Prostate Cancer: The Decisions Men Describe as Hardest
Men treated for prostate cancer describe the biopsy, the choice between surgery, radiation and surveillance, and the side effects nobody discusses aloud.
· By The Editors · 3 min read
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Prostate cancer is unusual among cancers in that the hardest part, for many men, is not the disease. It is choosing between treatments with similar survival statistics and very different consequences, while frightened, on a timeline.
What follows is drawn from first-person accounts gathered for our men's health volumes. It is not medical guidance, and staging and grade change everything about the right decision.
The path in is usually a blood test
Most contributors describe a raised PSA found at a routine appointment, often without symptoms. Several describe a GP who nearly did not test. Others describe urinary changes attributed to age for years.
What follows is an MRI and, in most accounts, a biopsy. Contributors describe the biopsy candidly: uncomfortable rather than agonising, the clicking sound of the device, blood in urine and semen afterwards for weeks, which alarms men who were not warned. A minority describe infection afterwards requiring hospital treatment.
The waiting is the worst part
Nearly universal. The days between biopsy and results are described as the longest of their lives, and contributors describe reading survival statistics at three in the morning and frightening themselves badly.
The choice
For localised disease, men are typically offered surgery, radiotherapy, or active surveillance, and told the outcomes are broadly comparable. Contributors describe this as bewildering rather than reassuring.
Those who chose surgery often describe wanting it out, and a preference for a definite event over months of treatment. They describe catheters for one to two weeks afterwards, which several rank among the most miserable experiences of the process, and a recovery of several weeks.
Those who chose radiotherapy describe daily sessions over several weeks, fatigue that accumulated, and bowel and urinary irritation. Several combined it with hormone therapy, which they describe separately and often more negatively than the radiation: hot flushes, weight gain, loss of muscle, emotional changes, and loss of libido. Contributors are frequently frustrated that hormone therapy's effects were undersold.
Those who chose active surveillance describe a different burden: living with a cancer, repeated PSA tests, and periodic biopsies. Some describe growing comfortable with it. Others describe the anxiety becoming intolerable and choosing treatment for that reason alone, which they defend.
The side effects men do not discuss
Incontinence and erectile dysfunction are named in consultations and lived with for years, and contributors write about them without euphemism because nobody else does.
Incontinence after surgery is described as near-universal at first and improving over months. Pelvic floor exercises, started before surgery, are the intervention contributors most often credit. Most report substantial recovery within a year; a minority describe ongoing leakage and the pads, the planning, and the embarrassment that comes with it.
Erectile dysfunction is described as the harder loss. Contributors describe nerve-sparing surgery that did not fully spare, recovery over one to two years in some cases, and none in others. They describe medication, pumps, and injections, discussed frankly. Several describe the effect on a marriage, and the men who withdrew from intimacy entirely rather than talk about it. Those who did talk about it generally describe partners who minded far less than they feared.
What men say they wish they had asked
Consistent items: the surgeon's own volume of procedures and outcomes; what continence and potency rates look like specifically at that centre; whether hormone therapy is proposed and for how long; what happens if the first treatment does not work; and whether a second opinion is worth the delay, which contributors almost universally say it was.
Afterwards
The PSA test recurs indefinitely, and contributors describe scanxiety before each one for years. Many describe an outcome they are content with and a life that resumed. Several describe recurrence and further treatment.
The most repeated piece of advice to other men is not about treatment at all. It is to get tested, and to tell other men to, because almost every contributor knows someone who did not.
Reading further
Full-length accounts of prostate cancer, erectile dysfunction, and other men's health subjects are collected in our Men's Health volumes, with wider cancer testimony in Cancer Journeys and intimacy after treatment in Sexual & Intimate Health.
Sources and further reading
- Prostate cancer: diagnosis and management (NICE guideline NG131). National Institute for Health and Care Excellence, updated December 2021.
- Prostate cancer (UK NSC screening recommendation). UK National Screening Committee, March 2026.
- Hormone Therapy for Prostate Cancer Fact Sheet. National Cancer Institute, reviewed October 2024.
- Surgery: radical prostatectomy. Prostate Cancer UK, updated July 2024.
- Fifteen-Year Outcomes after Monitoring, Surgery, or Radiotherapy for Prostate Cancer (ProtecT trial). New England Journal of Medicine, 2023.
Personal experiences only, not medical advice. Treatment decisions depend on your staging, grade, age, and health, and belong with your urologist and oncologist.
The Reading Room publishes personal stories and editorial notes from our press. Everything here is companion reading — never medical advice, diagnosis, or treatment. For guidance about your own health, please speak with a qualified clinician. Read how we collect and edit patient testimony in our Editorial Standards, or meet the editors on our Editors & Contributors page.
If this piece was useful, the volumes below hold fifty full-length accounts from people who have been through it — the part an article can only summarise.
