Learn  /  Prostate Cancer, Explained
Chapter 7

Treatment Overview

This chapter is general patient education from the book Prostate Cancer, Explained. It is not medical advice for your specific situation. Always discuss your care with your own doctor.

Chapter Opening — Robert's Story

Robert, 63, a retired firefighter, sat in his urologist's office staring at the words on the paper: "Gleason 3+4, Grade Group 2, PSA 8.2." His urologist recommended surgery. His neighbor, a prostate cancer survivor, swore by radiation. His brother-in-law told him to "just watch it." A coworker sent him a link to a clinic in another country offering a treatment he had never heard of.

Robert felt paralyzed. Three opinions, three different directions. He did not know whom to trust or where to begin.

Then his urologist did something that changed everything. He said: "Robert, I want you to see a radiation oncologist and a medical oncologist before you decide anything. I also want you to know — this is not an emergency. You have time to make a thoughtful decision."

Six weeks later, after seeing three specialists, getting a second pathology review, and attending a support group meeting, Robert made his choice with confidence. Not because one option was clearly "the best," but because he understood the trade-offs and chose the path that aligned with his values and priorities.

This chapter is about becoming Robert — informed, empowered, and in control of your journey.

Part 1: Your Cancer Care Team — Who Does What?

One of the first things you will notice after a prostate cancer diagnosis is that many different doctors and healthcare professionals become involved in your care. This can feel overwhelming, but each person plays a specific role. Understanding who they are and what they do will help you feel more in control.

Urologist

A urologist is usually the first specialist you see. Urologists are surgeons who specialize in the urinary tract and male reproductive system. They often perform your biopsy and are the ones who deliver the diagnosis. Some urologists specialize specifically in cancer (urologic oncologists), and these specialists typically perform radical prostatectomy (surgical removal of the prostate). Not all urologists perform prostate surgery — some focus on general urology (kidney stones, urinary problems, etc.), so it is important to know whether your urologist is also your surgeon or whether they will refer you to a surgical specialist.

Radiation Oncologist

A radiation oncologist is a doctor who specializes in treating cancer with radiation. This is a completely different specialty from surgery. Radiation oncologists design and oversee your radiation treatment plan. They work with a team that includes:

You may not meet all of these team members, but they are all working behind the scenes to ensure your treatment is safe and precise.

Medical Oncologist

A medical oncologist specializes in treating cancer with medications — including hormone therapy, chemotherapy, immunotherapy, and targeted therapies. For localized prostate cancer, you may not need a medical oncologist right away. However, if your cancer is more advanced, has spread, or requires systemic (whole-body) treatment, the medical oncologist becomes a central member of your team.

Pathologist

The pathologist is the doctor you will probably never meet in person, but who plays one of the most important roles in your care. Pathologists examine your biopsy tissue under a microscope and determine the Gleason score and Grade Group — the numbers that define how aggressive your cancer is. As we discussed in Chapter 4, pathology interpretation can be subjective, and second opinions on pathology can lead to meaningful changes in about 25–30% of cases.¹ ²

Radiologist

Radiologists are doctors who specialize in reading imaging studies — MRI, CT scans, PET scans, bone scans, and ultrasound. There are two types you might encounter:

Nurse Navigator / Oncology Nurse

Many cancer centers have nurse navigators — specialized nurses who help guide you through the healthcare system. They can help schedule appointments, coordinate between specialists, explain test results, and serve as your primary point of contact when you have questions. Oncology nurses also manage your care during treatment, monitor side effects, and provide education.

Other Important Team Members

Key Point: You are the most important member of this team. Every other person on this list works for you. Never hesitate to ask questions, express concerns, or request changes.

Your cancer care team
YOU the most important member UrologistSurgery & biopsy Radiation OncologistOversees radiation Medical OncologistDrug therapies PathologistReads your biopsy RadiologistReads your imaging Your wider support team Nurse Navigator Dietitian Physical Therapist Social Worker Psychologist Palliative Care Pharmacist Financial Counselor A strong team works together — and communicates with you.
You are the center of a team of specialists and support staff who work together.

