There is no single approach to treating prostate cancer. Treatment options depend upon the risk group and patient factors and preferences.
A patient who receives a diagnosis of localized or locally advanced prostate cancer has three primary treatment options:
Active surveillance: Follow the cancer closely with regularly scheduled PSA checks, DREs, MRIs and biopsies so that definitive treatment is administered only if and when necessary. This is an option for patients with low- risk disease and for select patients with intermediate- risk prostate cancer.
Surgery: Remove the entire prostate gland and seminal vesicles (radical prostatectomy). This is an option for men with intermediate- or high-risk cancer that has not spread.
Radiation therapy: Precisely kill cancer cells with ionizing radiation. As with surgery, it is very effective for localized or locally advanced prostate cancer and has the same cure rate as surgery.
For men with more-aggressive disease, certain treatment combinations may be recommended. Hormone therapy may be added. Also known as androgen deprivation therapy (ADT), this medication stops testosterone from being produced or directly blocks it from acting on prostate cancer cells.
In some cases, at initial diagnosis, prostate cancer is already aggressive and is metastatic, meaning it has spread outside the prostate. Furthermore, in men who already have been treated for prostate cancer, it can recur. Fortunately, men with advanced prostate cancer have several treatment options, including ADT alone or in combination with newer, second-generation anti-androgen medications. For patients with a low volume of metastatic disease at diagnosis, radiation therapy may be combined with ADT. Chemotherapy drugs can help manage pain and may improve survival in patients with metastatic disease. Other, newer treatments include immunotherapy drugs known as checkpoint inhibitors; a vaccine for prostate cancer that has spread to other parts of the body (sipuleucel-T; Provenge); treatments targeting cancer in the bones, such as radium-223; and poly adenosine diphosphate-ribose polymerase (PARP) inhibitors, which were approved in 2020.