Choosing a Treatment for Localized Prostate Cancer

A man diagnosed with localized prostate cancer generally has 3 major treatment options:

• Active surveillance
• Surgery
• Radiation therapy

Choosing a treatment is generally based on many factors, including how aggressive the cancer is, how far it has spread, your age and general health, and the risks and benefits of each treatment option.

Your doctor will assign your cancer into a “risk group,” meaning your risk of developing recurrent, aggressive prostate cancer. The most common system is defined by the National Comprehensive Cancer Network (NCCN) and is based on the PSA, rectal exam, and biopsy results. Your risk group guides your treatment options. Higher-risk cancers are at increased risk of spread outside the prostate at diagnosis and usually require more than one type of treatment.

Note: if you have been diagnosed with metastatic prostate cancer that has spread to distant organs or bones, please see Treatments for Metastatic Prostate Cancer. You will need to consider different types of treatment.

Each treatment plan has different risks and side effects. Ask your doctor to outline your risk for all possible outcomes of all possible treatment options before you select your path. For example, while one man might be more concerned about how quickly he can get back to work, another man might be more interested in maintaining long-term erectile function or urinary continence.

Ask your doctor which risk group your cancer is in and what your treatment options are. If you and your medical team have decided that active surveillance is not right for you, and you are deciding between radiation and surgery, you may find yourself feeling stuck or overwhelmed with the choice. Dr. Zachary Klaassen and Dr. Brian Chapin discuss factors to consider.

Last Reviewed: 12/2023