Treatment Choices 

for Men

With Early-Stage 

Prostate Cancer

National Cancer Institute

U.S. Department 

of Health and

Human Services

National Institutes

of Health
Things to Remember

There are many men with prostate cancer who have been 

in your shoes. Here are some things they would like you 

to know:

n There are treatment choices—be sure to know them all.

n Treatments and medical procedures keep getting better.

n Make the treatment choice that is right for you.

n Get the opinions of several different doctors, since 

some may suggest only the option they know best.

n Take the time you need to research your treatment 

choices before making a decision. There’s often no need 

to rush.

n Your spouse or partner plays an important role in the 

treatment that you choose and will be affected by your 

choice. Try to be open and honest with each other 

about your concerns.

n Organizations and support groups can help you learn how 

others in your situation are coping with prostate cancer.

n It is possible to live a full life after prostate cancer.
Treatment Choices for Men 

With Early-Stage Prostate Cancer

3 Men . . . 3 Different Treatment Choices

“I talked it over with my wife and son. I chose 

radiation therapy because we thought it was 

the best choice for my situation.”

“When my doctor said he would follow me 

closely without treatment, I thought he meant 

that I should give up. But after he explained my 

stage of cancer, it made sense to me. Now I know 

that I can decide to have treatment later.” 

“My wife and I looked at the benefits and risks of 

each treatment. After talking with several doctors 

who specialize in prostate cancer, we decided 

that surgery was the best choice for me.”
1-800-4-CANCER (1-800-422-6237

Table of Contents

About This Booklet....................................... 1

Facts About Prostate Cancer......................... 3

Thinking About Treatment Choices ............. 4

Comparing Your Treatment Choices.......... 12

Choosing Your Treatment.......................... 25

Ways to Learn More ................................... 32

Words to Know .......................................... 35
www.cancer.gov

1

About This Booklet

As a man with early-stage prostate cancer, you will be able to choose 

which kind of treatment is best for you. And while it is good to have 

choices, this fact can make the decision hard to make. Yet, each choice 

has benefits (how treatment can help) and risks (problems treatment 

may cause). 

Treatment often begins a few weeks to months after diagnosis. While 

you are waiting for treatment, you should meet with different doctors to 

learn about your treatment choices. Use this booklet to help you talk over 

treatment choices with your doctor before deciding which is best for you. 

You will want to think about what is important to you. It’s also a good 

idea to include your spouse or partner in your decision. After all, having 

prostate cancer and the treatment choice you make affect both of you.

Words that may be new to you appear in bold type. For a complete list of 

Words to Know, see pages 35 to 38.

This booklet is a starting point.

Its purpose is to help you learn about early-stage 

prostate cancer, different treatments, and the 

benefits and risks of each type of treatment. Most 

men will need more information than this booklet 

gives them to make a decision about treatment. 

For a list of groups that provide more information 

and support, please see the Ways to Learn More 

section on page 32. Also, see that section if you have 

prostate cancer that has spread beyond the prostate 

or that has returned after treatment.
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What is the prostate? 

The prostate is a gland that helps make semen. Semen is the 

milky fluid that carries sperm from the testicles through the 

penis during ejaculation. The prostate is part of the male 

reproductive system.

The prostate is about the size and shape of a walnut. It has 

sections, which are called lobes. The prostate lies low in the 

pelvis, below the bladder and in front of the rectum. The 

prostate surrounds part of the urethra, the tube that carries 

urine out of the bladder 

and through the penis.
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Facts About Prostate Cancer

Early-stage prostate cancer means that cancer cells are found only 

in your prostate. Compared with many other cancers, prostate cancer 

grows slowly. This means that it can take 10 to 30 years before a prostate 

tumor gets big enough to cause symptoms or for doctors to find it. 

Most men who have prostate cancer will die of something other than 

prostate cancer. 

n Prostate cancer is most common in men age 65 and older, 

although younger men can be diagnosed with it as well. 

n By age 80, more than half of all men have some cancer in 

their prostate.

n African American men tend to be diagnosed at younger ages and 

with faster-growing prostate cancer than men of other races.

Prostate cancer is most often found in early stages. When it is found 

early, there are a number of treatment choices available.

“Once I had enough 

information, I was 

better able to choose 

a treatment for me.” 

—Ken
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Thinking About Treatment Choices

Active surveillance, surgery, and radiation therapy are the 

standard therapy choices for men with early-stage prostate cancer 

(see Types of Treatment, starting on page 8). Each has benefits (how 

treatments can help) and risks (problems treatment may cause). 

There is seldom just one right treatment choice.

The choice of treatment depends on many factors:

n Your prostate cancer risk group. Doctors use details about your 

cancer to place you into a low-, medium-, or high-risk group. 

•	 Low-risk prostate cancer is not likely to grow or spread for 

many years. 

•	 Medium-risk prostate cancer is not likely to grow or spread 

for a few years. 

•	 High-risk prostate cancer may grow or spread within a 

few years. 

Doctors define low-, medium-, and high-risk groups as follows:

*PSA stands for prostate-specific antigen (see page 6)

**ng/ml stands for nanograms per milliliter of blood

Reprinted with permission from:

1.Macmillan Publishers Ltd: Mazhar & Waxman. (2008) Nature Clinical Practice Urology 5: 486-493. 

2. The American Medical Association: D’Amico, et al. (1998) JAMA 280 (11):969-974. Copyright © 1998 

American Medical Association. All rights reserved.

4

PSA Level*

Gleason

Score

(see page 6)

Tumor Stage

(see page 7)

Low-Risk

Less than 

10 ng/ml**

6 or lower

T1 or T2a

Medium-Risk

10 to 

20 ng/ml

7

T2b

High-Risk

More than 

20 ng/ml

8 or higher

T2c
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5

n Health problems other than prostate cancer. Having heart problems, 

diabetes, or other illnesses may affect your treatment options.

n If you have already had surgery for an enlarged prostate. If you have 

had prostate surgery, this may affect the treatment choices you have.

n Age. The benefits and risks of different treatments may vary with age. 

n Type of care available to you. The skills and experience of specialists and 

types of treatment available in your area may vary. You will need to ask 

tough questions to make sure you receive the best possible care. See pages 

30 and 31 for questions to ask.

n Thinking about what you value most. Your unique experiences in life 

shape your feelings and thoughts about how to deal with prostate cancer. 

Keeping in mind what is important to you will help guide your decision.

Many men may ask their doctor, “What would you do, if you were me?” 

Try to remember, the doctor isn’t you, and his or her personal values may 

be different from yours. 

Here are some things to think about:

•	 How do you view the benefits and risks of the treatment choices that

have been offered to you? 

