Prostate cancer is treated by a team of doctors, often including a urologist (a doctor who treats the urinary tract and usually performs surgery), a radiation oncologist (a doctor who specializes in radiation therapy), and a medical oncologist (a doctor who treats cancer mainly with medications). Your cancer care team will suggest treatment options based on details about your cancer, such as:

• The cancer stage (how large the cancer is and whether it has spread)
• The cancer grade (what cancer cells look under a microscope)
• The likelihood that a treatment will improve your outlook
• Your overall health
• Your personal goals and preferences

Not everyone with prostate cancer needs treatment right away. This is especially true for people with slow-growing prostate cancer that doesn’t cause symptoms. In these cases, the care team may recommend active surveillance (also called watchful waiting). This approach involves closely monitoring the cancer before starting treatment.

Being diagnosed with prostate cancer can make learning about treatment types feel overwhelming. This article explains the main prostate cancer treatment options to help you make informed decisions about your treatment plan.

1. Surgery

When cancer hasn’t spread out of the prostate, surgery is a common treatment option and may cure early-stage prostate cancer. For people with advanced prostate cancer, certain types of surgery may help relieve symptoms.

Radical Prostatectomy

Radical prostatectomy is the most common type of surgery for people who are otherwise healthy and whose cancer hasn’t spread. During a radical prostatectomy, the surgeon removes the entire prostate gland. They’ll also remove some surrounding tissue, including the seminal vesicles (glands that make semen) and nearby lymph nodes.

If you and your cancer care team decide that a radical prostatectomy is part of your treatment plan, the surgery can be performed several ways, including:

• Open prostatectomy — The surgeon removes the prostate through a larger incision in the lower belly or the perineum (the area between the anus and scrotum).
• Laparoscopic prostatectomy — The surgeon removes the prostate through several small incisions in the abdomen using a camera and long surgical tools.
• Robot-assisted prostatectomy — The surgeon performs laparoscopic prostatectomy using robotic arms and a camera.

Transurethral Resection of the Prostate

Transurethral resection of the prostate (TURP) is a surgical procedure in which a surgeon removes prostate tissue using a resectoscope (a thin tube with a cutting tool on the end). The resectoscope is inserted through the urethra, the tube that carries urine out of the body.

TURP is most often used to treat benign prostatic hyperplasia (noncancerous enlargement of the prostate). However, TURP may be used to relieve symptoms in people with advanced cancer. TURP isn’t used to cure prostate cancer because the entire prostate isn’t removed.

2. Radiation Therapy

Radiation therapy uses high-energy X-rays to kill cancer cells. This type of treatment can be used as a primary treatment of prostate cancer or combined with others, depending on how advanced the cancer is.

Radiation therapy may be delivered from a source outside the body. This is called external beam radiation therapy (EBRT). Different EBRT techniques may be used depending on the stage of prostate cancer, the dose of radiation needed, and the frequency of treatment.

Internal radiation — also called brachytherapy — uses one or more small, radioactive seeds (pellets) placed directly into the prostate. These seeds deliver radiation over time.

Another type of radiation therapy uses medications that contain radioactive substances. Drugs such as lutetium Lu 177 vipivotide tetraxetan (Pluvicto) can reach cancer cells anywhere in the body, including prostate cancer that has spread to the bones. This approach is called targeted radioligand therapy, also known as theranostics.

3. Hormone Therapy

Hormone therapy is a prostate cancer treatment that works by lowering or blocking androgens, often called male sex hormones. Androgens include testosterone and dihydrotestosterone. These hormones can help prostate cancer cells grow, so blocking them may help slow that growth. Hormone therapy is also called androgen deprivation therapy.

Hormone therapy can be used alone or with other prostate cancer treatments, depending on how advanced the cancer is and whether it has spread. Although hormone therapy can slow cancer growth, it usually doesn’t cure prostate cancer when used by itself. Over time, some cancers may stop responding to hormone therapy.

Several types of treatment can lower androgen levels or block their effect.

