Modern prostate cancer care follows a stepwise, personalized approach: active surveillance for many low-risk tumors; curative surgery or radiation for localized disease; and combinations of androgen-deprivation, targeted therapies, chemotherapy, and radioligand therapy for advanced or metastatic cancer. Genetic testing and multidisciplinary decision-making help match treatments to tumor biology and patient priorities.

Overview

Prostate cancer treatment uses a stepwise, individualized approach based on stage, grade, symptoms, biomarker results, and patient priorities. Goals range from cure for localized disease to life-prolonging and symptom control for advanced cancers. Multidisciplinary care (urology, radiation oncology, medical oncology, radiology, pathology) and shared decision-making are central.

Early-stage and low-risk disease

For low-risk, localized prostate cancer the emphasis is often on avoiding overtreatment while monitoring for progression.

Active surveillance

Many men with low-risk tumors (low PSA, low Grade Group, limited biopsy cores) start with active surveillance: regular PSA checks, periodic prostate MRI, and repeat biopsies. Curative treatment is offered if tests show progression.

Curative local treatments

When active treatment is chosen, options include:
  • Radical prostatectomy (open, laparoscopic, or robotic-assisted) to remove the prostate.
  • Radiation therapy: external beam radiation therapy (EBRT) using modern techniques such as intensity-modulated radiation therapy (IMRT) or stereotactic body radiation therapy (SBRT), and brachytherapy (seed implants).
Focal therapies - high-intensity focused ultrasound (HIFU) or cryotherapy - are available at specialized centers for carefully selected patients who want a middle ground between surveillance and whole-gland treatment.

Locally advanced disease

For higher-risk localized or locally advanced tumors, clinicians combine treatments: surgery or radiation plus short-term androgen-deprivation therapy (ADT) or extended ADT depending on risk. The Grade Group (Gleason pattern grouping), PSA, and imaging guide the plan.

Advanced and metastatic disease

When cancer spreads beyond the prostate, systemic therapies become central.

Androgen-deprivation therapy (ADT)

ADT reduces testosterone to slow tumor growth. It can be achieved surgically (orchiectomy) or medically with LHRH agonists/antagonists (e.g., leuprolide, degarelix). ADT is often paired with other systemic agents.

Combined systemic options

For metastatic disease, standard combinations can include ADT plus one or more of:
  • Androgen-receptor pathway inhibitors (abiraterone, enzalutamide, apalutamide) to further block androgen signaling.
  • Chemotherapy (docetaxel; cabazitaxel for later lines).
  • Targeted therapies for biomarker-selected patients: PARP inhibitors for tumors with homologous recombination repair gene alterations (BRCA1/2, etc.).
  • Radioligand therapy (lutetium-177-PSMA) for PSMA-positive, castration-resistant disease.
Immunotherapy (sipuleucel-T) or checkpoint inhibitors may have a role in select biomarker-defined cases.

Symptom control and palliative care

Advanced disease treatment often includes radiation for painful bone metastases, bisphosphonates or denosumab to reduce skeletal events, and symptom management (pain control, urinary relief). The intent and tradeoffs of each option should be discussed with the care team.

Genetic testing and clinical trials

Genetic testing (germline and tumor) for DNA repair mutations is increasingly recommended for men with advanced disease because it guides targeted therapy choices. Participation in clinical trials can provide access to new treatments.

Choosing a plan

Treatment selection depends on cancer features, life expectancy, comorbidities, side-effect profiles (sexual, urinary, bowel, metabolic), and patient preferences. Discuss expected benefits, risks, and supportive measures with a multidisciplinary team.

FAQs about Prostrate Cancer Treatment

What is active surveillance and who is it for?
Active surveillance is regular monitoring with PSA tests, prostate MRI, and repeat biopsies to delay or avoid treatment in men with low-risk prostate cancer. It is appropriate for many men with low PSA, low Grade Group, and limited tumor on biopsy.
When is surgery preferred over radiation?
Surgery (radical prostatectomy) may be preferred for younger men, those with a longer life expectancy, or when pathology from surgery could change further treatment. Radiation is an alternative with similar cancer control for many patients; decisions consider side effects and personal priorities.
What are the main systemic treatments for metastatic prostate cancer?
Main systemic treatments include androgen-deprivation therapy (surgical or medical), androgen-receptor inhibitors (abiraterone, enzalutamide, apalutamide), chemotherapy (docetaxel, cabazitaxel), PARP inhibitors for DNA-repair-mutated tumors, and radioligand therapy for PSMA-positive disease.
Should men with advanced prostate cancer get genetic testing?
Yes. Germline and tumor testing for DNA-repair gene mutations (e.g., BRCA1/2) is increasingly recommended because positive results can open options for PARP inhibitors and inform family risk.
Are HIFU and cryotherapy standard treatments?
HIFU and cryotherapy are available at specialized centers and may be offered for selected patients as focal or salvage therapies, but they're not universally standard for all early prostate cancers. Discuss risks and evidence with a specialist.