Prostate Cancer: Should I Have Radiation or Surgery for Localized Prostate Cancer?

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You may want to have a say in this decision, or you may simply want to follow your doctor's recommendation. Either way, this information will help you understand what your choices are so that you can talk to your doctor about them.

Prostate Cancer: Should I Have Radiation or Surgery for Localized Prostate Cancer?

Get the facts

Your options

  • Have radiation treatment.
  • Have surgery to remove your prostate.

This topic is for men who have cancer that hasn't spread outside of the prostate (localized cancer) and who have already decided that they want to treat their cancer with either radiation or surgery. (Men with low-risk localized cancer may choose active surveillance or watchful waiting instead of treating their cancer right away.)

This topic is not for prostate cancer that has grown or spread outside of the prostate or for cancer that has spread throughout the body. Treatment choices are different for that stage of cancer.

Key points to remember

  • Radiation and surgery are treatments that destroy or remove localized prostate cancer. Right now there isn't strong evidence to show that one works better than the other when it comes to helping a man live longer. And both treatments have long-term side effects, like bladder, bowel, and erection problems.
  • If your main goal is to get the cancer out of your body, then you may want to choose surgery. Surgery to remove the prostate will take out any cancer that is in your prostate. And after your surgery, you can find out if all the cancer is gone.
  • If your main goal is to avoid surgery, then you may want to choose radiation. Radiation may also be a better choice if you are older than 80 years of age or have other serious health problems, such as heart disease. In those cases, surgery may be too risky.
  • One treatment may be better for you than the other because of your age, your other health problems, and how you feel about each treatment. You and your doctor can talk about your situation.
  • Men have fewer problems from prostate surgery when they have a doctor who has done many of these surgeries.
FAQs

What is localized prostate cancer?

Prostate cancer is the abnormal growth of cells in the prostate gland . Localized prostate cancer has not spread outside the gland. Early prostate cancer usually doesn't cause symptoms.

Prostate cancer is the most common cancer in men. Most men who get it are older than 65. If your father, brother, or son has had prostate cancer, your risk is higher than average.

African-American men have the highest rates of both prostate cancer and deaths from it.

About 16 out of 100 men in the U.S. will get prostate cancer, but only 3 will die because of it. That means about 97 out of 100 men will die of something other than prostate cancer. footnote 1

Unlike many other cancers, prostate cancer is usually slow-growing. When prostate cancer is found early—before it has spread outside the gland—it may be cured with radiation or surgery.

Prostate cancer that has grown beyond the prostate is called advanced prostate cancer. Treatment choices are different for that stage of cancer.

Why is it important to know the risk level of your cancer?

Knowing whether your cancer is low-risk or higher-risk is important when you are making treatment choices.

The risk level of your cancer is based on the results from your tests and exams, such as the PSA test, digital rectal exam, and prostate biopsy.

  • Low-risk localized prostate cancer is cancer that may never cause any symptoms during your lifetime. This means your cancer may not need to be treated unless tests show that it has changed and is growing more quickly.
  • Higher-risk localized prostate cancer is cancer that is more likely to spread and cause symptoms. This means your cancer may need to be treated with surgery or radiation.

Your doctor can help you understand your test results and the risk level of your cancer. Then you can compare your treatment options and make the choice that seems best to you.

What are the treatments for localized prostate cancer?

  • Surgery takes out the prostate and any nearby tissue that may contain cancer, including lymph nodes . This surgery is called a radical prostatectomy (say "pros-tuh-TEK-tuh-mee"). A doctor can do it as open surgery by making a cut, or incision, in your belly or groin. Or he or she can do laparoscopic surgery by putting a lighted tube, or scope, and other surgical tools through much smaller cuts in your belly or groin. The doctor is able to see your prostate and other organs with the scope. In many places, robot-assisted laparoscopic prostatectomy is common. In this type of surgery, the surgeon controls the robotic arms that hold the tools and scope.
  • Radiation uses X-rays and other types of radiation to kill the cancer cells. This may be done with:
    • External-beam radiation, in which a machine aims high-energy rays at the cancer.
    • Brachytherapy (say "bray-kee-THAIR-uh-pee"), in which tiny pellets of radioactive material are injected into or near the cancer.
    • Both kinds of radiation.