Part 2: How to Choose Your Doctor

Choosing the right doctor is one of the most important decisions you will make. Here are the qualities to look for — what we call the 4 C's:

1. Compassion

Does the doctor listen to you? Do they treat you as a person, not just a diagnosis? Do they acknowledge your fears and concerns? A doctor who rushes through appointments, dismisses your questions, or makes you feel like "just another patient" may not be the right fit — no matter how skilled they are.

2. Competence

This includes training, experience, and outcomes. For surgeons, volume matters. Research consistently shows that surgeons and hospitals that perform more prostate cancer surgeries tend to have better outcomes — fewer complications, lower rates of positive surgical margins, better urinary and sexual function recovery, and even better cancer control.³ ⁴ ⁵ A systematic review in European Urology found that outcomes improve significantly at hospitals performing more than approximately 86 radical prostatectomies per year.³ For robotic surgery specifically, improvements in outcomes were seen up to about 100 procedures per year, beyond which there was marginal additional benefit.⁶ The NCCN Guidelines also state that high-volume surgeons in high-volume centers generally provide better outcomes.⁷

The same principle applies to radiation oncologists — experience with prostate cancer specifically, familiarity with the latest techniques, and a track record of good outcomes all matter.

It is perfectly appropriate to ask your doctor:

A confident, competent doctor will welcome these questions.

3. Communication

Can the doctor explain complex medical information in a way you understand? Do they use plain language or hide behind jargon? Do they encourage questions? Do they give you written materials or resources to review at home?

Good communication also means the doctor tells you about ALL your options — not just the one they provide. A surgeon should mention radiation as an alternative. A radiation oncologist should mention surgery. If a doctor only tells you about their own treatment, that is a red flag.

4. Commitment to Research

Doctors who are involved in research tend to be more up-to-date on the latest advances. They may also offer you access to clinical trials — which can provide cutting-edge treatments not yet widely available. This does not mean your doctor must be at a university hospital, but they should be aware of current evidence and guidelines.

The 4 C’s of choosing your doctor
C Compassion ✓ Listens without rushing✓ Acknowledges your fears✓ Treats you as a person✓ Welcomes your questionsSkill alone is not enough. C Competence ✓ Board-certified in specialty✓ High procedure volume✓ Shares outcomes openly✓ Knows your type of cancerVolume matters for outcomes. C Communication ✓ Explains in plain language✓ Discusses ALL options✓ Provides written materials✓ Available for follow-upOne option only? A warning sign. C Commitment to Research ✓ Aware of latest guidelines✓ Connected to clinical trials✓ Continuing education✓ Open to second opinionsCommunity doctors can excel too. The ideal doctor scores high in all four — and trust your gut.
Weigh compassion, competence, communication, and commitment to research together.

Academic Centers vs. Community Centers

Both have advantages:

The best approach for many patients is a combination — get your initial evaluation and second opinion at an academic center, then receive treatment closer to home if appropriate.

Trust Your Gut

Beyond credentials and statistics, the doctor-patient relationship matters. You will be working with this person for months or years. If something feels wrong — if you feel rushed, dismissed, or uncomfortable — it is okay to look elsewhere. Your comfort and trust in your doctor directly affect your experience and outcomes.

Part 3: Second Opinions — Your Right and Your Responsibility

Why Second Opinions Are Not an Insult

Many patients worry that seeking a second opinion will offend their doctor. The truth is the opposite: good doctors welcome second opinions. They understand that prostate cancer treatment decisions are complex, that multiple valid options often exist, and that patients deserve to hear different perspectives. If a doctor discourages you from getting a second opinion, that itself is a reason to get one.

