Treatment decisions will be made by balancing treatment effectiveness with side effects.

There's no single "best way" to treat prostate cancer. Along with effectiveness and side effects, you and your doctor will consider your general health and the grade and stage of the cancer. (For information about how cancer is graded and staged, go to Prostate Cancer Key Point # 2) 

In general, treatment options include surgery, radiation, hormone therapy, watchful waiting, or a combination of these.  For all of them, the side effects of most concern are the possibility of impotence (inability to have an erection sufficient to have sex) and/or incontinence (difficulty or inability to control urination). 

Surgery involves removing all or part of the prostate.  If possible, the surgeon will use a technique called nerve-sparing surgery. It may save the nerves that control erection, reducing the possibility of impotence as a side effect.  But the size and location of the cancer may make this technique impossible.  Several types of surgery are possible, including:

• Radical retropubic prostatectomy: The entire prostate and nearby lymph nodes are removed through an incision in the abdomen
• Radical perineal prostatectomy: The entire prostate but no lymph nodes are removed through an incision between the scrotum and the anus; nearby lymph nodes are sometimes removed through a separate incision in the abdomen. This is the less common form of surgery.
• Transurethral resection of the prostate (TURP): Part of the prostate is removed using an instrument inserted through the urethra. This procedure may not remove all the cancer, but it does remove tissue that blocks urine flow.
• Pelvic lymphadenectomy: Lymph nodes in the pelvis are removed to see if cancer has spread to them. This may be done before the prostate is removed.

New, less invasive types of surgery are now being practiced successfully at various medical centers.  These include:

• Cryosurgery: This procedure uses an instrument that freezes and destroys abnormal tissues.
• Laparoscopic prostatectomy: The surgeon makes very small incisions and uses a laparoscope (a thin, lighted tube used to look at inside the body) and tiny surgical instruments and a tiny camera (to see the surgery on a video monitor) to remove the prostate. 
• Robotic laparoscopic prostatectomy:  In this advanced, computer controlled form of laparoscopic prostatectomy, robotic arms manipulate the tiny surgical tools. The surgeon controls their movements through a computer system that allows the surgery to be extremely precise. 
• Evidence indicates that this technique leads to faster recovery, less post-operative pain and smaller scars than traditional surgery.
• It may not be able to readily remove all lymph nodes as open surgery can.

Radiation therapy (also called radiotherapy) kills cancer cells using high-energy rays. There are two main types, and some men receive both:

• External radiation: A machine aims a beam of radiation at the cancerous area.  Newer forms of this treatment use advanced techniques to aim the radiation more precisely and spare normal tissue.
• Brachytherapy (also called radioactive seed implants, implant  radiation, or internal radiation or): Radioactive material is put into seeds, needles, or thin plastic tubes that are put directly into the cancerous area. Again, new, computer controlled systems allow for more precise placement of the radioactive material.   

Hormone therapy uses drugs and other techniques to stop the body from producing the male hormones (androgens) that help cancer cells grow or to stop those hormones from getting to cancer cells.  Some of the forms of hormone therapy are:

• Luteinizing hormone-releasing hormone (LH-RH) agonists: The main male hormone, testosterone, is manufactured mostly in the testicles. These drugs stop that process.
• Other anticancer drugs: The adrenal glands make small amounts of testosterone. These drugs stop that process.
• Antiandrogens: These drugs can block the effect of androgens or stop them from reaching the cancer cells.
• Orchiectomy (also called castration): This is an operation to remove the testicles, which manufacture testosterone.

Although hormone therapy can be effective for several years, eventually most prostate cancers are able to grow with very little or no male hormones. Research is now underway to develop new treatments (such as new antiandrogens) that will remain effective.

Watchful waiting, as its name implies, means doing very little actual treatment, but monitoring the prostate cancer closely and carefully.  This is possible because prostate cancer grows very slowly.  It is, therefore, especially useful for older men with less life expectancy, men who have other serious medical problems that lower their life expectancy, and men with the earliest stages of prostate cancer that appears to be growing slowly.  One might also choose this approach if the risks and possible side effects of other treatments seem to outweigh their benefits.