Prostate cancer can be treated in many ways, not just with surgery. Thanks to medical advances, people now have several effective options that can control the disease, ease prostate cancer symptoms and protect quality of life. The best treatment plan depends on the stage of cancer, how fast it is growing, your age, and health conditions.
Understanding Tests and Treatment Choices in Prostate Cancer
From active surveillance to advanced therapies, knowing your options helps you make informed choices with your care team
Testing
Before treatment begins, doctors often use blood tests (PSA), a rectal exam, special scans, and sometimes a biopsy to understand the cancer. Newer scans, such as PSMA PET and MRI, can show tiny spots of cancer more clearly. Your team may also suggest genomic or biomarker testing on the tumour. These tests can reveal weaknesses in the cancer cells and help match you to the most effective therapy.
Active surveillance
For slow-growing, low-risk cancer, immediate treatment may not be necessary. Active surveillance means regular PSA tests, exams, scans, and sometimes repeat biopsies. The goal is to avoid side effects when treatment may not be needed yet, while staying ready to act if the cancer changes. This approach does not ignore cancer; it follows a careful plan.
External beam radiation therapy (EBRT)
Radiation can target the prostate from outside the body to destroy cancer cells.
- Image-guided and intensity-modulated radiation (IGRT/IMRT): Computers shape the radiation beams to match the prostate and spare healthy tissue.
- Stereotactic body radiotherapy (SBRT): Delivers higher doses in fewer sessions, often in about 1 to 2 weeks.
- Proton therapy: Uses protons instead of X-rays. It can reduce radiation to nearby tissues in some cases.
Common short-term effects include tiredness and mild urinary or bowel irritation. Many people continue daily activities during treatment.
Brachytherapy
Tiny radioactive seeds or temporary radiation sources are placed inside the prostate to treat the cancer from within. Brachytherapy can be used alone for lower-risk disease or combined with external radiation for higher-risk cases. Side effects can include urinary frequency or burning for a time after the procedure.
Focal therapies
If the cancer is small and well-mapped, focal treatments may target only the affected part of the prostate:
- High-Intensity Focused Ultrasound (HIFU): Uses focused sound waves to heat and destroy tumour tissue.
- Cryotherapy: Freezes cancer cells to kill them.
These options may reduce side effects compared to whole-gland treatment, but careful selection and close follow-up are essential.
Hormone therapy (androgen deprivation therapy, ADT)
Prostate cancer often needs male hormones, like testosterone, to grow. ADT lowers these hormone levels or blocks their action. It is commonly used when:
- Cancer is high-risk and is combined with radiation.
- Cancer has returned after earlier treatment.
- Cancer has spread beyond the prostate.
Newer hormone-blocking tablets (androgen receptor inhibitors) can add extra control. Possible side effects include hot flashes, fatigue, lower sex drive, and bone thinning. Doctors can help manage these effects with exercise, diet, vitamin D and calcium, and bone-strengthening medicines when needed.
Chemotherapy
When cancer spreads or stops responding to hormone therapy, chemotherapy drugs can slow it down and reduce prostate cancer symptoms like bone pain. These medicines are given in cycles, with rest periods between doses. Common side effects are tiredness, hair thinning, and lower blood counts, but supportive care has improved comfort and safety.
Immunotherapy
This treatment helps the body’s own immune system recognise and attack cancer:
- Cancer vaccine (sipuleucel-T): Made from a person’s own immune cells and used in some men with advanced disease and minimal symptoms.
- Checkpoint inhibitors: Work best when the tumour has certain features, such as high microsatellite instability (MSI-H) or high tumour mutation burden (TMB). Testing the tumour helps identify who may benefit.
Targeted therapy
Some prostate cancers carry changes in DNA repair genes (for example BRCA1/BRCA2 and other HRR genes). PARP inhibitors are tablets that exploit these changes to damage cancer cells while sparing many normal cells. Genetic and genomic testing guides whether targeted therapy is suitable for you.
Radiopharmaceuticals (radioligand therapy)
These are medicines that carry radiation directly to cancer cells:
- Radium-223: Targets cancer that has spread to bones and can relieve pain.
- PSMA-targeted therapy (for example, Lutetium-177 linked to a PSMA-binding molecule): Seeks out cells with PSMA on their surface and delivers radiation precisely where it is needed. A PSMA PET scan is typically used first to confirm the target.
People often feel less bone pain and may see PSA levels fall with these treatments.
Post-Treatment Care and Wellness
Whatever therapy you choose, good supportive care matters:
- Pelvic floor exercises can help with urinary control.
- Healthy eating, resistance training, and walking combat fatigue, protect bones, and support heart health during hormone therapy.
- Pain clinics, physiotherapy, and counselling improve day-to-day comfort and mood.
- Bone health checks and medicines may be used when needed.
Conclusion
Choosing the right treatment is a shared decision between you and your care team. It’s important to ask about the potential benefits, risks, side effects, and the impact on your daily life. Many patients also consider seeking a second opinion to feel more assured in their choice.
If you are in or around Pune, you can explore your options with an experienced oncologist in Pune who will also guide you on the availability of clinical trials. Leading cancer care centres like Onco-Life Cancer Centre provide personalised treatment plans that combine the latest non-surgical therapies, close monitoring, and comprehensive supportive care, helping you move forward with clarity and confidence.