•	 Can you cope with knowing cancer is in your body?

•	 Would you rather have treatment to remove or shrink the cancer,

knowing that there could be side effects? 

•	 Do you know other men who have had prostate cancer? If so, their

experiences may help you make your decision.

n Spouse or partner. Even though the treatment choice is yours, involving 

your spouse, partner, or other loved ones can help you sort out what is 

most important to you and your family. 
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Medical Tests 

By now you may have had many tests and exams to find out details about your 

cancer. As we discussed on pages 4 and 5, your doctor will take into account 

your general health, the results of your tests and exams, and the Gleason score 

of your cancer when talking with you about your treatment choices. What are 

these tests? What do their results mean?

n Prostate-Specific Antigen (PSA) test. PSA is a protein that is made by 

both normal prostate cells and prostate cancer cells. PSA is found in the 

blood and can be measured with a blood test. Because the amount of PSA 

in the blood often rises with prostate cancer, doctors may check your PSA 

level over time. If you have a score of 4ng/ml (which stands for nanograms 

per milliliter of blood) or higher, your doctor may want to do other tests, 

such as a prostate biopsy.

n Gleason score of your cancer. When you have a biopsy, samples are taken 

from many areas of your prostate. A doctor called a pathologist uses a 

microscope to check the samples for cancer. He or she assigns a Gleason 

score on a scale of 2 to 10 to your cancer. This score tells how different the 

prostate cancer tissue looks from normal prostate tissue and how likely it 

is that the cancer will grow or spread. Most men with early-stage prostate 

cancer have a Gleason score of 6 or 7.

n Digital Rectal Exam (DRE). In this exam, your doctor feels your prostate 

by inserting a gloved and lubricated finger into your rectum.

Stages of Early Prostate Cancer

The clinical stage of your cancer is important in choosing a treatment. The 

clinical stage tells how much the cancer may have grown within the prostate 

and whether it has spread to other tissues or organs. If you decide to have 

surgery, your prostate, nearby lymph nodes, and seminal vesicles will be 

removed and samples of them studied under a microscope. This exam gives 

the pathologist the information he or she needs to find out the pathological 

stage to your cancer.
7

www.cancer.gov

Your doctor may do one or more of the following tests or exams to help figure 

out the stage of your cancer:

n DRE

n Prostate biopsy

n Bone scan

n MRI

Tumor Stages

T1 means that the cancer is so 

small it can’t be felt during a DRE. 

T1a and T1b cancer is most often 

found by accident, when men 

have surgery to relieve symptoms 

of BPH (which stands for benign 

prostatic hyperplasia). 

T1c is most often found when a 

prostate biopsy is done because of a 

PSA test result that showed a high 

PSA blood level. This is the most 

commonly diagnosed stage 

of prostate cancer. 

A stage of T2 means that prostate 

cancer can be felt during a DRE, 

but is still only in the prostate. 

Your doctor may also assign a, b, 

or c to the stage, depending on the 

cancer’s size and whether it is in 1 

or more lobes of the prostate.

Stage

T1a

Stage

T1b

Stage

T1c

Stage

T2

n CT scan

n Biopsy of the lymph nodes in the pelvis

n Biopsy of the seminal vesicles
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Types of Treatment

Active Surveillance 

Active surveillance is closely watching for any sign that the cancer may be 

growing or changing. You don’t have to decide on a treatment right away. 

You will have frequent doctor visits and tests, such as DRE, PSA tests, and 

biopsies. If these tests show that your cancer is growing or changing in any 

way, your doctor will offer you radiation therapy or surgery to treat the cancer. 

You can also change your mind and decide to have treatment at any time. 

Active surveillance used to be called watchful waiting.

Active surveillance can be used for men with early-stage prostate cancer 

because the cancer often grows so slowly that it may not cause problems 

during a man’s lifetime. For some men, active surveillance may be a way to 

avoid the side effects and costs of treatment without shortening their life. 

Surgery

Surgery is a treatment choice 

for men with early-stage 

prostate cancer who are 

in good health. Surgery to 

remove the prostate is called 

prostatectomy. There are 

different types of surgery for 

prostate cancer. They include:

n Open prostatectomy. 

Also called retropubic 

prostatectomy. In this 

surgery, your doctor 

removes the prostate 

through a single long cut 

made in your abdomen 

from a point below your 

navel to just above the pubic bone. He or she might also check nearby 

lymph nodes for cancer (see drawing below). This type of surgery can 

be used for nerve-sparing surgery. Nerve-sparing surgery lessens the 

chances that the nerves near your prostate will be harmed. These important 

nerves control erections and normal bladder function.

You may want to talk with your surgeon about 

techniques that may spare the nerves that 

control your bladder and erections.
9

www.cancer.gov

n Laparoscopic surgery. In this type of surgery, your doctor uses a 

laparoscope to see and remove the prostate. A laparoscope is a long 

slender tube with a light and camera on the end. This surgery is done 

through 4 to 6 small cuts in the navel and the abdomen, instead of a single 

long cut in the abdomen. The laparoscope is inserted through one of the 

cuts, and surgery tools are inserted through the others. A robot can be used 

to do this type of surgery. This type of surgery can also be used for nervesparing surgery.

n Perineal prostatectomy. In this type of surgery, your doctor removes the 

prostate through an incision between your scrotum and anus. With this 

method, the surgeon is not able to check the lymph nodes for cancer and 

nerve-sparing surgery is more difficult to do. This type of surgery is not 

used very often.

Radiation Therapy 

This type of treatment uses high doses of radiation energy to treat cancer. 

Radiation therapy is a good choice for many men with early-stage prostate 

cancer. It is also the best treatment for older men or those who have other 

health problems. There are different types of radiation therapy:

n External beam radiation. In this type of radiation therapy, a machine 

aims radiation at your cancer. The machine moves around your body, 

sending radiation from many directions. Before you start treatment, your 

doctor will map out the exact location of your prostate. Then you will have 

treatment once a day, 5 days a week, for 6 to 9 weeks. Each treatment 

session usually lasts about 15 minutes. 

3-D conformal radiation therapy is a type of external beam radiation 

that is often used to treat prostate cancer. It allows doctors to carefully 

plan the shape of the radiation beam so it targets the cancer more precisely, 

while avoiding healthy tissues nearby.

n Brachytherapy is a type of internal radiation therapy in which a doctor 

places radioactive material inside the prostate. Brachytherapy is a choice 

for men with low-risk prostate cancer. There are two main types of 

brachytherapy used for prostate cancer, low-dose rate (also called LDR) 

and high-dose rate (also called HDR).
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•	 LDR brachytherapy. In this type of brachytherapy, a doctor will 

place low-dose sources of radiation, or seed implants, throughout your 

prostate. Each seed implant is smaller than a grain of rice. The number 

of seeds will depend on the size of your prostate. The radiation will get 

weaker each day and run out in 2 to 10 months. Once the radiation 

is gone, the seeds will remain in your prostate, but they should not 

bother you. You will probably have the seeds implanted as an outpatient, 

without a hospital stay.