Radiation and surgery are treatments that destroy or remove localized prostate cancer. Both treatments also have long-term side effects, like bladder, bowel, and erection problems.

In the first 2 to 5 years after treatment, the chance of having erection or bladder problems is higher with surgery. And the chance of having bowel problems, such as an urgent need to move your bowels, is higher with radiation. But at 15 years, the chance of erection, bladder, or bowel problems is about the same with either treatment. footnote 2

One treatment may be better for you than the other because of your age, your other health problems, and how you feel about each treatment. You and your doctor can talk about your situation.

Follow-up treatment

After either treatment, you will need regular checkups. You will probably have:

  • Physical exams.
  • Prostate-specific antigen (PSA) tests.
  • Digital rectal exams.

When is surgery used to treat localized prostate cancer?

You may choose surgery if:

  • You are in good general health and expect to live at least 10 more years.
  • It looks like all the cancer can be removed since it hasn't spread outside the prostate.
  • You don't have other health problems that add to the risks of major surgery.

This surgery usually works well to treat cancer that has not spread beyond the prostate gland. Men with localized prostate cancer who have surgery have a low risk of dying from prostate cancer. A study that followed men with localized prostate cancer for 15 years after their surgery found: footnote 3

  • Of the men who died, about 88 out of 100 men died of something other than prostate cancer. This means that about 12 out of 100 men who had surgery died from prostate cancer.
  • Of the men with localized prostate cancer whose cancer was low-risk, about 95 out of 100 men died of something other than prostate cancer. This means that about 5 out of 100 men with low-risk cancer who had surgery died from prostate cancer.

Many surgeons do robotic-assisted laparoscopic surgery. The surgeon controls robotic arms that hold the tools and scope. The rate of problems after laparoscopic surgery is about the same as open surgery.

Studies show that how well you come through the surgery and the extent of your side effects depend more on the skill of your surgeon than on the kind of surgery you have. footnote 1

When is radiation used to treat localized prostate cancer?

If you choose radiation, it may be used:

  • Alone.
  • Along with hormone therapy (if your cancer is high-risk).
  • When you have other health problems that make surgery too risky.

But if you are younger, your doctor may not recommend radiation because of concerns that the prostate is still there and any cancer cells that remain might grow over time.

What are the risks of surgery?

A radical prostatectomy has all the risks of any major surgery, including:

  • Heart attack.
  • A blood clot in an artery in the lung (pulmonary embolism).
  • Bleeding.
  • Infection.
  • Reactions to anesthesia or other medicines.
  • Death.

Prostatectomy also may cause bladder problems and erection problems. More and more often, this surgery is being done in a way that saves the nerves that control erections.

  • Erection problems. How much surgery affects a man's erections depends on his age, his sexual function before his surgery, and the location of his tumor. About half of the men who have nerve-sparing surgery regain most of their sexual function. footnote 4
  • Bladder control problems, such as not being able to hold urine (urinary incontinence). The degree of incontinence can range from needing to wear pads to dribbling urine now and then during stressful activities.

Surgery also can cause scar tissue that may narrow the outlet to your bladder. Or your rectum or urethra could be injured.

Studies show that men have fewer side effects when this surgery is done by a doctor who has done it many times. footnote 5

What are the risks of radiation treatment?

Radiation treatment for prostate cancer may increase a man's risk for having another cancer later in life, such as bladder or rectal cancer.

Some radiation side effects, like fatigue, are short-term problems that go away with time. But a radiation side effect can become a long-term problem. Common side effects from radiation treatment include:

  • Erection problems that develop over time.
  • Bowel problems, such as rectal pain, diarrhea, blood in your stool, and rectal leakage.
  • Bladder problems, such as a burning feeling when you urinate, blood in your urine, and not being able to control your bladder (urinary incontinence).
    • With external-beam radiation, you may have to urinate often or have a sudden urge to urinate (urge incontinence).
    • With brachytherapy, you may have a slow or weak urinary stream, be unable to urinate (urinary retention), or leak urine from an overfull bladder without any urge to urinate (overflow incontinence).

