That next step boils down to choosing surgery vs. radiation. If the patient picks surgery, known as a radical prostatectomy, the entire prostate gland plus some surrounding tissue is removed, either through an incision in the abdomen or between the scrotum and anus. A variation of this technique attempts to spare the nerves on either side of the prostate that are necessary for erection. Once again, impotence or incontinence can result. So this is where the choice for the patient is tricky.
Surgeons recommend surgery, and radiologists prefer radiation.
All these choices must be made against the widespread perception that with prostate cancer, the cure can be worse than the disease. That is not true for most, particularly younger, men, but doctors acknowledge that a man in his 80s, particularly one with other medical conditions, would be best off choosing watchful waiting. Chances are, he will die before the tumor can kill him. For everyone else, doctors stress the need for annual screening, lots of information, and a knowledgeable specialist. Survivor support groups are also recommended, to help patients with the emotional issues surrounding the disease.