•	 HDR brachytherapy. Before treatment starts, a doctor will place tiny 

catheters (hollow tubes) throughout your prostate. For each treatment, 

the doctor will place 1 or more sources of high-dose radiation in 

the prostate through the catheters. Then, he or she will remove the 

radioactive material after a few minutes. The catheters will remain in 

place for the entire course of your treatment. But once you have received 

all of your treatments, the catheters will be removed. You will stay in the 

hospital or radiation clinic for the entire course of treatment.

External beam radiation therapy and brachytherapy can be used together. 

For more information about external beam radiation and 

brachytherapy, see Radiation Therapy and You: Support for People with 

Cancer, a booklet from the National Cancer Institute. You can order 

a free copy at www.cancer.gov/publications or 1-800-4-CANCER 

(1-800-422-6237).

New Treatments 

New treatments for prostate cancer 

are being studied in clinical trials, 

which are research studies with 

people. Clinical trials give people 

with any stage of cancer the 

chance to try a new treatment that is not yet available outside the trial. But until 

the clinical trials are complete, we do not know if the new treatments will be 

effective in the long-term. 

Until clinical trials are complete, 

we do not know if new 

treatments will be effective 

in the long-term.
11

www.cancer.gov

Some treatments that researchers are studying for early-stage prostate 

cancer include:

n Intensity-Modulated Radiation Therapy (IMRT). IMRT is a type of 

external beam radiation. It uses computers to deliver radiation precisely to 

the cancer. It also reduces damage to the healthy tissue nearby, such as the 

rectum and bladder.

n Proton beam therapy is also a type of external beam radiation. It uses 

protons rather than x-rays. The use of protons may allow a very high dose 

of radiation to reach the prostate while reducing the amount of normal 

tissue that is affected. 

n Cryosurgery (also called cryoablation or cryosurgical ablation) is a type 

of treatment that involves freezing the prostate to destroy cancer cells. In 

this type of treatment, the doctor delivers liquid nitrogen to the prostate 

through a special probe. The doctor inserts the probe into the prostate 

through an incision between the scrotum and anus. Sometimes, the doctor 

may also use needles to deliver liquid nitrogen to the prostate. He or she 

can insert the needles through the skin without making an incision.

For more information about these treatments and other clinical 

trials, visit www. cancer.gov/clinicaltrials or call 1-800-4-CANCER 

(1-800-422-6237).

A Note About Hormone Therapy

Male sex hormones, such as testosterone, can help prostate cancer grow. 

Hormone therapy slows prostate cancer’s growth by reducing the body’s 

ability to make testosterone or by blocking testosterone’s action in prostate 

cancer cells. 

Hormone therapy can play a role in treating early-stage prostate cancer. For 

men with high-risk early-stage prostate cancer, it may be used along with 

radiation therapy. You can also receive it instead of surgery or radiation if:

n You are in your 70’s or older or have other health problems

n Your cancer begins to change or grow while you are on active surveillance

Your doctor may suggest that you take hormone therapy for as little as 

6 months or up to many years. Side effects may include loss of sex drive, 

erectile dysfunction (also called ED), hot flashes, and osteoporosis.
1-800-4-CANCER (1-800-422-6237) 12

Comparing Your Treatment Choices

The charts on the following pages list 9 common questions and 

answers for the 3 treatment choices discussed in this booklet. As 

mentioned before, most men will need more information than 

found in this booklet to reach their decisions. You may use the 

questions in these charts as a guide for talking with your doctor 

or learning more about your choices. 

For answers

see pages:

13

14–15

16

17–18

19

20–21

22

23

24 

Questions:

1. Which treatment is a good choice for me?

2. What can I expect during treatment?

3. What are the benefits of each treatment?

4. What are the side effects and other drawbacks 

of each treatment?

5. How will this treatment affect my sex life?

6. What can be done to help with side effects?

7. Will I have pain?

8. Will I need other treatments?

9. How long can I expect to live after I have this 

treatment?
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13

1. Which treatment is a good choice for me?

n If your cancer is:

•	 low-risk (see page 4)

•	 smaller or a slow-growing type of prostate cancer

•	 in the prostate only

n If you are in your 70s or older, or have serious medical 

problems.

n If you are able to accept the fact that the cancer will remain 

in your body.

n If you can be careful about always going to your 

check-ups.

n If you are younger than 70 and in good health.

n If you want the cancer to be removed.

n If you are able to accept that you might have serious side 

effects. 

n If you are able to accept that you may still need radiation 

therapy after your surgery. 

n If you are a man of any age with early-stage prostate cancer.

n If you have serious health problems that do not allow you 

to have surgery.

n If you are able to go for treatment 5 days a week for up to 9 

weeks.

n If you have high-risk cancer (see page 4) that is less likely to 

be cured by surgery alone.

Active 

Surveillance

Surgery

Radiation

Therapy
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2. What can I expect during treatment?

n You will not start treatment right away.

n You will have frequent visits to the doctor.

n You and your doctor will watch for signs that the cancer 

may be changing or growing. You will have:

•	 Frequent DRE and PSA tests, usually every 3 months

•	 Biopsies every 1 to 3 years

n Surgery takes about 2 to 4 hours.

n Most patients stay in the hospital for 2 to 4 days.

n The doctor will remove the entire prostate, the seminal 

vesicles, and a small part of the bladder.

n External Beam Radiation

•	 Your doctor will figure out the dose of the radiation

to the cancer with the least damage to the normal 

tissue nearby.

•	 You will lie on a table while a large machine aims

radiation at your cancer. 

•	 You will have no pain or discomfort.

•	 You will have treatment once a day, 5 days a week, for

up to 9 weeks.

n Brachytherapy 

LDR brachytherapy

•	 Your doctor will insert radioactive seeds (each smaller

than a grain of rice) into the prostate or surrounding 

area. He or she will implant the seeds using hollow 

needles inserted through the space between the 

scrotum and the anus.

continued on next page

Active 

Surveillance

Surgery

Radiation

Therapy

14
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15

•	 You will be numbed below the waist or put to sleep.

•	 It takes an hour or so for the doctor to implant

the seeds.

•	 You will spend a total of 5 to 6 hours in the hospital

and should not need to spend the night.

