Getting diagnosed with prostate cancer can feel overwhelming.
Some prostate cancers grow slowly and don’t need treatment right away. In those cases, doctors may recommend active surveillance, sometimes called watchful waiting, which means carefully watching the cancer over time. This often includes regular PSA blood tests and sometimes a prostate biopsy every year or two.
If treatment is needed, radiation therapy and surgery (called a prostatectomy) are the two most common choices. Both options can cure prostate cancer, but the best one for you depends on your health, age, and how far the cancer has spread.
Let’s break it down to help you feel more confident in your decision.
Understand your cancer
Before choosing a treatment for prostate cancer, your doctor will look at three key things:
- PSA level: This is a blood test that measures prostate activity. A low PSA is under 10, medium is 10–20, and high is over 20.
- Gleason score: This score shows how aggressive the cancer cells look under a microscope. The higher the number, the more likely the cancer is to grow or spread.
- Tumor stage (T-stage): This tells if the cancer is still inside the prostate or if it has spread. Doctors use a physical exam or MRI to find this.
Using these three results, your doctor will place you in a cancer risk group:
- Low risk: Cancer is small and slow-growing.
- Intermediate risk: Cancer might grow, but not quickly.
- High risk: Cancer may grow or spread quickly and needs treatment soon.
A good way to think about it:
- PSA is the alarm.
- Gleason score shows how serious the fire is.
- T-stage tells how far the fire has spread.
If your cancer is intermediate or high risk, your doctor may also recommend a special scan called a PSMA PET scan to check for cancer in other parts of the body.
Know your treatment options
Surgery (Prostatectomy)
- A surgeon removes the prostate gland and nearby tissues.
- Done in the hospital, usually with a few weeks of recovery.
- A small tube in the bladder, called a Foley catheter, may be needed for a short time to help you pee.
Radiation Therapy
- Uses high-energy x-ray beams to kill cancer cells.
- Painless, quick (about 15–20 minutes), and done as an outpatient.
- Different schedules are available, from daily for 6-8 weeks to just five sessions.
- Another type called brachytherapy places radiation directly into the prostate.
Before selecting a treatment for prostate cancer, meet with both a urologist (surgery expert) and a radiation oncologist (radiation expert). They can help you understand the pros and cons of surgery (prostatectomy) vs radiation. Even if you think you know what you want, keep an open mind and learn about both treatments!
Understand the side effects
Each treatment has different side effects. Knowing what to expect helps you prepare.
Surgery Side Effects
- Urine leaks
- Trouble with erections
- Infertility
- Small risk of infection or bleeding
- These usually improve over time with support from your care team
Radiation Side Effects
- Feeling tired
- Changes in bowel or bladder habits
- Very small extra risk of rectal cancer
These often start during treatment and fade afterward. Your doctor can help you understand which side effects are more likely based on your age, treatment type and overall health.
Think about your preferences and health
Consider the following:
- What is the best cure? Surgery or radiation are expected to both cure prostate cancer equally well in most cases.
- What happens if the cancer comes back? If, in the future, your doctor thinks the cancer has come back, there are “back up” treatment options for BOTH, no matter which treatment you chose.
- Timing: Surgery is a single procedure, but the active recovery still takes weeks. Radiation does require several days or weeks, but relative to a long healthy life, time flies!
- Invasive versus non-invasive: Some patients really want the cancer “out” whereas other patients prefer a treatment that doesn’t require a procedure. Radiation treatments take time, but most types allow you to avoid an invasive procedure.
- Side effects: Surgery does not usually impact bowel function but might have a greater effect on erections. Radiation very rarely causes incontinence but will cause more bowel irritation.
- If anti-testosterone medication is needed with radiation, some patients prefer surgery instead.
Take your time and ask questions
Unless your cancer is growing fast, you usually have time to decide. Don’t feel rushed.
- Bring a trusted friend or family member to your appointments
- Take notes and ask questions
- Getting a second opinion is okay
The most important thing is choosing the treatment that’s right for you.
You’re not alone
Radiation and surgery are both potentially curative options for treating prostate cancer. Your care team is here to guide you. Talk with your doctors, learn about your choices, and take the time you need.
Ready to take the next step?
Schedule a visit with a cancer expert to talk about your options and make a plan that fits your health, your lifestyle and your goals.