Radiation is used with the intent to cure the cancer. But other factors drive that decision, as well, Johnson says. "We are hesitant to consider it for two groups: young men or those with a significant amount of urinary symptoms because radiation can make that worse." In patients 75 and older, Middleton says, radiation is "likely to maintain you until you die" of something else.

Radiation treatment could involve external beam radiation or brachytherapy — placement of radioactive seeds that stay in the prostate or needles that are placed and then receive high-dose radiation before they are removed.

Surgery includes "radical prostatectomy" (still the gold standard treatment, Middleton says) where the entire prostate is removed, either with open surgery or laparoscopically. Some surgeons, Johnson included, do the latter using robotic surgery, operating through five or six small ports in the patient's skin. About one-third of prostatectomies are now being done that way, he says.

Laparoscopic surgery patients tend to heal a little faster and get back to work sooner. Recoveries can be shorter with smaller incisions, Johnson says.

"Some believe that (laparoscopic surgery) might do a better job of preserving continence" and other functions, Johnson says, but "studies have not necessarily shown significant difference for that."

New techniques, however, have greatly improved the surgery to reduce the risk a patient will become incontinent or lose erectile function, two common effects of surgery in bygone years.

Prostate cancer can recur, even if the prostate is removed, sometimes many years later. Follow-up needs to be consistent, with routine checks of the PSA level. The test, one of two screening tools, "is even more useful as follow-up after treatment" because an increase in the level after treatment "virtually always means cancer is present," Johnson says.

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E-mail: lois@desnews.com