•	 The seeds will stay in your body even after the

radiation is gone.

•	 While the seeds are giving off radiation you should

avoid being near children or pregnant women.

HDR brachytherapy

•	 A doctor will insert tiny catheters into the prostate

or surrounding area. 

•	 The doctor will deliver a radioactive source to the

prostate through the catheter and remove it after a 

short time.

•	 Most people have 3 treatments over 24 hours.

•	 You will remain in the hospital until you have

finished all of your treatments.

•	 Once you have finished your treatments, the

catheters will be removed.

Radiation

Therapy

continued
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3. What are the benefits of each treatment? 

n You will have no side effects. 

n Your doctor will follow you closely and you will have 

regular check-ups. 

n You can decide to begin treatment at any time. 

n The prostate cancer is removed by removing as much of the 

prostate as possible.

n External Beam Radiation

•	 You will not need to spend the night in the hospital.

•	 You will not need to be numbed below the waist or put

to sleep.

•	 You may have fewer problems with urination than if you

have surgery. 

n Brachytherapy 

•	 For LDR brachytherapy, you will not need to spend the

night in the hospital. 

•	 It can be easier on your body than surgery.

•	 There will likely be less damage to the rectum and

nearby tissue than with external beam radiation. 

Active 

Surveillance

Surgery

Radiation

Therapy

16
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17

4. What are the side effects and other drawbacks 

of each treatment?

n You may have feelings of worry and anxiety about living 

with cancer and putting off treatment.

n The cancer needs to be followed closely.

n You will have frequent tests, such as blood tests and biopsies.

n The cancer could spread and become harder to treat.

n There are risks with any major surgery, such as pain, 

bleeding, infection, heart problems, or death.

n It takes longer to recover than it does with radiation 

therapy.

n For 1 to 2 weeks after surgery, you will need to use a 

catheter (a hollow tube) to pass your urine.

n You may have problems with incontinence, which means 

you are not able to control the flow of urine. Managing this 

problem often means wearing pads, such as Depend® pads, 

to catch urine. The most common type of incontinence 

is passing a small amount of urine from the stress of 

coughing, laughing, or sneezing. A small number of men 

may have more serious incontinence that can last the rest 

of their life.

n Most men will have trouble getting an erection right after 

surgery, a problem called impotence, erectile dysfunction, or 

ED. This may improve over 1 to 2 years. Erectile dysfunction

may occur if the cancer is close to the nerves that control 

erections. If these nerves are damaged or removed during 

surgery, there is a strong chance that you will have problems 

with erectile dysfunction after surgery. Other factors that 

affect erectile dysfunction are your age, medicines you take, 

your hormone levels, other health problems, and how strong 

your erections were before surgery.

Active 

Surveillance

Surgery

continued on next page
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4. What are the side effects and other drawbacks 

of each treatment option? continued

n External Beam Radiation

During Treatment

•	 Fatigue (being very tired) toward the end of your course

of treatment

•	 More frequent and softer bowel movements

•	 Urinary problems, such as needing to go more urgently

and more often, especially at night

•	 Irritation or bleeding from your rectum

After Treatment

•	 You may develop erectile dysfunction within 5 years of

treatment. Half of the men who have radiation therapy 

will develop problems with erectile dysfunction that are 

like those seen with surgery.

•	 You may develop bowel problems, such as diarrhea,

trouble controlling bowel movements, and rectal bleeding. 

•	 You may feel discomfort in the bladder or rectal area.

•	 Your PSA may go up for a short time.

n Brachytherapy 

During Treatment

•	 More frequent and urgent need to pass urine

•	 More discomfort when passing urine

•	 Bowel problems, such as diarrhea, trouble controlling

bowel movements, and rectal bleeding 

After Treatment

•	 You may develop problems with:

–	 Emptying your bladder

– Dribbling of urine

–	 Erectile dysfunction, similar to that found with

surgery

Radiation 

Therapy
19

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5. How will this treatment affect my sex life? 

n It should not affect your sex life. 

n Surgery to remove the prostate can cause erectile 

dysfunction. Talk with your doctor about whether nervesparing surgery can be used to limit damage to the nerves 

that control erections. Medications and devices can help 

many men with erectile dysfunction (see page 20). 

n After your prostate is removed, your orgasm may be “dry,” 

which means that you will make little, if any, semen. If you 

want to have children in the future, you will need to bank 

your sperm before surgery. Banking your sperm means 

freezing it for future use. See Ways to Learn More on page 

32 for more information.

n You are just as likely to develop problems with erectile 

dysfunction as you are with surgery. But, these problems 

will develop 3 to 5 years after treatment, rather than right 

after. Your age and health can also affect problems you 

might have with erectile dysfunction. 

Active 

Surveillance

Surgery

Radiation

Therapy
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6. What can be done to help with side effects? 

n You will have no side effects

n For erectile dysfunction

•	 There are medicines you can take by mouth that can

increase blood flow to the penis, leading to an erection. 

They work best for men who have had nerve-sparing 

surgery. These medicines include:

– Sildenafil (Viagra®)

– Vardenafil (Levitra®)

– Tadalafil (Cialis®) 

•	 There are also medicines you can give yourself with a

shot into the penis. Once you give yourself the shot, it 

will take about 5 minutes to start working and the effect 

will last for 20 to 90 minutes. 

•	 If medicine you take by mouth or shots do not help you,

you should talk with your doctor about other choices. 

Other choices that may lead to an erection include:

– Medicated urethral system for erection, also called 

MUSE, in which you insert a small pellet into your 

urethra using an applicator.

– Vacuum erection devices, which use a vacuum tube 

connected to a pump to help produce an erection. 

The pump helps blood flow to the penis. 

– Penile implants, which are devices that are placed 

inside the penis through surgery. Implants can be 

firm rods or devices that inflate.

•	 You may need to try different treatments or

combination of treatments in order to find something 

that works for you.

n For incontinence

•	 Lack of bladder control may be severe for about 6 to 12

weeks after surgery. During this time, you will need to 

wear an absorbent pad, such as a Depend® pad. 

•	 Emptying your bladder often may help to control leaks.

Other choices for managing incontinence include 

collection devices, biofeedback, and surgery. 

continued on next page

Active 

Surveillance

Surgery

20
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21

•	 Collection devices consist of a pouch or condom-like

device that is securely placed around the penis. A drainage 

tube is attached at the tip of the device to remove urine. 

The drainage tube empties into a storage bag, which can be 

emptied directly into a toilet.

n Urinary problems

•	 Talk with your doctor or nurse if you have urinary

problems. He or she may refer you to a physical therapist 

who will assess your problem. The therapist can give you 

exercises to improve bladder control.

