The two main prostate cancer treatment paths

The two main prostate cancer treatment paths

  November 10, 2026    Stephen Cobb

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The eighth article in my 30-article series to raise money for prostate cancer research during November, 2026, describes what happens during the two main "radical treatment" options for prostate cancer.

(Note: I pledged to produce these articles, even though I am currently undergoing prostate cancer treatment, for a fundraising pledge which you can donate to here. Please consider doing so and sharing a link to this blog (CobbsBlog.com) on social media.)

Prostate Removal Surgery or Radiotherapy + Hormone-Ablation Therapy 

These are the two main pathways for treating prostate cancer, particularly when the cancer has not spread beyond the prostate itself. For brevity I am calling these options Surgery and RT+ADT for Radiotherapy and Androgen Deprivation Therapy (ADT) because ADT is the most common form of Hormone-Ablation therapy (it's those testosterone-crushing chemicals that I have described elsewhere).

Notice that the heading says surgery OR radiotherapy, not surgery VS. radiotherapy. As I described here, the probability of success is about equal for both pathways. Choosing between them begins with understanding them and their respective side effects and implications, addressed in this article. In my own experience I found that my urologists did not try to influence my decision one way or the other, which I appreciated.

Surgery

Surgery involves removing the prostate (radical prostatectomy). The entire prostate gland is taken out, usually along with the seminal vesicles (their job ito produce much of the fluid in semen). The goal of surgery is straightforward: remove the cancer before it spreads elsewhere. Modern procedures often use robotic assistance, allowing surgeons to operate with great precision. 

However, the prostate sits in a crowded and sensitive part of the male anatomy, to say the least. It is surrounded by nerves, blood vessels and structures essential to urination and sexual function. Removing it without disturbing these structures is difficult, even for highly skilled surgeons. 

While surgery can be very effective against cancer that has not spread, it can also produce lasting changes to the patient's body and quality of life. (I cover this in the blog post "Prostate cancer treatment: side effects and impacts.")

RT+ADT

Radiotherapy combined with androgen deprivation therapy (RT+ADT) takes a very different approach from surgery. Instead of removing the prostate, high-energy photon beams are precisely aimed at the gland to damage the DNA of cancer cells, preventing them from reproducing. 

For men with sufficiently significant disease, radiotherapy is often combined with androgen deprivation therapy (ADT), drugs that dramatically reduce the body's production of testosterone or block its effects. This is because testosterone encourages most prostate cancers to grow, so depriving the cancer of this hormone makes treatment more effective. 

However, as I quickly learned when I started taking ADT tablets, testosterone is not simply a hormone that makes men interested in sex. It plays an important role in physical strength, metabolism, bone health and mental wellbeing. Removing testosterone from your body will have consequences throughout the body. (I cover this in the blog post "Prostate cancer treatment: side effects and impacts.")

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