For most patients with localized tumors, even slow-growing ones, surgical removal of the prostate gland (prostatectomy) is the initial treatment, despite possible side effects of urinary incontinence and impotence. Localized prostate cancer can often be cured. After surgery, a repeated blood test for protein-specific antigen can indicate whether any cancer remains. In metastatic disease, other treatments are employed depending on the stage of the disease and the age and health of the patient. Treatment options include external-beam radiation, implantation of radioactive isotopes, and palliative surgery. Hormonal manipulation by giving estrogens or other drugs, or by orchiectomy (removal of the testes), is sometimes used to decrease levels of testosterone. Very small cancers or slow-growing cancers in older men are sometimes watched, but not treated, without compromising life expectancy.