•	 Your doctor may prescribe medicines that can help you

urinate, reduce burning or pain, and ease bladder spasms. 

n For diarrhea

•	 Drink plenty of clear liquids. After you have a bowel

movement, clean yourself with moist wipes, instead of 

toilet paper. 

•	 Try eating smaller meals and snacks, instead of 3 large

meals. Also, eat foods that are easy on the stomach. Avoid 

fried, greasy, and spicy foods, and those that are high in 

fiber, such as raw fruits and vegetables.

For more information about dealing with problems caused by

radiation therapy, see Radiation Therapy and You: Support for People with 

Cancer, a booklet from the National Cancer Institute. You can order 

a free copy at www.cancer.gov/publications or 1-800-4-CANCER 

(1-800-422-6237).

Surgery

continued

Radiation

Therapy
22 1-800-4-CANCER (1-800-422-6237)

7. Will I have pain? 

n You will have frequent tests, such as blood tests and 

biopsies, which may cause some discomfort.

n Some men have little pain after surgery, but others need pain 

relief. There are medicines that can help control pain after 

surgery. Be sure to tell your doctor or nurse if you need help.

n External beam radiation therapy

•	 External beam radiation therapy itself does not cause

pain, but over time it can cause side effects that cause 

discomfort in the bladder or rectal area. If you do have 

pain, be sure to tell your doctor or nurse.

n Brachytherapy 

•	 You might feel mild pain where the seeds were implanted.

•	 You might feel burning or pain when you pass urine.

For more information about pain and how to manage it,

see Pain Control: Support for People with Cancer, a booklet 

from the National Cancer Institute. You can order a free 

copy at www.cancer.gov/publications or 1-800-4-CANCER 

(1-800-422-6237).

Active 

Surveillance

Surgery

Radiation

Therapy

Medicines can help with pain or discomfort. Be sure to talk with 

your doctor or nurse about your pain. 
23

www.cancer.gov

8. Will I need other treatments?

n If tests show that your cancer is growing or changing, you 

may need surgery or radiation therapy. If you do not want 

to go through surgery or radiation therapy, are older or have 

other health problems, hormone therapy may be a good 

choice for you.

n Your doctor might suggest you have radiation therapy after 

you have had surgery. 

n Within 5 years of surgery, the blood level of PSA will start to 

go up again in about 1 out of 3 men. If your PSA level begins 

to rise, it may be a sign that your cancer has come back. If 

that happens, your treatment choices may include:

•	 Active surveillance

•	 Hormone therapy

•	 Radiation therapy, especially if your PSA level is less than

1 ng/ml

n If you have high-risk cancer, hormone therapy may be used 

to shrink the prostate before radiation therapy. You might 

also take it for many years after radiation therapy.

n Within 5 years of radiation therapy, the blood level of PSA 

will start to go up again in about 1 out of 3 men. If your PSA 

level begins to rise, your treatment choices will most likely 

include active surveillance or hormone therapy. Less often, 

your doctor may suggest surgery or cryotherapy.

For more information about treatment choices or 

clinical trials for prostate cancer, visit NCI’s Web site at 

www.cancer.gov/cancertopics/types/prostate or call the 

National Cancer Institute’s Cancer Information Service 

toll-free at 1-800-4-CANCER (1-800-422-6237).

Active 

Surveillance

Surgery

Radiation

Therapy
24 1-800-4-CANCER (1-800-422-6237)

9.How long can I expect to live after I have 

this treatment? 

n Most men with early-stage prostate cancer can expect to 

have many healthy years ahead of them. The average age 

for men to learn they have early-stage prostate cancer is 

65 years. For all 3 treatments:

•	 Nearly all men will still be alive 5 years after treatment.

•	 86% of men will still be alive 10 years after treatment.

•	 56% of men will still be alive 15 years after treatment.

n	 Even if the cancer comes back, there are many treatments

that can help. 

Active

Surveillance, 

Surgery, and

Radiation

Therapy
25

www.cancer.gov

Choosing Your Treatment

Most prostate cancers found in the early stages grow slowly. This means 

that you usually do not have to rush to make a treatment choice. Often, 

you have many weeks to many months from the time you first learn you 

have prostate cancer until you have to make a choice. 

Many men use this time to find out more about the different types of 

prostate cancer treatment. Be sure to find all of the information you need 

to answer your questions and be comfortable with your decision. 

It may be helpful to use this extra time to attend a prostate cancer 

support group to talk with other men who have faced the same decisionmaking process. Think about calling the National Cancer Institute’s 

toll-free number to request contact information for prostate cancer 

organizations. See page 32 for ways to reach them.

Research shows that men feel better about their treatment choice when 

they take part in making their own treatment decision. Making this 

decision can be hard to do. The following are some ideas that may help.

Be prepared when you talk with your doctor.

n Ask Questions. Ask your doctor or nurse questions that you are 

thinking about, even if you are not comfortable asking them. These 

questions can be about topics that are new to you or side effects that 

concern you. Write your questions down and bring them to your 

doctor visit. (See pages 30 and 31 for ideas of questions to ask.)

I looked at all my choices 

and was comfortable with 

the decision I made. I took 

my time because I didn’t 

want to second-guess 

myself once it was all 

over. —Lawrence
1-800-4-CANCER (1-800-422-6237) 26

n Know your health history. Your doctor or nurse will want to know about 

your health history. This history includes your family history, whether you 

have already had prostate surgery, and whether you have any other illness, 

such as diabetes or heart problems. 

n Talk about your treatment choices. It’s important to ask your doctors 

about all the treatment choices that are open to you. This includes benefits 

(how each treatment can help) and long- and short-term side effects. 

n Take part in making a choice. Men who take an active part in their 

treatment tend to feel better about their treatment than men who let 

others decide for them. Let your doctor know how active you want to be in 

making this choice.

n Think about what is important to you. Keep in mind what’s important to 

you and what worries you. This is also a good time for you and your spouse 

or partner to have an open, honest discussion with each other about your 

treatment choices and their possible side effects.

n Ask a family member or trusted friend or caregiver to come to doctor 

visits with you. This person can help listen, ask questions, take notes, and 

talk with you about what your doctor or nurse said.

n Get a copy of your pathology report. Ask your doctor for a copy of 

this report and bring a copy with you when you see new doctors. Your 

pathology report includes the results of tests that describe details about 

your cancer. If you are seeing a new doctor, it’s important to bring all the 

information he or she requests to your visit. 

