Treatment options for prostate cancer

A plain-language guide to active surveillance, surgery, radiation, hormone therapy and treatments for advanced prostate cancer, and how your team helps you choose.

6 min read · last reviewed September 30, 2026

When you learn you have prostate cancer, it's natural to want to act fast. But for most people there is time to learn about your choices, ask questions and decide together with your team. Often there is more than one good option.

Your team will tailor your plan to your cancer's risk group and stage, your age and general health, and what matters most to you. This guide explains the main treatments so you can take part in that conversation.

Who is on your team

You may meet a urologist (a surgeon who treats the prostate and bladder), a radiation oncologist, and a medical oncologist (a doctor who treats cancer with medicines). Nurses, pharmacists, social workers and physiotherapists are part of the team too. It's common, and a good idea, to talk with both a surgeon and a radiation oncologist before you choose.

Active surveillance

For many low-risk cancers, and some favourable intermediate-risk cancers, the best first step is careful watching. This is called active surveillance.

You have regular PSA tests and exams, MRI scans, and repeat biopsies from time to time. If the cancer shows signs of growing, you are offered treatment that aims to remove or destroy it. Many people on active surveillance never need treatment, or need it only years later. In the meantime, they avoid side effects like leaking urine and erection problems.

Watchful waiting is different. It is usually for people who are older or have other serious health problems. Tests are done less often, and treatment is aimed at easing symptoms if they happen, rather than removing the cancer.

Something you can do: If you're offered active surveillance, ask, "How often will I be checked, and what changes would make you recommend treatment?"

Surgery

A radical prostatectomy removes the whole prostate and the seminal vesicles. Nearby lymph nodes are sometimes removed too. It is most often done through small cuts with a robot-assisted method, and sometimes through one larger cut. You usually go home with a urinary catheter (a thin tube that drains pee) for a week or two.

Surgery is an option when the cancer hasn't spread outside the pelvis and you are healthy enough for an operation. The main side effects are leaking urine and erection problems. For many people these get better over months. Surgeons can sometimes spare the nerves that control erections.

Radiation therapy

Radiation uses high-energy rays to destroy cancer cells. There are two main ways to give it:

• External beam radiation comes from a machine outside the body. You lie on a table for a few minutes, usually on weekdays. A course can be as short as five visits or as long as several weeks, depending on your plan. It doesn't hurt, and you are not radioactive afterwards.
• Brachytherapy places a radioactive source inside the prostate. It can be tiny seeds left in place for good, or a source put in for a short time and then removed.

For intermediate- and high-risk cancers, radiation is often combined with hormone therapy for a few months or up to a few years. Radiation may also be used after surgery if PSA rises. Side effects can include needing to pee often, tiredness and bowel changes, and erection problems that may come on slowly over time.

Hormone therapy

Prostate cancer cells use male hormones, like testosterone, to grow. Hormone therapy, also called androgen deprivation therapy (ADT), lowers testosterone or blocks it from working.

• Medicines given as injections or implants, every one to six months, are the most common way.
• Surgery to remove the testicles (orchiectomy) is another option. It works quickly and permanently.
• Newer hormone medicines, such as abiraterone, enzalutamide, apalutamide and darolutamide, block the hormone signal in stronger ways. They are often added to standard hormone therapy when cancer has spread or is at high risk of spreading.

Hormone therapy can cause hot flashes, tiredness, lower sex drive, weight gain, muscle loss, thinning bones and mood changes. Exercise helps a lot. Your team will check your bones and heart health while you're on it.

When cancer has spread or comes back

If cancer has spread, or grows despite hormone therapy, there are more treatments. Many people live with advanced prostate cancer for a long time, moving from one treatment to the next.

• Chemotherapy, most often docetaxel, may be added to hormone therapy or used later.
• Radiopharmaceuticals are radioactive medicines given into a vein. Radium-223 targets cancer in the bones. Lutetium-PSMA seeks out cells that carry a marker called PSMA, found with a PSMA PET scan.
• PARP inhibitors, such as olaparib, are pills that may help if the cancer has certain gene changes, like BRCA.
• Immunotherapy helps a small number of people whose cancer has specific gene features.
• Bone-strengthening medicines, such as zoledronic acid or denosumab, help protect bones and lower the chance of fractures.
• Radiation to painful spots can ease bone pain quickly.

Clinical trials

Clinical trials test new treatments, or new ways to use current ones. Joining a trial can give you access to new options, with close follow-up. Trials aren't right for everyone, but it's always fair to ask.

Something you can do: Ask your team, "Is there a clinical trial that could be right for me?" You can also search ClinicalTrials.gov, which lists trials in Canada and around the world.

Making your choice

There is rarely one "right" answer. Think about how each option fits your life, and what side effects matter most to you. A second opinion is normal and won't upset your team. Bring a family member or friend to help you listen and remember.

Questions to ask your care team

• Which treatments are options for me, and which would you recommend? Why?
• Is active surveillance a safe choice for my cancer?
• What side effects could each option cause, and how long might they last?
• If I have radiation, will I need hormone therapy too? For how long?
• Could a clinical trial be right for me?
• How much time do I have to decide, and who can I call with questions?

This article is general information, not medical advice. Talk with your health care team about your own situation. In an emergency, call 9-1-1 or your local emergency number.

In an emergency, call 9-1-1 or your local emergency number.

General information, not medical advice. It does not replace your own care team. If you think you or someone else is having a medical emergency, call 9-1-1 or your local emergency number. If you are in crisis or thinking about suicide, call or text 9-8-8 (Canada and the US).

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