For men with high-risk prostate cancer, radiation treatment is given along with hormone therapy. Hormone therapy has side effects, such as the loss of bone density and muscle mass. It can also increase the risk for bone fractures, diabetes, and heart disease.

Does one treatment work better than the other?

Right now there isn't strong evidence to show whether surgery or radiation helps a man live longer. High quality studies that compare surgery with radiation for men with localized prostate cancer haven't yet been completed. But a study is currently being done to compare the treatments. footnote 6

Researchers have studied the past medical records of men who had prostate cancer. Most of these studies found that men who had surgery for localized prostate cancer were less likely to die from prostate cancer than men who had radiation therapy (external-beam radiation therapy). This seemed to be especially true for healthier men who were younger than age 65. footnote 7, footnote 8 Older men (over 80) and men who also had other serious health problems did better with radiation treatment. footnote 8

Why might your doctor recommend one treatment over the other?

Your doctor might advise you to have surgery if:

  • Surgery can remove all of the cancer.
  • You are young and want to do all you can to make sure that the cancer is removed.
  • You don't have other health problems that would add to the risks of major surgery.

Your doctor might advise you to have radiation if:

  • You have other health problems that make surgery too risky.
  • Your age makes surgery too risky.

Compare your options

Compare

What is usually involved?









What are the benefits?









What are the risks and side effects?









Have surgery Have surgery
  • You will be asleep for the surgery.
  • You will stay in the hospital for 2 to 4 days.
  • For 1 to 3 weeks after surgery, you will have a thin, flexible tube called a catheter in your bladder to drain your urine.
  • After surgery, you will have regular tests and doctor visits to find out right away if the cancer has come back or has grown (if the cancer wasn't able to be completely removed).
  • During surgery, your prostate will be removed. This allows your doctor to find out right away if all of the cancer is gone.
  • Your doctor will also be able to study the tumor to find out how likely it is that the cancer will come back or grow (if the cancer has already spread outside the prostate).
  • Removing the prostate makes it easier to look for future rises in PSA levels that may show the cancer has come back.
  • The cancer could come back or grow.
  • You may have trouble controlling your bladder for a few months after the catheter is removed.
  • Surgery often leads to longer-lasting bladder control problems (urinary incontinence). How bad it is ranges from dribbling now and then to needing to wear incontinence pads.
  • Many men have erection problems after surgery.
  • The urethra or the rectum could be damaged.
  • Risks of any surgery include bleeding, infection, blood clots, and problems from anesthesia.
Have radiation Have radiation
  • With external-beam radiation, the radiation is aimed at the cancer. Treatment usually is five times a week for 4 to 8 weeks.
  • For internal radiation, a doctor injects radioactive material into the prostate.
  • It takes time—maybe a year or more—to know from test results if the cancer is gone.
  • Radiation may be a better choice for older men (over 80 years of age).
  • It may be a better choice for men who have other health problems that make surgery too risky.
  • You avoid the risks of major surgery.
  • The cancer could come back or grow.
  • It can cause bowel problems, such as a sudden urge to move your bowels.
  • You could have erection problems. For some men, this problem gets worse over time.
  • It can cause bladder control problems (urinary incontinence).
  • Other risks can include diarrhea and trouble urinating.
  • If your cancer is high-risk, you'll likely have hormone therapy after radiation treatment. Hormone therapy has side effects, such as the loss of bone density and muscle mass. It can also increase the risk for bone fractures, diabetes, and heart disease.

Personal stories about having a prostatectomy or radiation therapy

These stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions.

My doctor told me I have prostate cancer. After I got over the shock, we talked about my treatment choices. My doctor told me the cancer is small, so I have taken some time to think about it. I could have surgery to remove my prostate or use radiation to try to kill the cancer. Except for this cancer, I am in good health and hope to live a good long while, so I have decided on a radical prostatectomy. I realize the surgery may cause problems with holding my urine or getting an erection, but I do not like the idea of cancer slowly growing in my prostate. I want to get rid of it and not just try to kill it with radiation.

Sam, age 50

My doctor told me after my last checkup that I have prostate cancer. I've got some heart problems that may make surgery more risky for me. So I'm choosing to have radiation therapy. We are also talking about using hormone therapy to try to increase the effectiveness of the treatment. I'm not that concerned about the side effects. I just want to enjoy a little more time with my family.