When to Seek a Second Opinion

A second opinion is always reasonable, but it is especially important when:

Pathology Second Opinions

This deserves special emphasis. As discussed in Chapter 4, Gleason scoring involves a pathologist's subjective interpretation of tissue patterns. Studies show that when prostate biopsy slides are reviewed by a second expert pathologist, disagreements occur in approximately 26% of cases, and in about 7–8% of cases, the change is significant enough to alter treatment decisions — for example, changing a patient from a candidate for active surveillance to one who needs definitive treatment, or vice versa.² Another study found that pathology changes at a multidisciplinary center led to disease reclassification in 9% of patients, and overall, 28.7% of patients had a change in their NCCN risk classification, N stage, or M stage after comprehensive re-evaluation.⁸

A study specifically examining the impact on radiation therapy management found that secondary pathology review is critically important for accurate risk designation and treatment recommendations, particularly for patients with high-risk disease.¹

How to Get a Second Opinion

What to Bring to a Second Opinion

How to Handle Conflicting Opinions

It is common for different doctors to recommend different treatments. This does not necessarily mean someone is wrong. For many prostate cancers — especially intermediate-risk disease — surgery, radiation, and sometimes even active surveillance can all be reasonable options with similar long-term cancer control rates. The differences often come down to side effect profiles, recovery time, and how each option aligns with your personal priorities.

When opinions conflict:

The "Surgeon Recommends Surgery" Phenomenon

It is a well-known pattern in medicine: surgeons tend to recommend surgery, and radiation oncologists tend to recommend radiation. This is not because doctors are dishonest — it is because each specialist knows their own treatment best, has the most experience with it, and has seen its successes firsthand. A population-based study found that among patients recommended radiation as the only option by their community urologist, only 26% actually received it — suggesting that many patients were not fully informed about radiation as an option.⁸ When patients were evaluated at a multidisciplinary conference, concordance between the conference recommendation and the treatment actually received was 92%, compared to only 65% for community recommendations alone.⁸

This is precisely why seeing more than one type of specialist is so important.

Second opinions — when, why, and how
You received a diagnosis and a treatment plan Do any of these apply? If yes → get a second opinion • Only ONE option was offered• Intermediate-risk disease• Borderline pathology (3+4 vs 4+3)• A rare or aggressive variant• Something does not feel right• Confirm surveillance is safe GET A SECOND OPINION In-Person A different specialistBring all records& imagingBring a companion Virtual / Remote Many major centersoffer thisSend records onlineNo travel needed Pathology Review Send slides to a GUpathologistChanges 25–30%of cases Good doctors welcome second opinions. If yours discourages one, get one.
A second opinion is almost always worthwhile, and it can be done in person, remotely, or on pathology alone.

Part 4: The Multidisciplinary Clinic

What Is a Multidisciplinary Clinic?

A multidisciplinary clinic (MDC) is a setting where you see multiple specialists — typically a urologist, radiation oncologist, and sometimes a medical oncologist — in a single visit or on the same day. Instead of scheduling three separate appointments weeks apart, you get all perspectives in one coordinated visit.

Research shows that multidisciplinary team discussions can alter treatment plans in 25–50% of prostate cancer cases.⁹ At one major center, community recommendations differed from multidisciplinary recommendations in 22% of patients.⁸ MDT-based decision-making increases the likelihood of treatment according to guidelines and provides the best expert opinion based on interdisciplinary case evaluations.⁹

A recent population-based study from Ontario, Canada, found that despite the recognized importance of multidisciplinary management, significant gaps remain — only 41% of high-risk patients had radiation oncology consultations before treatment, and multidisciplinary care involving all three specialties (urology, radiation oncology, and medical oncology) was uncommon, occurring in only about 40% of high-risk cases.¹⁰

Tumor Boards

Even if you do not attend a formal multidisciplinary clinic, your case may be discussed at a tumor board — a regular meeting where doctors from multiple specialties review complex cases together. Tumor boards typically include urologists, radiation oncologists, medical oncologists, pathologists, and radiologists. They review your biopsy, imaging, and clinical information and arrive at a consensus recommendation.

You can ask your doctor: "Will my case be discussed at a tumor board?" If not, you can request it.