When I was first faced with 

this decision, I was so confused 

I wanted to put myself in the 

hands of an expert. But, I 

knew it was a decision I had to 

make. Getting more than one 

opinion helped me make an 

informed choice.—Paul
www.cancer.gov

27

n Get a 2nd or even 3rd opinion. Seeking other opinions means talking 

about prostate cancer treatment with other doctors. You may want to talk 

with other prostate cancer specialists, such as those listed at the bottom of 

this page.

Getting 2nd and 3rd opinions can be confusing because you may get 

different advice. Because of this, many men find it helpful to see a medical 

oncologist for a general view of prostate cancer treatment choices. Talking 

with other doctors can give you ideas to think about or help you feel better 

about the choice you are making. Most insurance companies pay for 2nd 

opinions. Some companies even require them. It is better to get a 2nd 

opinion than to worry that you made the wrong choice.

Many cancer centers allow men to meet with a urologist, radiation 

oncologist, medical oncologist, and pathologist in one visit. Check to see 

if your treatment center provides this type of care.

Types of Doctors 

Here is a list of types of doctors who treat prostate cancer: 

n Medical oncologist. A doctor who specializes in diagnosing and 

treating cancer using chemotherapy, hormone therapy, and biological 

therapy. This doctor is often the main health care provider for people 

with cancer. He or she can also treat side effects and may coordinate 

treatment given by other specialists. 

n Pathologist. A doctor who finds diseases by studying cells and tissue 

under a microscope. Although you won’t meet with this doctor, he or 

she writes up a pathology report, which contains the information about 

your cancer from your biopsy or prostate surgery. 

n Radiation oncologist. A doctor who treats cancer with radiation. 

n Urologic oncologist. A doctor who treats cancers of the urinary system. 

n Urologist. A doctor who treats diseases of the urinary system and male 

sex organs.
28 1-800-4-CANCER (1-800-422-6237)

Learning as Much as You Want to Know

Many men with prostate cancer find that it helps to learn a lot about their 

cancer and its treatment. Doing so can help you feel more in control and at 

ease with the treatment you choose.

You can learn more by reading books and articles, searching the internet, or 

calling organizations that focus on prostate cancer. But keep in mind that 

too much information can be overwhelming as you are adjusting to your 

diagnosis. Instead, learn as much as you want to know when you are ready. 

Later, you can always find out more. Let your doctor or nurse know what else 

you need to know to be comfortable reaching a decision. 

Some men want to read books and articles about the current research on 

prostate cancer treatment choices. Others prefer to meet with men in support 

groups who have had prostate cancer to learn how they made their treatment 

choices. Some men may not want to talk or think about it, at first. But later, 

they are they ready for more information. All of these approaches are natural 

ways to cope with a diagnosis of prostate cancer. 

To learn more about finding information on the internet see the 

fact sheet “How to Evaluate Health Information on the Internet” at 

http://www.cancer.gov/cancertopics/factsheet/Information/internet. 

Also see Ways to Learn More on page 32. 

Thinking About Your Feelings and Values

It’s normal to have many feelings at this time. You may have many strong 

feelings at once. You may feel overwhelmed or angry. Your spouse or partner 

will also feel a range of feelings, but not have the same ones at the same time 

as you do.

Finding out you have cancer can bring up fears of the cancer getting worse or 

of dying. You may also worry about changes to your body or being intimate 

with your spouse or partner. Many men describe a feeling of loss—loss of the 

life they had before cancer, loss of energy levels, or the physical loss of the 

prostate. These feelings are a normal part of the coping process. 
29

www.cancer.gov

Your spouse or partner may be worried about losing you, changes to your lives, 

and how to best give you the support you need. At first, your loved one may 

want to talk about it more than you do. If you find that you need time to adjust 

and sort out your feelings and values, let your spouse or partner and family 

know your needs. Chances are that they are also trying to cope with the news 

and may not know how best to help you. If you are holding your worries and 

feelings inside for too long and your silence is hurting you or your family, ask 

your doctor, counselor, or religious leader for suggestions about getting help. 

Reaching a decision about how you want to treat your prostate cancer is very 

personal—it is a balance of what is important to you, what you value the most, 

what types of treatment choices are available to you, and what the benefits and 

risks are.

Talking With Others

Along with talking with their 

doctors and spouse or partner, 

many men find it helpful to talk 

with others, such as:

n Family. This includes your 

relatives and close friends who 

care about you. They can support 

your treatment choice.

n Men who have faced prostate cancer. There is a lot to learn from other 

men who have faced these same prostate cancer treatment decisions. 

You may want to join a support group or meet with others to talk about 

the choices they made and what life is like now that treatment is over. 

Remember that while your stage of prostate cancer may be the same as 

someone else’s, your life and desires may be very different. 

n Others who can help. You may have other people in your life who can 

help. This may be a neighbor, counselor, social worker, or religious leader 

you like and trust.
30 1-800-4-CANCER (1-800-422-6237)

Asking Questions

You may find it helpful to ask the following questions:

n What is the clinical stage and Gleason score of my cancer? ______________

n Is my cancer low-, medium-, or high-risk?

Low-risk

Medium-risk

High-risk

n What treatment do you recommend?

Active surveillance

Surgery (What type of surgery? Can the nerves be spared? How often do 

you do this procedure?)

________________________________________________________________

________________________________________________________________

Radiation (What type of radiation? What can be done to reduce 

side effects?)

________________________________________________________________

________________________________________________________________

Other

________________________________________________________________

________________________________________________________________

n What are the short- and long-term side effects of this treatment?

___________________________________________________________________

___________________________________________________________________

n What are my chances of:

Becoming incontinent?___________________________________________

Developing ED? _________________________________________________

Having other bladder or bowel problems? ___________________________
31

www.cancer.gov

n What are the chances of the cancer coming back if I have this treatment?

___________________________________________________________________

___________________________________________________________________

___________________________________________________________________

n What are my chances of survival?

___________________________________________________________________

___________________________________________________________________

___________________________________________________________________

n May I have a copy of my pathology report? _____________

n If I want to have another pathologist look at my prostate biopsy results, 

how do I get the slides? 

___________________________________________________________________

___________________________________________________________________

___________________________________________________________________

Making a Choice

“Prostate cancer gives you the opportunity to make a deliberate, 

considered choice. In the majority of cases, the disease is very slow 

growing and is never a medical emergency. With prostate cancer, you 

have ample time to assess the situation, evaluate your particular needs 

and resources, and devise the most sensible, strategic plan of action.

Doctors can and should help you to understand your medical situation, 

but only you can decide what trade-offs you can tolerate, what level 

of risk you find acceptable, and which potential sacrifices you’re willing 

to make.” 

