Prostate Cancer Treatment and Survival Rate

July 1, 2024

This page was reviewed under our medical and editorial policy by Wesley Yip, M.D., assistant professor, Division of Urology and Urologic Oncology, Department of Surgery; Tanya Barauskas Dorff, M.D., professor, Department of Medical Oncology & Therapeutics Research; Jeffrey Y.C. Wong, M.D., professor, Department of Radiation Oncology; and Percy Lee, M.D., professor, Department of Radiation Oncology, City of Hope 

For men diagnosed with prostate cancer, many high-quality treatments are available. Members of the care team will work closely with patients, their loved ones and one another to create an advanced prostate cancer treatment plan for each patient that takes into account:

• The cancer’s stage (1, 2, 3 or 4)
• The type of prostate cancer
• Whether the cancer is newly diagnosed or recurrent
• The patient’s age
• The patient’s personal treatment preferences
• Any previous prostate cancer treatments
• Side effects of treatment, including those affecting mental health, urinary, sexual and bowel function
• The patient’s medical history, including any current health conditions
• The cancer’s risk group, meaning how likely it is to spread beyond the prostate

Treatment for Prostate Cancer

Prostate cancer treatments may include one approach or a combination of approaches, including monitoring, screening, drug therapy, surgery, radiation therapy or ablative therapy. Below are six treatment options for men who have been diagnosed with prostate cancer.

Active Surveillance for Prostate Cancer

Since many prostate cancers grow slowly, men whose cancer has not spread beyond the prostate gland may choose to forgo treatment in favor of monitoring and testing. This approach is called active surveillance, and it typically includes:

• A prostate-specific antigen (PSA) test every three to six months to see whether levels of the PSA protein have risen, which may indicate the disease is progressing
• A digital rectal examination (DRE) at least once a year to manually check the prostate for any abnormal areas, such as bumps or spots
• A biopsy of prostate tissue within six to 12 months of the original or previous biopsy, then every two to five years if the follow-up biopsy shows no signs of cancer progression or spread
• Imaging every one to three years

Men with early-stage prostate cancer deemed at low risk for spreading may choose active surveillance, especially if the doctor has advised them that the cancer should respond well to surgery or radiation therapy if it does begin to spread.

Some men also pursue an observation or “watch and wait” approach to prostate cancer. This may be an option if a man has advanced prostate cancer that continues to progress or if he has other health issues that affect his life expectancy. With a watch and wait approach, patients seek treatment for symptoms but do not have active surveillance testing done to check the disease’s progress.

Prostate Cancer Surgery

One of the most common prostate cancer treatments is surgery, which involves removal of the prostate gland and surrounding tissues. Surgery is also sometimes recommended to treat urination issues, one of prostate cancer’s main symptoms. Less commonly, it is done as a form of hormone therapy. Urologic oncologists, surgeons who specialize in treatment of urinary tract and male reproductive organ cancers, perform prostate surgery.

Below are the three main types of prostate cancer surgery.

Radical prostatectomy: Prostatectomies are either performed through an incision in the lower abdomen (open prostatectomy) or by inserting tools and a camera attached to a long, thin tube into small incisions in the abdominal wall (laparoscopic prostatectomy). In both types, the prostate gland, seminal vesicles (two tubelike glands that produce and store fluid for semen) and sometimes surrounding lymph nodes are removed.

Transurethral resection of the prostate (TURP): Prostate cancer patients sometimes have trouble urinating because the tumor is pressing on the urethra, which carries urine out of the body. TURP surgery involves passing a resectoscope (a thin tube with an attached camera and tool) through the penis and urethra into the prostate to remove tissue and relieve urination issues.

Bilateral orchiectomy: Bilateral orchiectomy is a procedure to remove both testicles to reduce levels of sex hormones (androgens) such as testosterone in the body (testicles produce most male androgens). Because of this, it is also considered hormone therapy treatment. While lowering androgens does help reduce prostate cancer cell growth and may even shrink the tumor, orchiectomies are uncommon today because other types of hormone therapy are considered less drastic and as effective.

Drug Therapy for Prostate Cancer

Hormone therapy, targeted drug therapy and immunotherapy mainly use pharmaceutical drugs to help treat prostate cancer.

Hormone therapy for prostate cancer deprives the body of sex hormones (androgens) like testosterone that help prostate cancer grow. It may be deployed at all stages of cancer to help slow or reverse tumor growth. Hormone therapy is sometimes called androgen deprivation therapy (ADT) and includes those listed below.