Mark, age 67

I really was not all that surprised when my doctor told me I had prostate cancer. My father had prostate cancer too. My doctor told me there were several treatment options. Since I have a family history, I feel that I need to be as aggressive as possible in my treatment of the cancer. For me, that means having the radical prostatectomy.

David, age 62

Lots of men get prostate cancer as they get older. I guess that makes me a statistic. My doctor told me there are several different ways to treat my cancer. I want to do something, but at my age I'm not keen on having surgery. I also thought about my age and how long most men live after being diagnosed with prostate cancer. For me, choosing radiation therapy is the best balance between doing something and not doing too much.

Steven, age 72

What matters most to you?

Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.

Reasons to have surgery

Reasons to have radiation

I would rather have surgery.

I would rather have radiation.

More important
Equally important
More important

I am more concerned about the risks of radiation than I am about risks from surgery.

I am more concerned about the risks of surgery than I am about the risks from radiation.

More important
Equally important
More important

I want my doctor to know what kind of tumor I have.

It's not important to me for my doctor to know what kind of tumor I have.

More important
Equally important
More important

I'm not worried about the higher risks of erection problems in the first few years after surgery.

I don't want to risk having erection problems in the first few years after surgery.

More important
Equally important
More important

My other important reasons:

My other important reasons:

More important
Equally important
More important

Where are you leaning now?

Now that you've thought about the facts and your feelings, you may have a general idea of where you stand on this decision. Show which way you are leaning right now.

Surgery

Radiation

Leaning toward
Undecided
Leaning toward

What else do you need to make your decision?

Check the facts

1, Is surgery always the better treatment for a man who has localized prostate cancer?
2, In the first few years, does surgery have a greater risk of causing bladder control and erection problems than radiation?
3, Does your surgeon's experience affect your risk of side effects?

Decide what's next

1, Do you understand the options available to you?
2, Are you clear about which benefits and side effects matter most to you?
3, Do you have enough support and advice from others to make a choice?

Certainty

1. How sure do you feel right now about your decision?

Not sure at all
Somewhat sure
Very sure

Your Summary

Here's a record of your answers. You can use it to talk with your doctor or loved ones about your decision.

Your decision  

Next steps

Which way you're leaning

How sure you are

Your comments

Your knowledge of the facts  

Key concepts that you understood

Key concepts that may need review

Getting ready to act  

Patient choices

Credits

Credits
Author Healthwise Staff
Primary Medical Reviewer E. Gregory Thompson, MD - Internal Medicine
Primary Medical Reviewer Adam Husney, MD - Family Medicine
Specialist Medical Reviewer Christopher G. Wood, MD, FACS - Urology, Oncology
Specialist Medical Reviewer Richard M. Hoffman, MD, MPH - Internal Medicine
You may want to have a say in this decision, or you may simply want to follow your doctor's recommendation. Either way, this information will help you understand what your choices are so that you can talk to your doctor about them.

Prostate Cancer: Should I Have Radiation or Surgery for Localized Prostate Cancer?

Here's a record of your answers. You can use it to talk with your doctor or loved ones about your decision.
  1. Get the facts
  2. Compare your options
  3. What matters most to you?
  4. Where are you leaning now?
  5. What else do you need to make your decision?

1. Get the Facts

Your options

  • Have radiation treatment.
  • Have surgery to remove your prostate.

This topic is for men who have cancer that hasn't spread outside of the prostate (localized cancer) and who have already decided that they want to treat their cancer with either radiation or surgery. (Men with low-risk localized cancer may choose active surveillance or watchful waiting instead of treating their cancer right away.)

This topic is not for prostate cancer that has grown or spread outside of the prostate or for cancer that has spread throughout the body. Treatment choices are different for that stage of cancer.

