The treatment choices for prostate cancer depend on several things. These include your age, life expectancy, and overall health, as well as the size and location of the cancer. Choices also depend on lab test results, the cancer stage, and the risk assessment (such as very low risk and low risk) of the cancer. When prostate cancer is only in the prostate or has only spread to nearby areas, it's called early-stage prostate cancer. This means stage I and II, and some stage III prostate cancers. It's also called localized or local prostate cancer.

You may have questions and concerns about your treatment choices. For example, you may want to know if treatment will affect your urinary or sexual function. You may also want to know if you'll have to change your normal activities.

Your doctor is the best person to answer your questions. They can tell you what your treatment choices are, how successful they're expected to be, and what the risks and side effects might be. Your doctor may advise a certain treatment or a certain combination of treatments. Or they may offer more than one treatment, giving you a choice. This can be a hard decision to make. Each type of treatment has different benefits and risks. You may want to learn all you can about your cancer and your treatment choices so you can make decisions about your care.

Talk with your doctor to get answers to your questions. It's important to take the time to make the best decision for you.

The goal of active surveillance is to closely keep track of a cancer that is small and growing very slowly. The cancer will not likely do any harm for a long time, if ever. Active surveillance is done because the treatments for prostate cancer can cause more harm than living with the disease. This may be an option if you are younger in age and if the cancer is only in the prostate, doesn't cause symptoms, is lower risk, and isn't likely to shorten your life.

Active surveillance usually involves PSA tests, rectal exams, biopsies, and possibly an MRI scan done on a regular schedule. If the PSA starts to increase or the cancer starts growing faster or begins to cause symptoms, treatment can be started.

Another choice is watchful waiting, or observation. This may be a good choice for patients who are older, have a life expectancy of less than 5 years, have other health problems, and don't have symptoms of prostate cancer. It is a less aggressive way to keep track of prostate cancer. You may have a PSA test and physical exam 1 or 2 times per year. This choice doesn't usually include biopsies.

The main goal of surgery is to cure the prostate cancer by removing all the cancer cells. This surgery is called a radical prostatectomy. The prostate, nearby tissues, and seminal vesicles are removed. Pelvic lymph nodes may also be removed during the surgery.

Often the surgery is done using a less invasive surgical method called laparoscopic radical prostatectomy. It uses several small cuts (incisions) rather than a larger incision. This type of surgery may or may not use robot assistance. The surgery can also be done using one large incision, but the recovery is longer. The two most common but often temporary side effects of surgery are changes in your ability to hold your urine and your ability to have an erection.

Radiation therapy uses high-energy radiation from X-rays or other particles to kill or shrink cancer cells. There are two main ways to get radiation therapy.

• External beam radiation therapy (EBRT) sends radiation to the cancer from a source outside your body. For prostate cancer, a machine sends a beam of radiation to your prostate.
• Internal radiation, or brachytherapy, sends radiation to the cancer from a source inside your body. For prostate cancer, tiny radioactive metal seeds are placed into your prostate using thin, hollow needles.

Early-stage prostate cancer treatment may include EBRT alone, brachytherapy alone, or a combination of both types.

Cryotherapy, or cryosurgery, freezes and kills the cancer cells before they have a chance to spread. The doctor makes a tiny cut (incision) and puts a thin, metal, needle-like probe into the prostate so that the tip is at the tumor. The probe sends liquid nitrogen into the tumor to freeze the cancer cells. This isn't a common first treatment for prostate cancer.

This uses heat to treat prostate cancer. An ultrasound probe is placed into the rectum and sound waves are aimed at the prostate. It limits damage to normal tissue. This may not be an option for all people.

Hormone therapy usually is not used by itself for the treatment of early-stage prostate cancer. The goal of hormone treatment is to lower or block male hormones (also called androgens), such as testosterone, which can cause the cancer to grow.

Hormone therapy may involve hormone shots done once a month or 2 to 4 times a year. Another way is to have surgery to remove the testicles. (The testicles make most of a person's testosterone.)

Hormone therapy isn't a common treatment for early-stage cancer. It doesn't cure prostate cancer. It slows the cancer's growth. Still, hormone therapy may be used along with radiation therapy if:

• The cancer has grown outside the prostate but hasn't spread to other parts of the body (locally advanced prostate cancer).
• The cancer has a high risk of coming back after treatment.

At first, thinking about treatment choices may seem overwhelming. Talk with your doctors and loved ones. You may even want to think about getting a second opinion. Make a list of questions. Think about the benefits and possible side effects of each choice. Discuss your concerns with your doctors before you make a decision.