Luteinizing hormone-releasing hormone (LHRH) agonists: Examples of these drugs include leuprolide (Lupron Depot^®), goserelin (Zoladex^®) and triptorelin (Trelstar^®), and they are used to block signals that tell the testicles to produce testosterone. They are administered either by injection or by placing a patch under the skin.

LHRH antagonists: Also called gonadotropin-releasing hormone (GnRH) antagonists, these drugs stop the pituitary gland from making certain hormones that would normally trigger the testicles to make testosterone. They may be used for advanced prostate cancer and include relugolix (Orgovyx^®) given orally in tablet form and degarelix (Firmagon^®) given by injection, typically once a month.

Androgen receptor inhibitors: These drugs help stop testosterone from binding to androgen receptors in cancer cells and are used if the cancer grows despite lowered testosterone levels (known as castration-resistant prostate cancer or CRPC). They are taken orally. Examples include enzalutamide (Xtandi^®), apalutamide (Erleada^®) and darolutamide (Nubeqa^®).

Androgen synthesis inhibitors: Even though the testicles produce most of the body’s testosterone, cells such as adrenal gland cells or even prostate cancer cells may make some, too. The pill abiraterone acetate (Zytiga^®) is one example of a drug used today to stop this production. It blocks an enzyme called CYP17 and is typically given to treat either CRPC or high-risk prostate cancer.

In targeted therapy for prostate cancer, drugs go after different cell parts to help stop cancer cells from growing and spreading. For example, drugs called PARP inhibitors target defective cancer cell repair proteins to help stop their activity and destroy the cancer cells.

PARP inhibitor drugs may be used in certain types of prostate cancer where genes that normally repair cell DNA (such as BRCA1 and BRCA2) do not work correctly, especially if the cancer is resistant to hormone therapy or if it recurs (comes back). PARP inhibitors are capsules or pills taken daily or as prescribed. Examples of these drugs include:

• Olaparib (Lynparza^®)
• talazoparib (Talzenna^®)
• rucaparib (Rubraca^®)
• niraparib and abiraterone acetate (Akeega^™)

Immunotherapy for prostate cancer uses drugs that elevate a person’s immune system in order to help fight the disease. The following prostate cancer immunotherapy drugs are given via intravenous (IV) infusion.

Sipuleucel-T (Provenge^®): This is a cellular immunotherapy for prostate cancer that is made by taking a blood sample of a man’s white blood cells and mixing it with a specific prostate cancer protein to help trigger the body’s immune system to attack the cancer cells. It may be recommended for men with metastatic prostate cancer (cancer that has spread beyond the prostate) when the cancer is not responding to hormone therapy and the patient has few symptoms. It may prolong the patient’s life by several months. This medication may be referred to as a cancer vaccine; however, unlike most vaccines, sipuleucel-T does not prevent the disease.

Pembrolizumab (Keytruda^®) and dostarlimab (Jemperli^®): Some cancer cells are able to use immune system checkpoints (proteins made of immune cells) to spur the body not to launch an immune response against them. Pembrolizumab and dostarlimab are drugs that ensure a checkpoint called PD-1 is blocked so that the immune system is able to attack prostate cancer cells.

Prostate Cancer Chemotherapy

Chemotherapy uses drugs to destroy cancer cells and help patients live longer. It is typically given once prostate cancer has spread to other tissues and organs, particularly during Stage 4 prostate cancer.

Men diagnosed with advanced prostate cancer may be given chemotherapy drugs in combination with hormone therapy. For instance, docetaxel (Taxotere^®) is used for men who begin androgen deprivation therapy. It is usually the first chemotherapy drug used. Prednisone may also be prescribed with docetaxel to reduce inflammation and temporarily lower the patient’s immune response during treatment.

If docetaxel fails to stop prostate cancer from spreading, cabazitaxel (Jevtana^®) is often the next chemotherapy drug that doctors try. It may help reduce symptoms such as pain to improve quality of life.

Mitoxantrone (Novantrone^®) is another chemotherapy drug administered to reduce advanced prostate cancer pain, especially if other medications fail.

Carboplatin (Paraplatin^®) and cisplatin (Platinol^®) may be combined with docetaxel or cabazitaxel to treat extremely aggressive, advanced prostate cancer.

