Prostate Cancer

Treatment Options

Once cancer is confirmed and graded on the Gleason Grading Scale, you and your urologist will discuss treatment options. Treatment approaches for prostate cancer range from prostate removal surgery, called prostatectomy, to non-surgical treatments such as radiation, brachytherapy, hormone therapy, and cryotherapy. The choice of prostate cancer treatment depends on factors such as how fast the cancer is growing, how much it has spread, your age and overall health.

Men whose cancer is detected while confined to the prostate gland have an excellent chance for successful treatment with minimal or short-term side effects.

Mayo Clinic physicians see several thousand men who have prostate cancer each year. That experience helps Mayo guide patients toward the most appropriate treatment approach. Physicians take great care to ensure patients understand the benefits and risks associated with each treatment option.

Mayo Clinic offers all treatment options for prostate cancer, including surgery (prostatectomy), external beam radiation therapy, brachytherapy, radioactive seed implants, hormone therapy, cryotherapy, and expectant management (also known as watchful waiting).

Surgery

Surgery is the mainstay of prostate cancer treatment. As a single treatment method — meaning that no radiation, chemotherapy or additional treatment is anticipated — surgery is an effective way to treat cancer confined to the prostate gland.

Mayo Clinic surgeons use great care and proven techniques to remove the prostate (radical prostatectomy) while making every effort to spare the muscles and nerve bundles that control urination and sexual function. Based on your preferences and medical needs, Mayo surgeons may pursue robotic prostatectomy or the more traditional open retropubic surgery. Read more about prostate surgery.

External Beam Radiation Therapy

Radiation therapy uses high-powered X-rays or other radiation to kill cancer cells. Cancer cells are generally more sensitive to the harmful effects of radiation compared to normal tissues. Radiation may be used to treat most stages of prostate cancer, with or without surgery, depending on each patient's overall health and cancer severity.

Mayo Clinic radiation oncologists and physicists have developed a method that uses special imaging devices to precisely track the internal movement of the prostate while daily radiation beam treatments are administered. Intensity modulated radiation therapy (IMRT) uses gold markers implanted in the prostate to allow radiologists to precisely guide radiation beams toward their intended target, reducing radiation exposure to the rectum and bladder. IMRT safely delivers more radiation to the prostate while sparing surrounding tissue, resulting in increased cure rates.

Radiation After Surgery

Radiation therapy is also commonly used after surgery to treat the prostate bed (the area formerly containing the prostate). Specialists examine the removed prostate under a microscope to determine whether any cancer cells possibly may not have been completely removed via surgery. If suspected traces of cancer are thought to remain, additional radiation therapy may be administered at some point following surgery.

Post-surgical radiation treatments reduce the chances that cancer will return. Treatment usually begins within two to three months following surgery and lasts for six to seven weeks. Radiation therapy also may be administered if the PSA level rises after surgery. At all times, the patient is considered to be a member of the treatment team and is involved in decision making.

Brachytherapy Radiation

Brachytherapy involves the implantation of rice-sized radioactive seeds into the prostate to destroy the cancer. In permanent prostate brachytherapy, implanted seeds are left in place, but their radioactivity decreases over time.

Hormone Therapy

When advanced prostate cancer can't be treated through surgery or other means, hormone therapy is an option. Hormone therapy reduces the supply of male sex hormones that make prostate cancers grow faster. In most cases, hormone therapy is not a cure but may help control prostate cancer.

Cryotherapy

Cryotherapy involves freezing the prostate gland, offering yet another cancer treatment alternative. Short-term results are encouraging, but long-term survival rates appear lower than with surgery or radiation.

Expectant Management

Expectant Management may be an option for men over 70, those in poor health, or men whose cancer is small and slow growing. (Expectant management was formerly referred to as watchful waiting.)