Key points to remember

  • Radiation and surgery are treatments that destroy or remove localized prostate cancer. Right now there isn't strong evidence to show that one works better than the other when it comes to helping a man live longer. And both treatments have long-term side effects, like bladder, bowel, and erection problems.
  • If your main goal is to get the cancer out of your body, then you may want to choose surgery. Surgery to remove the prostate will take out any cancer that is in your prostate. And after your surgery, you can find out if all the cancer is gone.
  • If your main goal is to avoid surgery, then you may want to choose radiation. Radiation may also be a better choice if you are older than 80 years of age or have other serious health problems, such as heart disease. In those cases, surgery may be too risky.
  • One treatment may be better for you than the other because of your age, your other health problems, and how you feel about each treatment. You and your doctor can talk about your situation.
  • Men have fewer problems from prostate surgery when they have a doctor who has done many of these surgeries.
FAQs

What is localized prostate cancer?

Prostate cancer is the abnormal growth of cells in the prostate gland . Localized prostate cancer has not spread outside the gland. Early prostate cancer usually doesn't cause symptoms.

Prostate cancer is the most common cancer in men. Most men who get it are older than 65. If your father, brother, or son has had prostate cancer, your risk is higher than average.

African-American men have the highest rates of both prostate cancer and deaths from it.

About 16 out of 100 men in the U.S. will get prostate cancer, but only 3 will die because of it. That means about 97 out of 100 men will die of something other than prostate cancer. 1

Unlike many other cancers, prostate cancer is usually slow-growing. When prostate cancer is found early—before it has spread outside the gland—it may be cured with radiation or surgery.

Prostate cancer that has grown beyond the prostate is called advanced prostate cancer. Treatment choices are different for that stage of cancer.

Why is it important to know the risk level of your cancer?

Knowing whether your cancer is low-risk or higher-risk is important when you are making treatment choices.

The risk level of your cancer is based on the results from your tests and exams, such as the PSA test, digital rectal exam, and prostate biopsy.

  • Low-risk localized prostate cancer is cancer that may never cause any symptoms during your lifetime. This means your cancer may not need to be treated unless tests show that it has changed and is growing more quickly.
  • Higher-risk localized prostate cancer is cancer that is more likely to spread and cause symptoms. This means your cancer may need to be treated with surgery or radiation.

Your doctor can help you understand your test results and the risk level of your cancer. Then you can compare your treatment options and make the choice that seems best to you.

What are the treatments for localized prostate cancer?

  • Surgery takes out the prostate and any nearby tissue that may contain cancer, including lymph nodes . This surgery is called a radical prostatectomy (say "pros-tuh-TEK-tuh-mee"). A doctor can do it as open surgery by making a cut, or incision, in your belly or groin. Or he or she can do laparoscopic surgery by putting a lighted tube, or scope, and other surgical tools through much smaller cuts in your belly or groin. The doctor is able to see your prostate and other organs with the scope. In many places, robot-assisted laparoscopic prostatectomy is common. In this type of surgery, the surgeon controls the robotic arms that hold the tools and scope.
  • Radiation uses X-rays and other types of radiation to kill the cancer cells. This may be done with:
    • External-beam radiation, in which a machine aims high-energy rays at the cancer.
    • Brachytherapy (say "bray-kee-THAIR-uh-pee"), in which tiny pellets of radioactive material are injected into or near the cancer.
    • Both kinds of radiation.

Radiation and surgery are treatments that destroy or remove localized prostate cancer. Both treatments also have long-term side effects, like bladder, bowel, and erection problems.

In the first 2 to 5 years after treatment, the chance of having erection or bladder problems is higher with surgery. And the chance of having bowel problems, such as an urgent need to move your bowels, is higher with radiation. But at 15 years, the chance of erection, bladder, or bowel problems is about the same with either treatment. 2

One treatment may be better for you than the other because of your age, your other health problems, and how you feel about each treatment. You and your doctor can talk about your situation.

Follow-up treatment

After either treatment, you will need regular checkups. You will probably have:

  • Physical exams.
  • Prostate-specific antigen (PSA) tests.
  • Digital rectal exams.

When is surgery used to treat localized prostate cancer?

You may choose surgery if:

  • You are in good general health and expect to live at least 10 more years.
  • It looks like all the cancer can be removed since it hasn't spread outside the prostate.
  • You don't have other health problems that add to the risks of major surgery.