Most chemotherapy drugs are administered by intravenous (IV) infusion at a hospital, clinic or doctor’s office, although estramustine (Emcyt^®) is a pill that may be taken at home.

IV chemotherapy is given in cycles, which are typically three weeks long. It may be given once during a three-week cycle (followed by a period of rest) or more depending on the patient’s treatment plan and any side effects he experiences. Altogether, chemotherapy usually lasts for six to 10 cycles. 

Chemotherapy is one of several tools, used in sequence, to prolong life and improve quality of life by reducing cancer symptoms.

Radiation Therapy

Radiation therapy for prostate cancer destroys cancer cells using high-energy particles. It is used for the treatment of prostate cancer that is localized to the prostate gland and as an alternative to surgery. Radiation therapy is also used if prostate cancer recurs after surgery, sometimes referred to as salvage radiotherapy. Radiation therapy is also used to treat patients with metastatic disease, often in combination with other therapies. 

Three main types of radiation therapy are used for prostate cancer.

In external beam radiation therapy (EBRT), a radiation therapy technician uses an external device or machine to beam the particles into the patient’s body. EBRT includes:

3D conformal radiation therapy (3D-CRT), which uses computer mapping to create a 3D picture of the prostate, allowing for precise targeting of the gland with radiation therapy

Image guided intensity modulated radiotherapy (IG-IMRT), which is the most common form of external beam radiotherapy and has replaced 3D-CRT in most cases. IG-IMRT has at least two major advances over 3D-CRT. First, the treatment uses finer millimeter pencil beamlets of radiation that results in radiation therapy being much more confined to the prostate gland, significantly reducing side effects and risk. The second advantage is that the IG-IMRT treatment machine has built-in CT imaging for every treatment to account for daily motion of the prostate gland and to ensure the radiotherapy is on target.

Stereotactic ablative radiotherapy (SABR), which uses advanced computer imaging to deliver radiation therapy to the prostate in large doses over several days

Hypofractionated radiation therapy, which delivers a higher dose of radiation per day than is standard, over a shorter time period

Magnetic resonance imaging (MRI)-guided radiation therapy, which merges elements of SABR and 3D-CRT imaging abilities to target the prostate with radiation and also allows for images to be taken as the therapy is delivered

Proton beam therapy, which uses protons rather than X-rays (delivered in a similar manner to IG-IMRT), allowing for less tissue damage, comparable to IG-IMRT

The second type of radiation therapy is internal radiation therapy (brachytherapy), which uses radioactive pellets or seeds that are inserted into the prostate gland. These pellets give off low-dose radiation for several weeks or months or higher-dose radiation for a shorter period.

Radiopharmaceutical therapy, meanwhile, is used to target and destroy cancer cells that have spread beyond the prostate. Drugs such as lutetium Lu 177 vipivotide tetraxetan (Pluvicto^®), which have radioactive molecules, are inserted into the bloodstream by IV, destroying the cancer cells.

HIFU for Prostate Cancer

High-intensity focused ultrasound (HIFU), also called MRI-guided focused ultrasound (MRgFUS), is a type of ablative therapy, meaning it uses heat to destroy prostate cancer cells. This particular technique generates heat to destroy the cancer tissue by focusing beams of ultrasound waves onto it, guided by MRI. Unlike surgery or radiotherapy, it can treat only one portion of the gland, potentially reducing risks.

HIFU is a fairly new therapy in the United States, and it may be used as a primary treatment, or if prostate cancer has returned after being treated with radiation therapy.

Prostate Cancer Survival Rate

The five-year relative survival rate is the estimated percentage of patients expected to survive their cancer for five years, or more.

Below are the five-year relative prostate cancer survival rates for each stage of prostate cancer between 2013 to 2019, according to the National Cancer Institute.

• Localized (cancer is confined to the prostate gland): 100%
• Regional (cancer is confined to the prostate gland and surrounding lymph nodes): 100%
• Distant (cancer has spread to other parts of the body): 34.1%
• Unknown (cancer is not staged): 91.5%

Overall, the five-year relative survival rate for men diagnosed with prostate cancer is 97.1%, and 82% of cases are diagnosed at the localized or regional stages.

Screenings, such as DREs and PSA tests help doctors discover potential prostate cancer warning signs so that necessary treatments may begin right away. 

Read more about Stage 4 prostate cancer survival rates.