prostate cancer as well as for cancers that have spread in the body. Hormone therapy may be accomplished with the use of drugs or surgery. Hormone therapy cannot cure prostate cancer but can help shrink the tumor and slow the growth of the cancer.
  
  The drugs used in hormone therapy work in different ways. Some drugs, known as luteinizing hormone-releasing hormones (LH-RH) agonists, help prevent the production testosterone. Other drugs (anti-androgens) work to decrease the body’s ability to use testosterone. Patients eventually may become resistant to hormone therapy but intermittent hormone therapy programs may help the effectiveness of treatment. The side effects of hormone therapy may include breast enlargement, hot flashes, reduced sex drive and weight gain. Some of the drugs may also cause gastrointestinal problems, including nausea and diarrhea, and liver damage. Guidelines for hormone therapy are changing, both in terms of the type of hormone therapy, when to start it and the other risks associated with it. Regular patient-physician consultation about the disease and its treatment course is the best approach for hormone therapy.
  
  
• Orchiectomy (surgical castration). Surgical version of hormone therapy. This has the same effect as hormone drug therapy but is irreversible. It is usually an outpatient procedure or can involve brief hospitalization. It involves local, spinal or general anesthesia. The surgeon makes an incision in the scrotum to remove the testicles. Prosthetic testicles may be inserted to give the scrotum a normal look. Orchiectomy can cause hot flashes and will cause impotence and loss of interest in sex.
  
  
• Cryotherapy (also called cryosurgery). Freezing and destruction of prostate cancer cells. This is a newer treatment that uses liquid nitrogen to kill prostate cancer cells. In the past, poor precision with application of the treatment resulted in damage to surrounding tissues and some long-term bladder complications. New techniques now allow smaller probes and more accurate monitoring of the temperature. These advances have made cryotherapy more effective with few complications. However, additional research is necessary to determine the success of cryotherapy for prostate cancer treatment.
  
  
• Chemotherapy. Use of powerful drugs to destroy cancer cells. Chemotherapy is a less common treatment for prostate cancer than for most other types of cancer. It is sometimes used for late-stage metastatic prostate cancer that has not responded to or no longer responds to hormone therapy.