If Your Center Does Not Have a Multidisciplinary Clinic

Not every hospital has a formal MDC. If yours does not, you can approximate the experience by:

The Value of a "Quarterback"

With multiple doctors involved, it helps to have one physician who coordinates your overall care — your "quarterback." This might be your urologist, your radiation oncologist, or your primary care doctor. This person keeps track of the big picture, ensures nothing falls through the cracks, and serves as your main point of contact.

Part 5: The Big Picture — Treatment Categories at a Glance

Before diving into the detailed treatment chapters that follow, here is a brief overview of the main treatment approaches for prostate cancer. Think of this as a map — the detailed directions come in the next chapters.

Active Surveillance (Chapter 8)

Active surveillance means closely monitoring your cancer with regular PSA tests, imaging (usually MRI), and periodic biopsies — but not treating it right away. The goal is to avoid or delay treatment (and its side effects) for cancers that are growing slowly and may never cause harm. If the cancer shows signs of becoming more aggressive, treatment is started with the intent to cure. Active surveillance is the preferred approach for low-risk prostate cancer and is an option for some favorable intermediate-risk cancers.¹¹ ¹²

Active surveillance is NOT the same as "doing nothing." It is an active, structured monitoring program.

Surgery — Radical Prostatectomy (Chapter 9)

Radical prostatectomy means surgically removing the entire prostate gland, along with the seminal vesicles and sometimes nearby lymph nodes. It can be performed as open surgery, laparoscopic surgery, or (most commonly today) robot-assisted surgery. Surgery offers the advantage of removing the cancer entirely and providing a complete pathology specimen for analysis. The main side effects are urinary incontinence and erectile dysfunction, though both often improve over time.³ ⁷

Radiation Therapy (Chapter 10)

Radiation therapy uses high-energy beams to kill cancer cells. It can be delivered from outside the body (external beam radiation therapy, or EBRT) or from radioactive seeds placed directly inside the prostate (brachytherapy). Modern radiation techniques are highly precise and can be delivered in various schedules — from conventional daily treatments over several weeks to ultra-short courses of just five treatments (SBRT). Radiation therapy is an alternative to surgery with similar long-term cancer control rates for most risk groups. The main side effects involve urinary, bowel, and sexual function.

Focal Therapies (Chapter 11)

Focal therapies treat only the part of the prostate that contains cancer, rather than the whole gland. These include cryotherapy (freezing), HIFU (high-intensity focused ultrasound), and other emerging technologies. Focal therapies aim to reduce side effects by preserving healthy tissue. They are still considered investigational for most patients and are best suited for carefully selected cases.

Systemic Therapy (Chapter 12)

Systemic therapy refers to treatments that work throughout the entire body. These include:

Treatment options at a glance
YOUR DIAGNOSIS Watch & Wait Surgery Radiation Focal Therapy Systemic Active surveillanceRegular PSA, MRIChapter 8 ProstatectomyOpen or roboticChapter 9 External beamBrachytherapyChapter 10 Cryotherapy, HIFUSelect patientsChapter 11 Hormones, chemoTargeted, radioligandChapter 12 Most patients use one or two of these — your risk, health, and goals decide. Later chapters explore each path in depth.
Five broad treatment categories branch from a single diagnosis; each has its own chapter.

How Treatment Choice Depends on Multiple Factors

No single factor determines the best treatment. The decision depends on:

  1. Your risk group — very low, low, favorable intermediate, unfavorable intermediate, high, or very high
  2. Your life expectancy — based on age and overall health, not just age alone
  3. Your other medical conditions (comorbidities) — heart disease, diabetes, prior surgeries, etc.
  4. Your baseline function — how well your urinary, sexual, and bowel function are working BEFORE treatment
  5. Your personal preferences and values — what matters most to you in terms of quality of life
What determines the best treatment for you
Cancer Factors • Risk group (very low → very high)• Grade Group / Gleason• PSA level• Clinical stage (T, N, M)• Genomic test results• Imaging findings Patient Factors • Life expectancy (age & health)• Baseline function (EPIC-26)• Other medical conditions• Your personal preferences• Practical logistics• Family and support Shared decision-making Same cancer, different patients → different best choices.
The right treatment balances the cancer’s features against your own health and priorities.