—Dr. Peter Scardino, Chairman of the Department of Urology, 

Memorial Sloan Kettering Cancer Center
1-800-4-CANCER (1-800-422-6237) 32

Ways to Learn More 

National Cancer Institute (NCI) 

You can find out more from these free NCI services: 

Call:	 1-800-4-CANCER (1-800-422-6237)

Visit: www.cancer.gov 

Chat: www.cancer.gov/livehelp 

Email: cancergovstaff@mail.nih.gov 

Free booklets that are available include: 

•	 What You Need To Know About Prostate Cancer

•	 Radiation Therapy and You: Support for People With Cancer

•	 Pain Control: Support for People With Cancer 

•	 When Someone You Love Is Being Treated for Cancer: 

Support for Caregivers 

Other Federal Resources 

Medicare 

Call:	 1-800-MEDICARE (1-800-633-4227)

Visit: www.medicare.gov 

National Kidney and Urologic Diseases 

Information Clearinghouse 

Call: 1-800-891-5390 

Visit: www.kidney.niddk.nih.gov
www.cancer.gov

33

Other Organizations 

American Cancer Society Man-to-Man Program 

This support group of the American Cancer Society offers advice on coping with illness and the side effects of treatment, along with newsletter archives and a directory 

of prostate cancer publications. 

Call: 1-800-ACS-2345 (1-800-227-2345)

Visit: www.cancer.org

American Urological Association Foundation 

The AUA Foundation supports research; provides education to patients, the general 

public, and health professionals; and offers patient support services for those who 

have or may be at risk for a urologic disease or disorder. The Foundation provides 

information on urologic diseases and dysfunctions, including prostate cancer treatment choices, bladder health, and sexual function. It also offers prostate cancer 

support groups (Prostate Cancer Network). Some Spanish language publications are 

available. 

Call: 1-800-828-7866 

Visit: www.urologyhealth.org

The Cancer Support Community 

Dedicated to providing support, education, and hope to people affected by cancer.

Call: 1-888-793-9355

Visit: www.cancersupportcommunity.org

Email: help@cancersupportcommunity.org

CancerCare 

CancerCare is a national nonprofit agency that offers free support, information, 

financial assistance, and practical help to people with cancer and their loved ones. 

Services are provided by oncology (cancer) social workers and are available in person, over the telephone, and through the agency’s Web site. A section of the CancerCare Web site and some publications are available in Spanish, and staff can respond 

to calls and e-mail in Spanish. 

Call:	 1-800-813-HOPE (1-800-813-4673)

Visit: www.cancercare.org
34 1-800-4-CANCER (1-800-422-6237)

Fertile Hope 

Fertile Hope is a national organization that provides reproductive information, 

support, and hope to cancer patients whose medical treatments present the risk of 

infertility. The organization offers fertility preservation financial assistance choices for 

patients. 

Call: 1-866-965-7205

Visit: www.fertilehope.org

Prostate Cancer Foundation 

The Prostate Cancer Foundation is a nonprofit organization that provides funding 

for research projects to improve methods of diagnosing and treating prostate cancer. 

It also offers printed resources for prostate cancer survivors and their families. The 

mission of the Prostate Cancer Foundation is to find better treatments and a cure for 

prostate cancer. 

Call:	 1-800-757-CURE (1-800-757-2873)

Visit: www.prostatecancerfoundation.org

Us TOO International 

Us TOO International Prostate Cancer Education and Support Network is a nonprofit education and support group organization with more than 325 chapters 

throughout the world. It provides men and their families with fellowship, peer counseling, and timely, personalized, unbiased, and reliable information about prostate 

cancer, enabling informed choices about detection, treatment choices, and quality of 

life after treatment. 

Call: 1-800-80-USTOO (1-800-808-7866)

Visit: www.ustoo.org
35

www.cancer.gov

Words to Know

3-D conformal radiation therapy (3-D kun-FOR-mul RAY-dee-AY-shun 

THAYR-uh-pee): A procedure that uses a computer to create a threedimensional picture of the tumor. This allows doctors to give the highest 

possible dose of radiation to the tumor, while sparing the normal tissue as 

much as possible. Also called 3-dimensional radiation therapy. 

Active surveillance (AK-tiv ser-VAY-lents): Closely watching a patient’s 

condition but not giving treatment unless there are changes in test results.

Anus (AY-nus): The opening of the rectum to the outside of the body.

Benign prostatic hyperplasia (beh-NINE prah-STA-tik HY-per-PLAY-zhuh):

A benign (not cancer) condition in which an overgrowth of prostate tissue 

pushes against the urethra and the bladder, blocking the flow of urine. Also 

called BPH.

Biofeedback: A method of learning to voluntarily control certain body 

functions such as heartbeat, blood pressure, and muscle tension with the help 

of a special machine. 

Biopsy (BY-op-see): The removal of cells or tissues for examination by a 

pathologist. He or she may study the tissue under a microscope or perform 

other tests on the cells or tissue. 

Brachytherapy (BRAY-kee-THAYR-uh-pee): A type of radiation therapy in 

which radioactive material sealed in needles, seeds, wires, or catheters is placed 

directly into or near a tumor. Also called implant radiation therapy, internal 

radiation therapy, and radiation brachytherapy.

Clinical stage: The stage of cancer that is based on all of the available 

information obtained before a surgery to remove the tumor.

Cryosurgery (KRY-o-SER-juh-ree): A procedure in which tissue is frozen to

destroy abnormal cells. Liquid nitrogen is used to freeze the tissue. Also called 

cryoablation and cryosurgical ablation.

CT scan: A series of detailed pictures of areas inside the body taken from 

different angles. The pictures are created by a computer linked to an x-ray 

machine. Also called CAT scan, computed tomography scan, computerized 

axial tomography scan, and computerized tomography.

Diagnosis (DY-ug-NOH-sis): The process of identifying a disease, such as 

cancer, from its signs and symptoms.
36 1-800-4-CANCER (1-800-422-6237)

Digital rectal examination (DRE): An examination in which a doctor inserts a 

lubricated, gloved finger into the rectum to feel for abnormalities. 

Ejaculation (i-JAK-yoo-LAY-shun): The release of semen through the penis 

during orgasm. 

Erectile dysfunction (ED) (ih-REK-tile dis-FUNK-shun): Not being able to have an

erection of the penis adequate for sex. Also called impotence. 

External beam radiation (RAY-dee-AY-shun): A type of radiation therapy that uses 

a machine to aim high-energy rays at the cancer from outside the body. Also called 

external radiation. 

