What Are the Treatment Options for Prostate Cancer?

Prostate cancer is the most common cancer in men, and it’s estimated there will be more than 313,000 new cases this year. Advances in treatment have improved outcomes and quality of life for patients. However, there are several options for treatment and no one size fits all.

“Prostate cancer is different than other cancers in that consequence of treatment may have a profound impact on quality of life including urination and sexual function,” said Isaac Kim, MD, PhD, chief of urology, Yale New Haven Health, and chair of urology, Yale School of Medicine. “For that reason, the benefit of cancer control has to be weighed against the risk or cost on quality of life.”

Dr. Kim says there are three major options when it comes to prostate cancer treatment: active surveillance, surgery and radiation. Other options currently being aggressively explored include focal therapy and a combined treatment or multimodal approach.

Surveillance

Prostate cancer treatment depends greatly on whether the cancer was caught early. Those with low-risk disease may be surprised to learn that they don’t need intervention right away. Instead, a clinician may keep them under surveillance, meaning they will monitor their progress and determine at a later point if treatment is needed.

“Patients need to be aware that whenever you’re observing cancer, there’s always risk of spreading beyond control,” said Dr. Kim. “A recent study found roughly 60% of patients had either surgery or radiation over about a 15-year period of surveillance. That said, even if these patients eventually need something done, you are still preserving their quality of life for that period before they undergo intervention.”

Surgery

The next option for prostate cancer treatment is surgery, and there are different surgical options including open and robotic surgeries.

One type of robotic surgery is called a single-port radical prostatectomy. It includes the removal of the prostate, but instead of a traditional multi-port radical prostatectomy, patients can go home the same day after the surgery because they have a reduced risk of complications.

“The robotics technology certainly has changed how we care for patients,” said Dr. Kim. “This technology allows patients to come in, have the operation and then sleep in their bed the same night. This is amazing.”

Radiation

In addition to surgery, radiation is another main option for patients with localized prostate cancer. Radiation uses radioactive material to kill cancer cells. Depending on the patient, they may require both surgery and radiation. Dr. Kim says quality of life immediately after radiation can be better than with surgery, but in the long-term, outcomes are similar.

“Within the first 10 years or so, I think radiation and surgery probably have no significant differences in terms of outcomes,” he said. “So ultimately it comes down to patient preference and what their perspective is.”

Focal therapy

One of the biggest advances in the treatment of prostate cancer is focal therapy. In patients with a dominant or aggressive cancer that can be visualized on imaging, focal therapy can ablate or kill the area without damaging other parts of the prostate. This can result in better urinary control and sexual function. This is also a same-day procedure.

“Patients with low-risk disease are excellent candidates for focal therapy,” said Dr. Kim. “Intermediate-risk disease is being explored in different clinical trials.”

Combined therapies & clinical trials

For patients with advanced or metastatic cancer, where the cancer has spread to different parts of the body, oncologists may recommend a combination of treatments. For example, a treatment plan may include a combination of hormonal therapy and radiation.

Patients receiving treatment at Smilow Cancer Hospital also have the opportunity to participate in clinical trials. For example, Dr. Kim is the principal investigator of the SIMCAP (Surgery in Metastatic Carcinoma of Prostate) trial, which looks to evaluate the impact of surgical removal of the prostate when combined with antiandrogen therapy and chemotherapy.

Importance of screening

While there continues to be innovation in the treatment of prostate cancer, Dr. Kim emphasizes the importance of early detection.

“There are some patients who think prostate cancer is indolent and that the disease is not going to hurt you, so why even get screened? But the reality is that prostate cancer is lethal and incurable if found after it has spread. In 2025, it is estimated that roughly 20% of all new prostate cancer diagnosis in the U.S. will be found after it spread to lymph nodes or distant organs. Prostate cancer screening does work. The earlier you get a diagnosis, the better your outcomes are going to be,” he said.

Starting at 40, Dr. Kim recommends that all men should get a baseline prostate-specific antigen (PSA) test, a simple blood test that can screen for prostate cancer. Depending on the results of that test, patients can work with their doctor to determine next steps for future screenings. Some patients may not need to be screened again for several years, while others with risk factors may need more frequent screening. Common risk factors can include age, family history of prostate cancer, and ethnicity.