Part 6: Baseline Function — Why It Matters Before You Treat

This is one of the most important — and most overlooked — aspects of prostate cancer treatment planning.

Why Measure Baseline Function?

Every treatment for prostate cancer can affect three key areas of function:

Here is the critical point: your function AFTER treatment is strongly related to your function BEFORE treatment.¹¹ A man who has excellent erections before treatment is more likely to recover erections after treatment than a man who already has erectile difficulties. A man who already has urinary problems may experience more urinary side effects.

This is why the NCCN Guidelines specifically recommend measuring baseline function using a standardized questionnaire — preferably the EPIC-26 — before any treatment decision is made.¹¹

What Is EPIC-26?

The EPIC-26 (Expanded Prostate Cancer Index Composite — 26 questions) is a validated questionnaire that measures your urinary, sexual, bowel, and hormonal function. It takes about 10 minutes to complete. Your scores provide a baseline that can be compared to your scores after treatment, giving you and your doctor an objective measure of how treatment has affected your quality of life.

We provided a sample EPIC-26 in Chapter 2. If you have not completed one yet, ask your doctor about it before starting treatment.

Other Important Questionnaires

Prehabilitation: Preparing Your Body Before Treatment

Just as athletes train before a competition, you can prepare your body before cancer treatment:

Part 7: Shared Decision-Making — Your Voice Matters

What Is Shared Decision-Making?

Shared decision-making (SDM) is a process where you and your doctor make treatment decisions together. It is not the doctor telling you what to do, and it is not you making the decision alone. It is a partnership.

The AUA/ASTRO Guidelines state that the selection of a management strategy for clinically localized prostate cancer is preference-sensitive and very often based on patients' interpretation of the balance between treatment-specific risks and benefits.¹² Randomized trials of SDM versus routine care have shown that patients engaged in SDM are more knowledgeable, have more realistic expectations, participate more actively in care, and more frequently arrive at decisions aligned with their personal preferences.¹²

The NCCN Guidelines emphasize that shared decision-making should include an explanation of the potential benefits and harms of each option, the likelihood of cure, recurrence, disease progression, and disease-specific mortality, as well as the predicted impact on quality of life.¹¹

What Should Your Doctor Discuss With You?

A thorough shared decision-making conversation should cover:

Bringing Someone With You

One of the most practical pieces of advice: bring a partner, family member, or trusted friend to your appointments. When you are anxious (and you will be), it is hard to absorb everything the doctor says. A second person can:

Recording Your Visit

Many patients find it helpful to record their doctor visits (audio recording on a phone). Most doctors are comfortable with this — just ask permission first. Having a recording allows you to review the information at home, share it with family members who could not attend, and catch details you may have missed.

It Is Okay to Take Time

For most localized prostate cancer, this is NOT an emergency. You typically have weeks to months to make a thoughtful decision. Studies show that reasonable delays (4–6 weeks, sometimes longer) between diagnosis and treatment do not worsen outcomes for localized disease. Rushing into a decision you are not comfortable with helps no one.

That said, do not delay indefinitely. Set a reasonable timeline — perhaps 4 to 8 weeks — to gather information, see specialists, get second opinions, and make your decision.

Decision Aids and Worksheets

Several tools exist to help you organize your thoughts and compare options:

Part 8: Clinical Trials — Should You Consider One?

What Is a Clinical Trial?

A clinical trial is a carefully designed research study that tests new treatments, new combinations of treatments, or new ways of using existing treatments. Clinical trials are how every treatment you have ever heard of was proven to work — including surgery, radiation, and every medication used in prostate cancer today.

The Phases of Clinical Trials

Clinical trials proceed through a series of phases, each designed to answer different questions:¹³

Common Myths About Clinical Trials

Myth: "I will be a guinea pig."

Fact: Clinical trial participants are among the most closely monitored patients in medicine. You receive more frequent check-ups, more testing, and more attention than patients receiving standard care. Strict ethical rules protect your safety, and you can leave a trial at any time.