Gleason score (GLEE-sun): A system of grading prostate cancer tissue based on how

it looks under a microscope. Gleason scores range from 2 to 10 and indicate how 

likely it is that a tumor will spread. A low Gleason score means that the cancer tissue 

is similar to normal prostate tissue and less likely to spread. A high Gleason score 

means that the cancer tissue is very different from normal prostate tissue and is 

more likely to spread. 

Hormone therapy: Treatment that adds, blocks, or removes hormones. To slow or 

stop the growth of certain cancers (such as prostate and breast cancer), synthetic 

hormones or other drugs may be given to block the body’s natural hormones. 

Sometimes surgery is needed to remove the gland that makes a certain hormone. 

Incontinence (in-KAHN-tih-nens): Inability to control the flow of urine from 

the bladder (urinary incontinence) or the escape of stool from the rectum (fecal 

incontinence). 

Intensity-modulated radiation therapy (IMRT) (in-TEN-sih-tee-MAH-juh-LAYtid RAY-dee-AY-shun THAYR-uh-pee): A type of 3-dimensional radiation therapy 

that uses computer-generated images to show the size and shape of the tumor. Thin 

beams of radiation of different intensities are aimed at the tumor from many angles. 

This type of radiation therapy reduces the damage to healthy tissue near the tumor. 

Laparoscopic prostatectomy (LA-puh-ruh-SKAH-pik PROS-tuh-TEK-toh-mee):

Surgery to remove all or part of the prostate with the aid of a laparoscope (a thin, 

lighted tube attached to a camera). 

Lobe: A portion of an organ, such as the prostate.

Lymph node (limf): A rounded mass of lymphatic tissue that is surrounded by a 

capsule of connective tissue. Lymph nodes filter lymph (lymphatic fluid), and store 

lymphocytes (white blood cells). They are located along lymphatic vessels. Also 

called a lymph gland. 
37

www.cancer.gov

MRI: A procedure in which radio waves and a powerful magnet linked to a computer 

are used to create detailed pictures of areas inside the body. These pictures can show 

the difference between normal and diseased tissue. 

Medical oncologist (MEH-dih-kul on-KAH-loh-jist): A doctor who specializes in

diagnosing and treating cancer usi ng chemotherapy, hormone therapy, biological 

therapy, and targeted therapy. A medical oncologist often is the main health care 

provider for someone who has cancer. A medical oncologist also gives supportive 

care and may coordinate treatment given by other specialists.

Medicated urethral system for erection (MUSE): A small pellet is inserted into the 

urethra using an applicator to help with erections. 

Milliliter (MIH-luh-LEE-ter): A measure of volume in the metric system. One

thousand milliliters equal one liter. Also called cc, cubic centimeter, and ml.

Nanogram: A measure of weight. One nanogram weighs a billion times less than one 

gram, and almost a trillion times less than a pound.

Nerve-sparing surgery: A type of surgery that attempts to save the nerves near the 

tissues being removed.

Osteoporosis (OS-tee-oh-puh-ROH-sis): A condition that is marked by a decrease in 

bone mass and density, causing bones to become fragile.

Pathological stage (PA-thuh-LAH-jih-kul stayj): The stage of cancer that is 

determined based on how the cells in the samples look under a microscope.

Pathology report (puh-THAH-loh-jee): The description of cells and tissues made 

by a pathologist based on microscopic evidence, and sometimes used to make a 

diagnosis of a disease. 

Pelvis: The lower part of the abdomen, located between the hip bones.

Perineal prostatectomy (PAYR-uh-NEE-ul PROS-tuh-TEK-toh-mee): Surgery to

remove the prostate through an incision made between the scrotum and the anus. 

Prostate (PROS-tayt): A gland in the male reproductive system. The prostate 

surrounds the part of the urethra (the tube that empties the bladder) just below the 

bladder and makes a fluid that forms part of the semen. 

Prostate cancer: Cancer that forms in tissues of the prostate (a gland in the male 

reproductive system found below the bladder and in front of the rectum). 

Prostate-specific antigen (PSA)(PROS-tayt-speh-SIH-fik AN-tih-jen) : A protein 

made by the prostate gland and found in the blood. Prostate-specific antigen blood 

levels may be higher than normal in men who have prostate cancer, benign prostatic 

hyperplasia (BPH), or infection or inflammation of the prostate gland. 
38 1-800-4-CANCER (1-800-422-6237)

Prostate-specific antigen (PSA) test: A blood test that measures the level of 

prostate-specific antigen (PSA), a substance made by the prostate and some other 

tissues in the body. Increased levels of PSA may be a sign of prostate cancer. 

Prostatectomy (PROS-tuh-TEK-toh-mee): Surgery to remove all or part of the

prostate. Radical (or total) prostatectomy is the removal of the entire prostate and 

some of the tissue around it.

Radiation Oncologist (RAY-dee-AY-shun on-KAH-loh-jist): A doctor who 

specializes in using radiation to treat cancer. 

Radiation therapy (RAY-dee-AY-shun THAYR-uh-pee): The use of high-energy 

radiation from x-rays, gamma rays, neutrons, and other sources to kill cancer cells 

and shrink tumors. Radiation may come from a machine outside the body (external 

beam radiation therapy). Or, it may come from radioactive material placed in the 

body near cancer cells (internal radiation therapy or brachytherapy). 

Rectum: The last several inches of the large intestine closest to the anus.

Reproductive system (REE-proh-DUK-tiv SIS-tem): The organs involved in

producing offspring. In men, it includes the prostate, the testes, and the penis.

Retropubic prostatectomy (re-tro-PYOO-bik pros-ta-TEK-toemee): Surgery to

remove the prostate through an incision made in the wall of the abdomen. 

Scrotum: In males, the external sac that contains the testicles.

Seminal vesicle (SEH-mih-nul VEH-sih-kul): A gland that helps make semen.

Standard therapy: Treatment that experts agree is appropriate, accepted, and 

widely used. 

Testosterone (tes-TOS-teh-RONE): A hormone made mainly in the testes (part

of the male reproductive system). It is needed to develop and maintain male sex 

characteristics, such as facial hair, deep voice, and muscle growth. 

Tumor: An abnormal mass of tissue that results when cells divide more than they 

should or do not die when they should. Tumors may be benign (not cancer) or 

malignant (cancer). Also called neoplasm. 

Urologist (yoo-RAH-loh-jist): A doctor who specializes in diseases of the urinary 

organs in females and the urinary and sex organs in males.

Watchful waiting (WACH-ful WAY-ting): Closely monitoring a patient’s condition 

but not giving treatment unless symptoms appear or change. It is used in conditions 

that progress slowly, are hard to diagnose, or may get better without treatment. 

NIH Publication No. 11-4659

Printed January 2011