Balancing Cure and Quality of Life: Navigating Functional Outcomes in Localized Prostate Cancer

Current guidelines for clinically localized prostate cancer offer a wide range of management options, from active surveillance to surgery and radiation therapy (RT). Treatment selection depends on tumor characteristics, overall health, and patient goals. Advances in surgical and radiation techniques have improved survival and functional outcomes, yet treatment continues to have significant impacts on quality of life. Sexual, urinary, and bowel dysfunction are common, and psychological distress, including anxiety, depression, and decisional regret, frequently accompany survivorship. Patients must navigate complex trade-offs between disease control and functional or personal outcomes. This review explores the interplay between treatment options, functional outcomes, and psychosocial considerations in localized prostate cancer care. Key topics include patient priorities, surgical strategies to optimize functional outcomes of radical prostatectomy, advances in RT which improve precision and reduce toxicity, and the role of mental health and lifestyle in survivorship. Integrating these approaches into multidisciplinary care can support overall quality of life. Aligning treatment decisions with patient values and goals is essential for reducing decisional regret and supporting patients through the complex and deeply personal decisions inherent in localized prostate cancer management.