This surgery usually works well to treat cancer that has not spread beyond the prostate gland. Men with localized prostate cancer who have surgery have a low risk of dying from prostate cancer. A study that followed men with localized prostate cancer for 15 years after their surgery found: 3

  • Of the men who died, about 88 out of 100 men died of something other than prostate cancer. This means that about 12 out of 100 men who had surgery died from prostate cancer.
  • Of the men with localized prostate cancer whose cancer was low-risk, about 95 out of 100 men died of something other than prostate cancer. This means that about 5 out of 100 men with low-risk cancer who had surgery died from prostate cancer.

Many surgeons do robotic-assisted laparoscopic surgery. The surgeon controls robotic arms that hold the tools and scope. The rate of problems after laparoscopic surgery is about the same as open surgery.

Studies show that how well you come through the surgery and the extent of your side effects depend more on the skill of your surgeon than on the kind of surgery you have. 1

When is radiation used to treat localized prostate cancer?

If you choose radiation, it may be used:

  • Alone.
  • Along with hormone therapy (if your cancer is high-risk).
  • When you have other health problems that make surgery too risky.

But if you are younger, your doctor may not recommend radiation because of concerns that the prostate is still there and any cancer cells that remain might grow over time.

What are the risks of surgery?

A radical prostatectomy has all the risks of any major surgery, including:

  • Heart attack.
  • A blood clot in an artery in the lung (pulmonary embolism).
  • Bleeding.
  • Infection.
  • Reactions to anesthesia or other medicines.
  • Death.

Prostatectomy also may cause bladder problems and erection problems. More and more often, this surgery is being done in a way that saves the nerves that control erections.

  • Erection problems. How much surgery affects a man's erections depends on his age, his sexual function before his surgery, and the location of his tumor. About half of the men who have nerve-sparing surgery regain most of their sexual function. 4
  • Bladder control problems, such as not being able to hold urine (urinary incontinence). The degree of incontinence can range from needing to wear pads to dribbling urine now and then during stressful activities.

Surgery also can cause scar tissue that may narrow the outlet to your bladder. Or your rectum or urethra could be injured.

Studies show that men have fewer side effects when this surgery is done by a doctor who has done it many times. 5

What are the risks of radiation treatment?

Radiation treatment for prostate cancer may increase a man's risk for having another cancer later in life, such as bladder or rectal cancer.

Some radiation side effects, like fatigue, are short-term problems that go away with time. But a radiation side effect can become a long-term problem. Common side effects from radiation treatment include:

  • Erection problems that develop over time.
  • Bowel problems, such as rectal pain, diarrhea, blood in your stool, and rectal leakage.
  • Bladder problems, such as a burning feeling when you urinate, blood in your urine, and not being able to control your bladder (urinary incontinence).
    • With external-beam radiation, you may have to urinate often or have a sudden urge to urinate (urge incontinence).
    • With brachytherapy, you may have a slow or weak urinary stream, be unable to urinate (urinary retention), or leak urine from an overfull bladder without any urge to urinate (overflow incontinence).

For men with high-risk prostate cancer, radiation treatment is given along with hormone therapy. Hormone therapy has side effects, such as the loss of bone density and muscle mass. It can also increase the risk for bone fractures, diabetes, and heart disease.

Does one treatment work better than the other?

Right now there isn't strong evidence to show whether surgery or radiation helps a man live longer. High quality studies that compare surgery with radiation for men with localized prostate cancer haven't yet been completed. But a study is currently being done to compare the treatments. 6

Researchers have studied the past medical records of men who had prostate cancer. Most of these studies found that men who had surgery for localized prostate cancer were less likely to die from prostate cancer than men who had radiation therapy (external-beam radiation therapy). This seemed to be especially true for healthier men who were younger than age 65. 7, 8 Older men (over 80) and men who also had other serious health problems did better with radiation treatment. 8

Why might your doctor recommend one treatment over the other?

Your doctor might advise you to have surgery if:

  • Surgery can remove all of the cancer.
  • You are young and want to do all you can to make sure that the cancer is removed.
  • You don't have other health problems that would add to the risks of major surgery.

Your doctor might advise you to have radiation if:

  • You have other health problems that make surgery too risky.
  • Your age makes surgery too risky.

