Prostate cancer is one of the most commonly diagnosed cancers in men worldwide. Treatment planning is complex and must be individualized. In this article, we describe how is prostate cancer treated, covering the full spectrum from observation to advanced systemic therapies, and we explain scientific evidence, risks, benefits, and clinical decision factors.
Principles and Decision Factors in Treatment
Risk Stratification and Staging
A cornerstone of prostate cancer treatment is classifying disease by stage and risk group (based on PSA, Gleason grade, tumor volume).
Patient Factors and Preferences
Age, comorbidities, baseline urinary/sexual/bowel function, and quality-of-life priorities strongly affect choice of treatment.
Therapeutic Goals
Depending on stage, goals vary from curative intent to survival prolongation or palliative care.
Observation and Active Monitoring
Watchful Waiting and Active Surveillance
For low-risk prostate cancers, how is prostate cancer treated may often start with close monitoring rather than immediate intervention.
When Observation Is Appropriate
Candidates include those with low-risk disease, minimal symptoms, long life expectancy, and willingness to undergo regular testing.
Local Therapies: Surgery and Radiation
Radical Prostatectomy
Surgical removal of the prostate gland, often performed robotically, with risks of incontinence and erectile dysfunction.
Radiation Therapy
- External Beam Radiation Therapy (EBRT)
- Brachytherapy (seed implants)
- Stereotactic Body Radiation Therapy (SBRT) and Proton Therapy
Focal and Ablative Therapies
Examples: cryotherapy, high-intensity focused ultrasound (HIFU), and photodynamic therapy.
Androgen Deprivation & Hormonal Therapy
Rationale
Prostate cancer cells depend on androgens (testosterone, dihydrotestosterone) for growth.
Methods
- Surgical castration (orchiectomy)
- LHRH agonists/antagonists
- Antiandrogens and next-generation drugs (enzalutamide, abiraterone, apalutamide, darolutamide)
Role
Used with radiation, for metastatic disease, or as neoadjuvant therapy.
Side Effects
Hot flashes, sexual dysfunction, osteoporosis, metabolic syndrome, cardiovascular risks.
Chemotherapy, Immunotherapy & Targeted Agents
Chemotherapy
Docetaxel (first-line) and cabazitaxel (later line).
Immunotherapy & Radiopharmaceuticals
Sipuleucel-T, radium-223, and PSMA-targeted radioligand therapy.
Targeted & Novel Agents
PARP inhibitors, investigational therapies, and clinical trial options.
Combined and Multimodal Approaches
- Prostatectomy plus radiation
- Radiation plus long-term ADT
- Salvage therapy for recurrence
- Integration of systemic and local therapies in advanced disease
Treatment by Stage
Very Low / Low Risk
Active surveillance; surgery or radiation if chosen.
Intermediate Risk
Definitive therapy (surgery or radiation ± ADT).
High / Very High Risk
Multimodal therapy: surgery + adjuvant radiation or radiation + ADT.
Locally Advanced / Node-positive
Radiation + ADT, with or without surgery.
Metastatic
Systemic therapy backbone: ADT ± chemo/hormonal agents; local therapy for palliation.
Recurrent / Castrate-Resistant
Salvage local therapy, systemic drugs, immunotherapy, and clinical trials.
Side Effects, Quality of Life, and Supportive Care
Common Side Effects
Urinary, sexual, bowel, hormonal, and systemic complications.
Mitigation
Pelvic floor rehab, medications, bone health support, and lifestyle modification.
Monitoring
PSA follow-up, late toxicity management, survivorship care.
Current Research and Future Directions
- Biomarkers and personalized medicine
- PSMA radioligand therapy
- Immunotherapy combinations
- PARP inhibitors and genomic targeting
- Improved focal therapies
- De-intensification in low-risk disease
Summary
The answer to how is prostate cancer treated depends on stage, risk, and patient preference. Approaches include:
- Surveillance for low-risk disease
- Surgery or radiation for curative intent
- Hormonal therapy as a foundation in advanced cases
- Chemotherapy, immunotherapy, and targeted agents for refractory or metastatic disease
- Ongoing research driving toward more personalized, effective, and less toxic care.
Sources
- National Institutes of Health, Prostate Cancer Treatment (PDQ®)–Health Professional Version
- MD Anderson Cancer Center, Prostate Cancer Treatment