Treatments That Lower Androgens From the Testicles

The testicles are the main source of androgens. Treatments that reduce androgen production include:

• Luteinizing hormone-releasing hormone (LHRH) agonists, such as goserelin (Zoladex), leuprolide acetate (Eligard, Lupron Depot), leuprolide mesylate (Camcevi ETM), and triptorelin (Trelstar)
• LHRH antagonists, including degarelix (Firmagon) and relugolix (Orgovyx)
• Orchiectomy (surgical removal of the testicles)

Medications That Lower Androgens From Other Parts of the Body

Androgens can also be made in other parts of the body, including the adrenal glands and prostate cancer cells. Medications that block androgen production include abiraterone (Zytiga) and ketoconazole.

Medications That Prevent Androgens From Working

Androgens affect prostate cancer cells by attaching to androgen receptors, which are proteins on the surface of the cells. Antiandrogen drugs block these receptors so that androgens can’t stimulate cancer cell growth. Examples include:

• Apalutamide (Erleada)
• Bicalutamide (Casodex)
• Darolutamide (Nubeqa)
• Enzalutamide (Xtandi)
• Flutamide
• Nilutamide (Nilandron)

4. Targeted Therapy

Targeted therapy uses drugs that attack specific changes in cancer cells that aren’t found in healthy tissue. To find out if targeted therapy may be an option for you, your cancer team can test your blood or cancer cells for specific proteins or genetic changes.

One example of a target is poly(ADP)-ribose polymerase (PARP) protein. Normally, PARP proteins help repair damaged DNA in cells. PARP inhibitors block this protein, making it more difficult for cancer cells to repair themselves. Examples of PARP inhibitors include:

• Niraparib plus abiraterone (Akeega)
• Olaparib (Lynparza)
• Rucaparib (Rubraca)
• Talazoparib (Talzenna)

5. Immunotherapy

Immunotherapy helps your own immune system better recognize and kill cancer cells. One type, a cancer vaccine called sipuleucel-T (Provenge), helps train the immune system to target and destroy prostate cancer cells. Studies show that sipuleucel-T may not significantly delay disease progression and doesn’t cure prostate cancer, but it may help some people with metastatic prostate cancer — cancer that has spread to other parts of the body — live longer.

Some people also may benefit from immune checkpoint inhibitors. Drugs such as dostarlimab and pembrolizumab can help the immune system better detect prostate cancer cells in people whose cancer has genetic changes.

6. Ablative Therapies

Ablative therapies (also called focal therapy) may be an option for some people with small, localized prostate tumors. These treatments use extreme heat or cold to destroy prostate cancer cells. Examples include:

• Cryotherapy — Uses extreme cold to kill prostate cancer cells
• High-intensity focused ultrasound (HIFU) — Uses ultrasound (high-energy sound waves) to heat and destroy prostate cancer cells
• Irreversible electroporation — Uses an electric current to destroy cancer cells

Compared with treatments such as surgery and radiation, ablative therapies may have fewer side effects. However, ablative treatments may not be good options for people whose tumors are close to the urethra or rectum. It’s also not yet clear how well these treatments work long term, and close follow-up is required after treatment.

7. Chemotherapy

Chemotherapy isn’t typically used to treat early prostate cancer. However, chemotherapy may be included in a treatment plan for some people with advanced prostate cancer that has spread to other parts of the body.

8. Clinical Trials

Clinical trials are research studies that help cancer doctors learn about the safety and effectiveness of new prostate cancer treatments. If you join a clinical trial, you may receive a standard treatment or a new treatment. You can consider joining a clinical trial before, during, or after starting prostate cancer treatment.

Clinical trials may be a good option if you have a type of prostate cancer that’s hard to treat, such as cancer that no longer responds to hormone therapy, or if you’ve already tried several treatments. Talk with your healthcare team if you’re interested in joining a clinical trial for new prostate cancer treatments.

Join the Conversation

On MyProstateCancerTeam, people share their experiences with prostate cancer, get advice, and find support from others who understand.

What prostate cancer treatments did your cancer care team recommend? Let others know in the comments below.