2. Compare your options

  Have surgery Have radiation
What is usually involved?
  • You will be asleep for the surgery.
  • You will stay in the hospital for 2 to 4 days.
  • For 1 to 3 weeks after surgery, you will have a thin, flexible tube called a catheter in your bladder to drain your urine.
  • After surgery, you will have regular tests and doctor visits to find out right away if the cancer has come back or has grown (if the cancer wasn't able to be completely removed).
  • With external-beam radiation, the radiation is aimed at the cancer. Treatment usually is five times a week for 4 to 8 weeks.
  • For internal radiation, a doctor injects radioactive material into the prostate.
  • It takes time—maybe a year or more—to know from test results if the cancer is gone.
What are the benefits?
  • During surgery, your prostate will be removed. This allows your doctor to find out right away if all of the cancer is gone.
  • Your doctor will also be able to study the tumor to find out how likely it is that the cancer will come back or grow (if the cancer has already spread outside the prostate).
  • Removing the prostate makes it easier to look for future rises in PSA levels that may show the cancer has come back.
  • Radiation may be a better choice for older men (over 80 years of age).
  • It may be a better choice for men who have other health problems that make surgery too risky.
  • You avoid the risks of major surgery.
What are the risks and side effects?
  • The cancer could come back or grow.
  • You may have trouble controlling your bladder for a few months after the catheter is removed.
  • Surgery often leads to longer-lasting bladder control problems (urinary incontinence). How bad it is ranges from dribbling now and then to needing to wear incontinence pads.
  • Many men have erection problems after surgery.
  • The urethra or the rectum could be damaged.
  • Risks of any surgery include bleeding, infection, blood clots, and problems from anesthesia.
  • The cancer could come back or grow.
  • It can cause bowel problems, such as a sudden urge to move your bowels.
  • You could have erection problems. For some men, this problem gets worse over time.
  • It can cause bladder control problems (urinary incontinence).
  • Other risks can include diarrhea and trouble urinating.
  • If your cancer is high-risk, you'll likely have hormone therapy after radiation treatment. Hormone therapy has side effects, such as the loss of bone density and muscle mass. It can also increase the risk for bone fractures, diabetes, and heart disease.

Personal stories

Personal stories about having a prostatectomy or radiation therapy

These stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions.

"My doctor told me I have prostate cancer. After I got over the shock, we talked about my treatment choices. My doctor told me the cancer is small, so I have taken some time to think about it. I could have surgery to remove my prostate or use radiation to try to kill the cancer. Except for this cancer, I am in good health and hope to live a good long while, so I have decided on a radical prostatectomy. I realize the surgery may cause problems with holding my urine or getting an erection, but I do not like the idea of cancer slowly growing in my prostate. I want to get rid of it and not just try to kill it with radiation."

— Sam, age 50

"My doctor told me after my last checkup that I have prostate cancer. I've got some heart problems that may make surgery more risky for me. So I'm choosing to have radiation therapy. We are also talking about using hormone therapy to try to increase the effectiveness of the treatment. I'm not that concerned about the side effects. I just want to enjoy a little more time with my family."

— Mark, age 67

"I really was not all that surprised when my doctor told me I had prostate cancer. My father had prostate cancer too. My doctor told me there were several treatment options. Since I have a family history, I feel that I need to be as aggressive as possible in my treatment of the cancer. For me, that means having the radical prostatectomy."

— David, age 62

"Lots of men get prostate cancer as they get older. I guess that makes me a statistic. My doctor told me there are several different ways to treat my cancer. I want to do something, but at my age I'm not keen on having surgery. I also thought about my age and how long most men live after being diagnosed with prostate cancer. For me, choosing radiation therapy is the best balance between doing something and not doing too much."

— Steven, age 72

3. What matters most to you?

Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.

Reasons to have surgery

Reasons to have radiation

I would rather have surgery.

I would rather have radiation.

             
More important
Equally important
More important

I am more concerned about the risks of radiation than I am about risks from surgery.

I am more concerned about the risks of surgery than I am about the risks from radiation.

             
More important
Equally important
More important

I want my doctor to know what kind of tumor I have.

It's not important to me for my doctor to know what kind of tumor I have.

