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Once you have been diagnosed with prostate cancer, your treatment will depend on multiple factors, including your overall health; whether the cancer has spread; and if so, how fast it is spreading. Then, after consulting with your doctor, you will choose the best treatment for your individual situation. This will typically be active surveillance, surgery, or radiation.

Your doctor may suggest additional tests, such as imaging studies, if there is a risk your cancer has spread outside the prostate. But research shows that if you have very low-risk disease based on prostate-specific antigen (PSA) testing and biopsies of the prostate, then you have a very small chance of having cancer that has spread.

Common Treatments

Robotic-assisted prostatectomy is far and away the most common surgical technique for prostate cancer. Surgery is performed through several small incisions in the abdomen, with the surgeon operating via a console.

Radiation therapy may be a good option if surgery doesn't seem feasible. The two types of radiation therapy commonly used are external-beam radiation therapy, which directs high doses of radiation toward the tumor while sparing healthy tissue; and brachytherapy, which involves placing radioactive seeds inside the prostate.

Focal therapies that use freezing, heat, or electricity are under investigation for cancer confined to the prostate. These may also be used if you have cancer that returns after radiation therapy.

Classifying Prostate Cancer

Prostate cancer is classified differently from other tumor types. In deciding on a treatment, doctors use the distribution of the disease, whether it is localized or has spread, and whether or not it is sensitive to androgen therapy.

Patients with very low-risk disease are generally offered active surveillance. You will get PSA testing, scans, and biopsies at regular intervals to monitor the cancer's growth.

Patients with intermediate-risk disease can be offered surgery or radiation and possibly active surveillance in patients with favorable risk features. Radiation is sometimes also given along with a short course of hormonal therapy, which uses medications to combat testosterone's role in fueling cancer cell growth in the prostate.

In high-risk and very high-risk patients, surgery may still be an option, but they may often need radiation after the completion of surgery. Radiation therapy is usually given with prolonged hormonal therapy, often for 18-24 months.

Factors to Consider When Choosing Treatment

Some of the factors to consider when looking at treatment options include your age, overall health, life expectancy, other medical conditions, and personal preference. Discuss with your doctor the potential risks that your prostate cancer may cause, including the potential side effects of the treatments available to you. You will need to weigh the potential immediate side effects against the possible risks of delaying treatment.

It's best to talk to multiple doctors before making a decision, particularly doctors who are skilled in both surgery and radiation therapy. The doctor should be able to explain your individual risks as well as the need for additional tests, especially if you have high-risk disease. If your prostate cancer is more aggressive, the doctor may suggest you enroll in a clinical trial.

Read previous installments in this series:

For Your Patients: Risk Factors, Signs, and Symptoms of Prostate Cancer

For Your Patients: How Will My Doctor Diagnose Prostate Cancer?

For Your Patients: How to Talk to Your Doctor About Whether You Need a PSA Test

"Medical Journeys" is a set of clinical resources reviewed by physicians, meant for the medical team as well as the patients they serve. Each episode of this journey through a disease state contains both a physician guide and a downloadable/printable patient resource. "Medical Journeys" chart a path each step of the way for physicians and patients and provide continual resources and support, as the caregiver team navigates the course of a disease.