Myth: "I might get a sugar pill (placebo) instead of real treatment."

Fact: In cancer clinical trials, you almost always receive at least the current standard of care. The experimental group typically receives standard care PLUS the new treatment. Pure placebo-only arms (where you get no treatment at all) are extremely rare in cancer trials and would be unethical when effective treatments exist.

Myth: "Clinical trials are only for people who have run out of options."

Fact: Many clinical trials are designed for newly diagnosed patients. Some of the most important prostate cancer trials enrolled men at the time of initial diagnosis. Participating early can give you access to promising treatments before they are widely available.

Myth: "If I join a trial, I cannot leave."

Fact: You can withdraw from a clinical trial at any time, for any reason, without penalty. Your regular care will continue.

How to Find Clinical Trials

Questions to Ask About a Clinical Trial

Clinical trial phases
Phase I Phase II Phase III Phase IV 20–80 people Up to a fewhundredDoes it work? Hundreds tothousandsBetter thanstandard care?GOLD STANDARD Thousands, afterapprovalLong-term safety& effectiveness Is it safe? Every treatment used today was once a clinical trial.
Trials climb from small safety studies to large trials that prove a treatment works.

Part 9: Navigating Conflicting Information

The Internet: Powerful Tool, Dangerous Trap

After a cancer diagnosis, it is natural to search the internet for information. This can be empowering — research shows that the majority of cancer patients use the internet to learn about their diagnosis and treatment, and many report that online research helps them feel more prepared for discussions with their doctors.¹⁴

But the internet is also full of misinformation. A systematic review and meta-analysis of 75 studies encompassing nearly 300,000 posts found that approximately 27% of cancer-related posts on social media contained misinformation, 21% contained potentially harmful information, and 12% contained commercial bias.¹⁵ Another study found that among the most popular social media articles on the four most common cancers, 32.5% contained misinformation and 30.5% contained harmful information — and articles with misinformation received significantly more engagement (likes, shares) than factual articles.¹⁶ Research confirms that inaccurate and misleading health-related posts on social media often get more views and engagement from users compared with accurate information.¹⁷

How to Evaluate Online Information

Use this simple checklist — think of it as a "traffic light" system:

🟢 GREEN LIGHT (Trustworthy Sources)

🟡 YELLOW LIGHT (Use With Caution)

🔴 RED LIGHT (Be Very Skeptical)

When Friends and Family Share Stories

After your diagnosis, well-meaning friends and family will share stories: "My uncle had prostate cancer and he just took supplements and he is fine." "My neighbor had surgery and he has been in diapers ever since."

These stories are almost never relevant to your specific situation. Every prostate cancer is different. Every patient is different. What happened to someone else — even a close relative — may have nothing to do with what will happen to you. Listen politely, but make your decisions based on your own medical team's advice and the evidence.

Discuss What You Find Online With Your Doctor

Your doctor would rather you bring questions from the internet than silently worry about something you read. If you find something concerning or confusing online, bring it to your next appointment. A good doctor will take the time to address it.

Part 10: Support Groups and Resources

The Value of Peer Support

A cancer diagnosis affects not just your body but your mind, your relationships, and your daily life. Connecting with other men who have been through the same experience can be profoundly helpful. Support groups offer:

National Organizations

Online Communities — Benefits and Cautions

Online forums and social media groups can provide 24/7 access to peer support. However, be cautious:

Caregiver and Family Support

Cancer does not just happen to the patient — it happens to the whole family. Partners, children, and close friends are also affected. Resources exist specifically for caregivers:

Part 11: Questions to Ask Your Doctor

The following questions are organized by situation. You do not need to ask all of them — choose the ones most relevant to you. Consider printing this list and bringing it to your appointments.

At Diagnosis

  1. What is my exact diagnosis — Grade Group, Gleason score, PSA, and clinical stage?
  2. What is my NCCN risk group?
  3. Do I need any additional tests (MRI, PET scan, bone scan, genomic testing)?
  4. Should I get a second opinion on my pathology?
  5. How much time do I have to make a treatment decision?

