So nothing below is an answer. It’s how you find the person who has yours — and how you walk into that appointment with better questions. Every link comes from a government health agency, a major medical center, a doctors’ professional body, or an established cancer nonprofit. No forums, no influencers, no one selling anything.

Start here

Finding — and checking — your doctor

How to tell if a source is any good

Before you believe anything — a website, a video, a forum post, this blog — ask:

  • Who runs it? A government health agency, a major medical center, a doctors’ professional group, or a long-standing cancer nonprofit is a decent start. Anyone else, be suspicious.
  • Are they selling something? A supplement, a device, a clinic, a “protocol,” a book. If money changes hands at the end, it’s an ad — even when it’s wearing a lab coat. That includes the websites of the companies that make the machines.
  • Is it current? Prostate cancer care changes fast. No date, no trust.
  • Does it promise? “Cure.” “Breakthrough.” “What your doctor won’t tell you.” Close the tab.
  • Is it one person’s story? Mine included. Stories are for feeling less alone. They aren’t evidence, and they aren’t your case.

The government’s own guides to spotting junk:

Understanding it

The posts are link-free on purpose — reading shouldn’t feel like a pop-up ad. The reading list lives here.

The tests and the numbers

Screening

I was diagnosed at 42, with no symptoms, because my doctor felt something during a routine physical. Read the guidelines, then ask your doctor what they mean for you.

Who’s on your team

Prostate cancer usually means more than one kind of doctor, and each one tends to see the world through their own tool. A surgeon leans toward surgery. A radiation oncologist leans toward radiation. That isn’t bad faith — it’s why you talk to more than one before you decide.

  • Urologist — usually the first stop. Does the biopsy, and the urologic oncologists among them do the surgery.
  • Radiation oncologist — plans and runs radiation, from external beam to seeds.
  • Medical oncologist — handles the drugs: hormone therapy, chemo, targeted therapy, immunotherapy. Becomes central if the cancer has spread or comes back.
  • Pathologist and radiologist — you’ll rarely meet them, but they read your biopsy and your scans. Second opinions on pathology are a thing, and worth asking about.

Read: Choosing a Cancer Doctor — ACS

Treatment, type by type

What your doctors are working from. Read it so you can follow along — not so you can overrule them. Which of these is even on the table depends on your risk group — PSA, Gleason / Grade Group, stage, and sometimes genomic tests and imaging.

The big picture first

Active surveillance

For many low-risk cancers, watching closely is the treatment: regular PSA tests, MRIs, and repeat biopsies, with treatment only if things change. It’s not “doing nothing,” and it lets you skip side effects you may never need to have. (Watchful waiting is a gentler version, usually for older men or those with other health problems.)

Surgery

A radical prostatectomy removes the whole prostate and the seminal vesicles, and sometimes nearby lymph nodes. Most are now done robotically through small cuts. The upside is that the pathologist gets the whole thing to study, and your PSA should drop to almost zero, which makes it easy to watch for a return. The trade-offs are mostly urinary leakage and erection problems — usually improving over months, not always all the way. This is what I had.

Radiation

Radiation can be a full alternative to surgery for cancer that hasn’t spread, a follow-up after surgery, or a way to treat spots where cancer has spread. It’s often paired with hormone therapy for higher-risk cancer. The main kinds:

  • External beam (IMRT) — beams aimed from outside, usually five days a week for several weeks.
  • SBRT — higher doses in about five sessions. CyberKnife is one brand of machine.
  • Proton therapy — a different particle, not proven better than modern X-ray radiation for prostate cancer, and often harder to get covered. Ask why, specifically, it would be better for you.
  • Brachytherapy — radioactive seeds or temporary sources placed inside the prostate.
  • Radiopharmaceuticals — a radioactive drug that travels through your blood to find cancer that has spread, like Pluvicto (which targets PSMA) or Xofigo (for bone). Usually for advanced cancer.

Read:

Focal and ablative therapy

Instead of treating the whole prostate, these destroy just the part with cancer: freezing it (cryotherapy), heating it with focused ultrasound (HIFU), and others. Fewer side effects is the pitch. The catch is less long-term data, and cancer can turn up in the parts that weren’t treated. Ask whether it’s being offered as standard care or as a study.

Medical oncology: the drugs

This is the medical oncologist’s world. These are mostly for higher-risk cancer, cancer that has spread, or cancer that came back — and they’re changing fast.

  • Hormone therapy (ADT) — prostate cancer feeds on testosterone. ADT shuts it down, with shots, pills, or (rarely now) surgery. Newer pills like abiraterone, enzalutamide, apalutamide, and darolutamide block it further. It’s often paired with radiation and is the backbone for advanced disease. Side effects can include hot flashes, fatigue, lost libido, weight gain, and bone and heart effects — ask how they’ll be watched.
  • Chemotherapy — mostly docetaxel and cabazitaxel, for cancer that has spread, sometimes started alongside hormone therapy.
  • Targeted therapy — PARP inhibitors like olaparib, for men whose tumors or genes carry certain changes (BRCA1, BRCA2, and others). This is one reason genetic testing matters.
  • Immunotherapy — sipuleucel-T (Provenge) is a vaccine made from your own immune cells. Pembrolizumab is an option for a small number of tumors with specific genetic markers.
  • Radiopharmaceuticals — see Radiation, above. Your medical oncologist and radiation oncologist often share these.

Read:

If it comes back, or has spread

A rising PSA after treatment is called biochemical recurrence. It’s scary, but it isn’t the end of the road — there are second-line treatments, like radiation after surgery, and newer scans (PSMA PET) can find small spots earlier than older imaging could.

Clinical trials

Trials are how today’s standard treatments got here. You can join one at any stage, not just as a last resort.

After treatment

Every treatment above has side effects. The common ones after surgery and radiation are urinary leakage and erection problems, and both have real treatments — pelvic floor physical therapy, medication, devices, and surgery. Nobody wants to ask. Ask anyway.

Money and work

People, not pages

When you need a human:

Where I went

The soundtrack

None of this is medical advice. It’s a map — bring it to your own doctor, and then trust them.

Links last checked October 12, 2026.