Prostate cancer is the second most common cancer in men, but advances in diagnosis and treatment have made outcomes better than ever. Many cases are detected at an early, localized stage, which means men often have more than one effective treatment option. The challenge is choosing the path that best matches the biology of the cancer and the patient's personal goals, whether that means preserving urinary control and sexual function, minimizing recovery time, or pursuing definitive removal of the gland.
At Atlanta Prostate Center, we focus on evidence-based, individualized care. This blog explains the four main approaches to prostate cancer management today: active surveillance, Pulsed Electric Field (PEF) Ablation, robotic prostatectomy, and radiation therapy. Understanding the benefits, limitations, and appropriate candidates for each will help you make an informed decision about your next steps.
Understanding Your Prostate Cancer Risk
Before discussing treatment, it's important to understand the factors that guide decision-making:
Gleason Score/Grade Group:
Gleason 6 (Grade Group 1) is considered low-risk.
Gleason 7 can be either 3+4 (favorable intermediate risk) or 4+3 (unfavorable intermediate risk).
Gleason 8-10 indicates high-risk disease.
Tumor Volume and Location: MRI and targeted biopsies show whether cancer is confined to one area or spread across multiple regions.
PSA and Clinical Staging: PSA levels, PSA density, and staging help assess aggressiveness. Genomic testing can add further insight.
Your personal values matter too. Some men prefer to avoid treatment side effects as long as possible, while others want definitive removal right away. These preferences should guide your choice as much as your lab results.
Active Surveillance for Low-Risk Prostate Cancer
Active surveillance is often the first recommendation for men with Gleason 6 prostate cancer and some with favorable Gleason 7 disease. Instead of immediate treatment, patients are monitored closely with regular PSA tests, MRIs, and sometimes biopsies.
The benefit is clear: you avoid side effects from treatment while your cancer is stable. If the cancer shows signs of progression, you can switch to an active treatment option such as PEF Ablation, surgery, or radiation.
The challenge is the psychological burden of "watching and waiting." It requires commitment to follow-up appointments and comfort with uncertainty. Still, for many men, active surveillance is a safe and effective starting point.
PEF Ablation for Prostate Cancer
Pulsed Electric Field (PEF) Ablation is one of the most exciting advances in prostate cancer care. This non-thermal focal therapy uses precisely controlled electrical pulses to destroy cancer cells while sparing the surrounding nerves and structures that control urinary continence and sexual function.
Unlike heat-based treatments like HIFU or freezing therapies like cryoablation, PEF Ablation does not damage nearby tissues. That makes it especially promising for men who want effective cancer control without sacrificing quality of life.
Benefits of PEF Ablation
Organ-sparing treatment: Only the cancerous region is targeted, leaving the rest of the prostate intact.
Lower risk of side effects: Because surrounding nerves and sphincters are preserved, most men maintain urinary control and erectile function.
Fast recovery: The procedure is usually outpatient, with most patients resuming normal activities in a few days.
Future options preserved: If cancer returns or new lesions develop, you can still undergo surgery or radiation.
Who Is PEF Ablation Best For?
PEF Ablation is an excellent option for men with:
Gleason 6 (low-risk) prostate cancer who prefer treatment over surveillance.
Gleason 7 (3+4) disease that is localized and visible on MRI.
Select cases of Gleason 7 (4+3) where disease is still confined to the prostate.
Men who prioritize preserving continence, sexual function, and future treatment flexibility.
PEF Ablation is generally not appropriate for men with very large prostates, extensive multifocal disease, or high-risk cancer that extends beyond the gland.
Robotic Prostatectomy (RALP)
Robotic-assisted radical prostatectomy (RALP) remains the gold standard for men with high-grade or high-volume prostate cancer. Using minimally invasive robotic instruments, surgeons remove the entire prostate and, when necessary, nearby lymph nodes.
The main advantage of RALP is definitive treatment: you know the prostate is removed, and a complete pathology report confirms whether the cancer was contained or spread.
Benefits of Robotic Prostatectomy
Definitive removal: Offers the most certainty for aggressive cancers.
Full pathology: Postoperative results help guide any additional treatments.
Excellent cancer control: Especially when performed by high-volume, experienced surgeons.
Considerations
Surgery comes with risks, including temporary or permanent urinary incontinence and erectile dysfunction. Nerve-sparing techniques can improve outcomes, but results vary depending on cancer location, age, and baseline function. Recovery usually takes several weeks, with gradual improvement over time.
Radiation Therapy for Prostate Cancer
Radiation therapy is a non-surgical option that uses high-energy beams to destroy cancer cells. It is often recommended for men who are not surgical candidates or who prefer a non-operative approach.
There are several types:
IMRT (Intensity-Modulated Radiation Therapy): Delivered daily over several weeks.
SBRT (Stereotactic Body Radiation Therapy): Fewer, higher-dose treatments, often completed in about a week.
Brachytherapy: Placement of radioactive seeds directly into the prostate.
Benefits of Radiation Therapy
Radiation is highly effective across all risk levels and avoids incisions or anesthesia. It is also well tolerated by men with other health conditions.
Considerations
Side effects may include temporary urinary urgency, bowel changes, and gradual erectile dysfunction. Modern techniques such as rectal spacers reduce risks, and most men find symptoms manageable.
Comparing Prostate Cancer Treatment Options
Each treatment has its place depending on cancer grade, volume, and patient priorities:
Active Surveillance: Best for men with low-risk Gleason 6 disease who want to avoid overtreatment.
PEF Ablation: Ideal for men with Gleason 6 or favorable Gleason 7 who want targeted treatment with minimal side effects and fast recovery.
Robotic Prostatectomy: Best for men with high-grade or high-volume disease requiring definitive removal.
Radiation Therapy: A strong choice for men with comorbidities or those who prefer a non-surgical approach.
Conclusion
With modern imaging, advanced focal therapies like PEF Ablation, robotic surgery, and precise radiation options, prostate cancer treatment is more personalized than ever before.
For men with Gleason 6 or favorable Gleason 7 disease, PEF Ablation often provides the best balance between cancer control and quality of life. For men with high-grade or high-volume cancers, robotic prostatectomy offers definitive removal and clear pathology. For those who are not surgical candidates, radiation therapy delivers excellent results without an operation.
Contact us at Atlanta Prostate Center today for more information.
