Treatment for Early-Stage Prostate Cancer

When you’re diagnosed with prostate cancer at an early stage, usually stage I or II, it means the disease hasn't spread outside your prostate gland. That means you have a few good treatment options to choose from.

It’s important to pick one that’s right for your condition and one that will give you the best quality of life. Talk with your doctor about the benefits and side effects of each type. Ask a lot of questions, so you can find the therapy that will give you the best results, with the fewest risks.

Doctors usually recommend three main types of treatment for prostate cancer in its early stages:

  • Watchful waiting or active surveillance
  • Surgery
  • Radiation therapy

Watchful Waiting and Active Surveillance

Prostate cancer often grows very slowly. You might not need to treat it right away -- or at all -- especially if you're older or have other health issues.

For some men, the treatments themselves have risks that are greater than the benefit of getting rid of the cancer. Watchful waiting may be an option in this case. It means you and your doctor will look out for symptoms and treat them if they start. The doctor may do tests from time to time to see if the cancer is growing.

Active surveillance might be a choice if the cancer is likely to grow very slowly, if at all, but you would still want to cure it if it does get worse. Your doctor will do tests, including PSA blood tests and rectal exams, usually about every 3-6 months to check on the cancer. You might also have a biopsy, where your doctor takes a small piece of tissue from your prostate and checks it under a microscope.

These options don’t mean that you ignore your cancer. Your doctor will keep a close eye on your health to be sure the disease doesn’t cause any problems for you. If it does, your doctor will talk to you about starting treatment.

Surgery

Because the cancer hasn’t spread beyond your prostate in stage I or II, surgery to remove the gland can sometimes cure the disease. The main operation doctors do is called a radical prostatectomy. The surgeon will remove the whole organ, plus some of the tissue around it.

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There are a couple of ways your doctor can do this:

Retropubic prostatectomy. This is the most common type of prostate surgery. A surgeon removes the prostate through a cut on your lower belly.

Perineal prostatectomy. The surgeon removes the prostate through a cut between your anus and testicles.

Doctors can also do prostatectomy through very small cuts in your pelvis using tiny tools. This technique is called laparoscopy, and the cuts are smaller than in the other operations. A surgeon can also use robotic arms to control the surgical tools and make more precise cuts, called robotic surgery.

Your surgeon will try not to damage nerves and other structures around your prostate during surgery, but sometimes, it’s not possible. If your cancer has spread to those nerves, doctors will have to remove them. If that happens, you might have side effects afterward, including:

  • A leaky bladder or trouble controlling your urine
  • Trouble getting or keeping an erection or having orgasms
  • Loss of your ability to get a woman pregnant

Radiation

Radiation therapy uses high-energy X-rays to kill cancer cells. You can get it in one of two ways:

External beam radiation therapy focuses X-rays on your prostate from a machine outside your body. The doctor will direct the radiation right to the gland and adjust the dose to target the cancer. The treatment takes just a few minutes, and it doesn’t hurt. You’ll probably go in to a clinic and get it 5 days per week for about 7 to 9 weeks.

Newer forms of this technique use tiny particles called protons instead of X-rays. Proton therapy better targets prostate tissue in hopes of causing less damage to other parts, but it's not available at many medical centers.

Brachytherapy uses small pellets, about the size of rice grains, which slowly give off low levels of radiation inside your prostate for a few weeks or months. Doctors will give you medicine to put you to sleep or make your body numb, then put the pellets in through thin needles. You may have to stay away from pregnant women and children during this treatment. Doctors can also give the radiation through small tubes that they place in your prostate for a few minutes at a time.

Your doctor will do everything possible to keep from harming the area around your prostate, but some men have side effects from radiation, such as:

  • Diarrhea, blood in their stool, and other bowel problems
  • Trouble controlling urination, or a leaky bladder
  • Erection problems
  • Feeling tired

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Other Treatments

Radiation and surgery are the main treatments for early-stage prostate cancer. But other options include:

Cryosurgery. This treatment uses very cold gas to freeze and kill cancer cells. Side effects include blood in your urine, bladder and bowel problems, and trouble getting an erection.

Hormone therapy. Male hormones like testosterone can make prostate cancer cells grow. If your doctor thinks your disease could come back after surgery, you might get therapy to stop your body from making those substances. Another type of hormone therapy prevents cancer cells from receiving testosterone. You might get it along with radiation treatments. Side effects can include a lower sex drive, erection problems, and bone thinning.

WebMD Medical Reference Reviewed by Laura J. Martin, MD on May 12, 2018

Sources

SOURCES:

American Cancer Society: "Prostate Cancer."

Horwich, A. Annals of Oncology, 2013.

National Cancer Institute: "Prostate Cancer PDQ." "Treatment Choices for Men with Early-Stage Prostate Cancer."

National Comprehensive Cancer Network: "Prostate Cancer: NCCN Guidelines for Patients."

Prostate Cancer Foundation: "Understanding Prostate Cancer--Treatment Options."

UpToDate: “Initial approach to low- and very low-risk clinical localized prostate cancer.”

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