Prostate Cancer: What Treatment Options Are Available as of 2026?

There isn't a single standard for prostate cancer—today's approach is to choose among active surveillance, robotic surgery, radiation therapy (including particle/proton therapy), hormone therapy, and targeted therapy depending on risk group (low, intermediate, high, or metastatic).

Key Takeaways

• Korea's 5-year relative survival rate for prostate cancer is 96.9%, up 37.7 percentage points from the group diagnosed in 1993–1995 (National Cancer Registration Statistics 2019–2023, National Cancer Center Korea Central Cancer Registry).
• Based on US SEER 2016–2022 data, the 5-year relative survival rate is 98.2%; both figures are nationwide statistics, not from any specific hospital.
• Korea has extensive experience with robotic prostatectomy, and particle (heavy-ion) therapy became available starting in 2023.
• Low-risk disease is one of the few cancers where active surveillance—monitoring at set intervals without treatment—is included as a standard option.
• For metastatic disease, the standard approach has become combining hormone therapy as the backbone with anti-androgens or chemotherapy from the start.

How do you choose among surgery, radiation therapy, and particle therapy?

• There isn't a 'better' option—there's a 'right fit' option. Treatment decisions combine PSA level, Gleason score (a scoring system based on two patterns showing how different cancer cells are from normal tissue, organized into Grade Groups 1–5) and stage into a risk group, then factor in age, life expectancy, and comorbidities.
• Robotic radical prostatectomy is widely used for localized prostate cancer surgery. Because it allows nerve-sparing manipulation within the narrow pelvis, it is known to be advantageous for recovery of urinary continence and erectile function. Hospital stays are typically 5–7 days.
• Intensity-modulated radiation therapy (IMRT) is the standard form of radiation therapy, delivered in divided doses over several weeks. Stereotactic body radiation therapy (SBRT) significantly reduces the number of sessions and is used when risk group and prostate size criteria are met.
• Particle (heavy-ion) therapy has been available in Korea since 2023 and typically completes in around 12 sessions for localized prostate cancer. Whether it can be used depends on prior radiation history, presence of artificial hip joints, and bowel/bladder condition. Proton therapy is also considered as one form of radiation therapy.

What drug treatments are considered for metastatic cases?

• For metastatic prostate cancer, hormone therapy is the backbone of treatment, and combining it from the start with stronger anti-androgens or chemotherapy has become the standard.
• Once hormone therapy stops working, other drug classes, chemotherapy, and radioligand therapy targeting PSMA (prostate-specific membrane antigen) are considered. If bone metastasis is present, bone-protective agents and pain-reducing radiation therapy are added.
• For advanced prostate cancer with alterations in DNA repair genes such as BRCA, matched targeted therapies are considered. Targeted therapy cannot be selected without test results, and is not an option if no mutation is present.
• That said, the goal at the metastatic stage is long-term control, not cure.

What is the sequence from diagnosis to treatment direction?

• Step 1: If PSA blood test is elevated or digital rectal exam shows abnormality, a prostate MRI is done first.
• Step 2: If a suspicious area appears on MRI, an MRI-fusion biopsy targeting that site is performed to obtain the Gleason score and Grade Group.
• Step 3: MRI confirms whether the prostate capsule has been invaded, and if risk is high, a bone scan or PSMA PET checks for metastasis.
• Step 4: PSA, Grade Group, and stage are combined to determine risk group, and direction is set among active surveillance, surgery, radiation therapy, and hormone therapy.
• Step 5: After treatment, PSA is measured at set intervals to check for recurrence.

FAQ — Is sexual function preserved after radiation therapy?

Radiation-based treatments are known to tend to show changes in sexual function later and more gradually than surgery. However, individual variation is substantial, and effects differ when combined with hormone therapy, so this is not something that can be assured for any individual.

FAQ — Can cancer that has spread to bone still be treated?

Metastatic prostate cancer can be managed long-term with hormone therapy as the backbone. Combining drugs from the start has become standard, along with bone-protective agents and pain-reducing radiation therapy. However, this is not a stage aimed at cure, and the duration of control varies by individual.

Sources and Notes

• This article was written based on National Cancer Registration Statistics 2019–2023 (National Cancer Center Korea Central Cancer Registry), US SEER 2016–2022, the National Cancer Information Center, and NCCN patient guidelines.
• This content is intended for general medical information purposes only. Diagnosis, treatment methods, and outcomes may vary depending on individual circumstances. Please consult with your medical team to determine accurate diagnosis and treatment.