             
More important
Equally important
More important

I'm not worried about the higher risks of erection problems in the first few years after surgery.

I don't want to risk having erection problems in the first few years after surgery.

             
More important
Equally important
More important

My other important reasons:

My other important reasons:

   
             
More important
Equally important
More important

4. Where are you leaning now?

Now that you've thought about the facts and your feelings, you may have a general idea of where you stand on this decision. Show which way you are leaning right now.

Surgery

Radiation

             
Leaning toward
Undecided
Leaning toward

5. What else do you need to make your decision?

Check the facts

1. Is surgery always the better treatment for a man who has localized prostate cancer?

  • Yes
  • No
  • I'm not sure
You're right. One treatment may be better for you than the other because of your age, your other health problems, and how you feel about each treatment. You and your doctor can talk about what is better for you.

2. In the first few years, does surgery have a greater risk of causing bladder control and erection problems than radiation?

  • Yes
  • No
  • I'm not sure
That's right. In the first 2 to 5 years after treatment, the chance of having erection or bladder problems is higher with surgery. But at 15 years, the chance of erection, bladder, or bowel problems is about the same with either treatment.

3. Does your surgeon's experience affect your risk of side effects?

  • Yes
  • No
  • I'm not sure
That's right. The chances of side effects from surgery are lower if your doctor has done a lot of these surgeries.

Decide what's next

1. Do you understand the options available to you?

2. Are you clear about which benefits and side effects matter most to you?

3. Do you have enough support and advice from others to make a choice?

Certainty

1. How sure do you feel right now about your decision?

         
Not sure at all
Somewhat sure
Very sure

2. Check what you need to do before you make this decision.

  • I'm ready to take action.
  • I want to discuss the options with others.
  • I want to learn more about my options.
 
Credits
By Healthwise Staff
Primary Medical Reviewer E. Gregory Thompson, MD - Internal Medicine
Primary Medical Reviewer Adam Husney, MD - Family Medicine
Specialist Medical Reviewer Christopher G. Wood, MD, FACS - Urology, Oncology
Specialist Medical Reviewer Richard M. Hoffman, MD, MPH - Internal Medicine

References
Citations
  1. Scher HI, et al. (2015). Cancer of the prostate. In VT DeVita Jr et al., eds., DeVita, Hellman, and Rosenberg's Cancer Principles and Practices of Oncology, 10th ed., pp. 932–980. Philadelphia: Walters Kluwer.
  2. Resnick MJ, et al. (2013). Long-term functional outcomes after treatment for localized prostate cancer. The New England Journal of Medicine, 368(5): 436–445.
  3. Stephenson AJ, et al. (2009). Prostate cancer-specific mortality after radical prostatectomy for patients treated in the prostate-specific antigen era. Journal of Clinical Oncology, 27(26): 4300-4305. DOI: 10.1200/JCO.2008.18.2501. Accessed October 14, 2015.
  4. National Cancer Institute (2012). Prostate Cancer Treatment (PDQ)—Health Professional Version. Available online: http://www.cancer.gov/cancertopics/pdq/treatment/prostate/HealthProfessional.
  5. Rosenberg JE, Kantoff PW (2011). Prostate cancer. In EG Nabel, ed., ACP Medicine, section 12, chap. 9. Hamilton, ON: BC Decker.
  6. Lane JA, et al. (2014). Active monitoring, radical prostatectomy, or radiotherapy for localised prostate cancer: Study design and diagnostic and baseline results of the ProtecT randomised phase 3 trial. Lancet Oncology, (10): 1109–1118. DOI: 10.1016/S1470-2045(14)70361-4. Accessed August 14, 2015.
  7. Hoffman RM, et al. (2013). Mortality after radical prostatectomy or external beam radiotherapy for localized prostate cancer. Journal of the National Cancer Institute, 105(10): 711–718. DOI:10.1093/jnci/djt059. Accessed September 4, 2015.
  8. Sooriakumaran P, et al. (2014). Comparative effectiveness of radical prostatectomy and radiotherapy in prostate cancer: Observational study of mortality outcomes. BMJ, 348: g1502. DOI:10.1136/bmj.g1502. Accessed September 4, 2015.

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