Prostate cancer treatment has expanded well beyond one-size-fits-all approaches. Patients now have a spectrum of options—ranging from established surgeries to innovative, targeted therapies—so care can be matched to the cancer’s characteristics and each man’s priorities. This article outlines standard treatments, likely side effects, promising advances, how clinicians decide on a plan, and the support services available during and after treatment.

Common treatment options

Surgery - Radical prostatectomy involves removal of the prostate gland and is frequently used for cancer confined to the prostate. Procedures may be done with traditional open techniques or with minimally invasive approaches such as laparoscopic or robotic-assisted surgery, which can reduce blood loss and shorten recovery time.

Radiation therapy - High-energy radiation destroys cancer cells and can be delivered externally (external beam radiation) or internally via brachytherapy, where small radioactive seeds are implanted directly into the prostate. Radiation regimens vary in dose and schedule depending on tumor risk and patient factors.

Hormone therapy - Also called androgen deprivation therapy (ADT), hormone therapy lowers levels of male hormones (androgens) that stimulate prostate cancer growth. It may be used alongside radiation for higher-risk disease or as the main therapy for advanced or recurrent cancer.

Chemotherapy - Systemic chemotherapy is reserved mainly for advanced or metastatic prostate cancer that no longer responds to hormone therapy. Chemotherapy circulates through the body to target cancer cells beyond the prostate.

How treatments can affect urination and overall health

Because the prostate surrounds the urethra and sits close to pelvic nerves, treatments often affect urinary and sexual function as well as general well-being. Common consequences include:

• Urinary incontinence: Leakage or loss of bladder control is more common after surgery and can also follow radiation. Severity ranges from occasional dribbles to more persistent issues.
• Urinary urgency and frequency: Many men experience a stronger, more frequent urge to urinate after treatment, which can interfere with daily activities.
• Urinary retention: Some treatments can make it hard to fully empty the bladder, sometimes requiring temporary catheterization or other interventions.
• Sexual dysfunction: Erectile dysfunction and diminished libido are frequent after surgery, radiation, or hormone therapy; nerve-sparing techniques and rehabilitation can help but may not fully restore function.
• Fatigue and systemic effects: Radiation and chemotherapy can cause pronounced tiredness; hormone therapy also produces metabolic and emotional side effects.

Clinicians address these problems with medication, pelvic floor (Kegel) exercises, bladder training, lifestyle adjustments (such as fluid timing and caffeine reduction), assistive devices, and referral to specialist physical therapists or sexual health programs.

Recent and emerging advancements

• Precision medicine: Genetic testing and molecular profiling of tumors enable more tailored therapies that target specific mutations or pathways in an individual’s cancer.
• Immunotherapy: Treatments that stimulate the immune system to fight cancer are under active investigation for prostate cancer. Some immunotherapies have shown benefit in select patients, and ongoing trials are expanding these options.
• Focal therapy: Instead of treating the whole gland, focal therapies (for example, high-intensity focused ultrasound or cryotherapy) target only the cancerous area, potentially lowering side effects while preserving quality of life.
• Advanced imaging: Multiparametric MRI and other imaging advances improve detection, staging, and treatment planning, helping clinicians target disease more accurately.
• Proton beam and other precision radiation modalities: These approaches can concentrate radiation on tumors while sparing nearby healthy tissue, which may reduce side effects for certain patients.

How treatment decisions are made

Choosing the most appropriate therapy involves a careful assessment of multiple factors:

• Cancer stage and grade: The extent of spread and tumor aggressiveness (Gleason score/grade group) are primary determinants of recommended care.
• PSA levels and kinetics: Absolute PSA and changes over time help evaluate risk and monitor response to treatment.
• Patient age and overall health: Comorbidities, life expectancy, and fitness for surgery or other interventions guide the intensity of treatment.
• Patient values and goals: Preferences about quality of life, tolerable side effects, and treatment intent (curative vs. palliative) are central to shared decision-making.
• Risk stratification tools: Nomograms and validated risk calculators help predict outcomes and recurrence probability, informing recommendations.

Multidisciplinary teams—urologists, medical oncologists, radiation oncologists, radiologists, pathologists, and specialist nurses—typically collaborate to create individualized plans.

Support services and rehabilitation

Comprehensive care includes support to manage physical, emotional, and practical challenges:

• Support groups: Peer groups provide emotional support and shared coping strategies.
• Psychological counseling: Therapists help patients and families navigate anxiety, depression, and adjustment to life changes.
• Nutritional guidance: Dietitians assist with appetite, weight management, and strategies to reduce treatment-related symptoms.
• Pelvic floor and sexual rehabilitation: Physical therapists and sexual health specialists provide targeted programs to improve urinary control and sexual function.
• Palliative care: For advanced disease, palliative teams focus on symptom control and quality of life.
• Financial counseling: Navigating costs, insurance, and treatment planning is made easier with professional financial advisors at many institutions.

Working closely with a care team and exploring available supports can markedly improve recovery and long-term quality of life.

This article is for informational purposes only and should not be considered medical advice. Please consult a qualified healthcare professional for personalized guidance and treatment.