About Treatment Options

  1. What are ALL my treatment options — including active surveillance?
  2. What do you recommend, and why?
  3. What are the chances of curing my cancer with each option?
  4. What are the main side effects of each option?
  5. How will each option affect my urinary function? Sexual function? Bowel function?
  6. How long will treatment take?
  7. How long is the recovery period?
  8. Will I need additional treatments after the primary treatment (e.g., hormone therapy with radiation, radiation after surgery)?

About Your Doctor

  1. How many of these procedures do you perform each year?
  2. What are your personal outcomes and complication rates?
  3. Are you board-certified in your specialty?
  4. Is there a multidisciplinary clinic where I can hear from multiple specialists?

About Practical Matters

  1. Will my insurance cover this treatment?
  2. What will my out-of-pocket costs be?
  3. Are there clinical trials I should consider?
  4. How often will I need follow-up visits after treatment?
  5. Who should I call if I have problems or questions between appointments?
  6. Can you recommend a support group?

Part 12: Myth vs. Fact

Myth: "Surgery is always better than radiation."

Fact: For most localized prostate cancers, surgery and radiation provide similar long-term cancer control. The ProtecT trial, which randomized men to surgery, radiation, or active monitoring, found no significant difference in prostate cancer-specific mortality at 15 years of follow-up.¹⁸ The choice between them depends on side effect profiles, your anatomy, your baseline function, and your personal preferences — not on one being universally "better."

Myth: "If you have cancer, you need to treat it immediately."

Fact: Most localized prostate cancers are not emergencies. For low-risk and many favorable intermediate-risk cancers, active surveillance — carefully monitoring without immediate treatment — is the recommended approach. Even when treatment is chosen, taking 4–8 weeks to gather information, see specialists, and make a thoughtful decision does not worsen outcomes.

Myth: "Radiation makes you radioactive and dangerous to be around."

Fact: External beam radiation therapy does not make you radioactive. You can safely be around family, children, and pregnant women during and after treatment. With brachytherapy (radioactive seeds), there are minor temporary precautions, but the radiation levels are very low and the seeds are permanently implanted inside the prostate.

Myth: "Robotic surgery is always better than open surgery."

Fact: The robot is a tool — what matters most is the skill and experience of the surgeon using it. A highly experienced open surgeon may achieve better outcomes than an inexperienced robotic surgeon. That said, robotic surgery has become the dominant approach because it generally offers less blood loss, shorter hospital stays, and faster recovery.³ ⁷

Myth: "Only old men get prostate cancer."

Fact: While prostate cancer is more common in older men, it can occur in men in their 40s and 50s. Younger men with prostate cancer may have more aggressive disease and should be evaluated carefully. Age alone should not determine treatment — overall health and life expectancy matter more.

Myth: "Alternative treatments can cure prostate cancer without surgery or radiation."

Fact: No alternative therapy has been proven to cure prostate cancer. Some complementary approaches (exercise, healthy diet, stress reduction) can improve quality of life and may complement standard treatment, but they should never replace proven therapies. Delaying or refusing evidence-based treatment in favor of unproven alternatives can allow cancer to progress to an incurable stage. (See Chapter 14 for a detailed discussion.)

Part 13: Key Takeaways

Support Resources

References

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  3. 3. Bravi CA, Paciotti M, Sarchi L, et al. Robot-assisted radical prostatectomy: a systematic review and meta-analysis of comparative studies. Eur Urol. 2024;85(2):121–138.
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  6. 6. Leow JJ, Chang SL, Meyer CP, et al. Robot-assisted versus open radical prostatectomy: a contemporary analysis of an all-payer discharge database. Eur Urol. 2016;70(5):837–845.
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  10. 10. Hanna TP, Nguyen P, Gao Y, et al. Multidisciplinary management of prostate cancer: a population-based study. JAMA Netw Open. 2025;8(5):e2513413.
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  13. 13. National Institutes of Health. Learn about clinical studies. ClinicalTrials.gov. Accessed 2026.
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