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By Ackerman Cancer Center


Surgery vs. Radiation for Prostate Cancer

When it comes to prostate cancer treatment, the American Urological Association has not been able to definitively point to either surgery or radiation therapy as offering a superior cure rate to the other. Recently, a study published online in the medical journal European Urology indicated radiation therapy and surgery are equally effective in treating even aggressive prostate cancer.

The study was the first of its kind to compare radiation therapy and surgery outcomes in patients with aggressive forms of prostate cancer, as indicated by Gleason scores of 9 or 10. The Gleason scale is a tumor grading system that assigns scores, ranging from 2 to 10, to cancer cell after microscopic examination. Focusing on the two most common tumor patterns revealed in the biopsy sample, the number grade is determined by how normal or abnormal the cancer cells appear. A high Gleason score indicates the tumor is likely fast growing and aggressive.

The study information is valuable for men currently weighing the benefits and risks of surgery and radiation. As the only treatment methods capable of curing prostate cancer, the almost indistinguishable difference in cure rates between the two means the choice really comes down to the side effects.

In addition to risks associated with anesthesia and all surgical procedures such as bleeding and infection, potential adverse side effects that can occur with prostate surgery include:

  • Urinary incontinence – dribbling, leakage, and difficulty emptying the bladder are common side effects seen in the first weeks after surgery. In most cases bladder control returns gradually, although some men experience long-term or persistent urinary incontinence
  • Erectile dysfunction – the nerves that control the ability to have an erection are located very near the prostate. If the cancer is extended to this area, the nerves on one or both sides may require removal, making spontaneous erection impossible. Even when the nerves are not removed, nerve damage can still occur.

Men undergoing radiation therapy for prostate cancer may receive one of the following types of radiation:

  • Proton therapy
  • External beam radiation 
  • Brachytherapy (internal radiation or seed implants)

Proton therapy is an advanced radiation delivery system that makes it possible to deliver high doses of cancer-fighting radiation directly to prostate cancer while sparing sensitive surrounding tissues and organs. Patients typically experience little to no fatigue with proton therapy and bowel symptoms are rare. Symptoms of bladder irritation may develop in the years following treatment but are usually much less severe than those seen with other therapies.

Side effects of other types of radiation therapy vary depending on the delivery system, patient age, and whether or not the patient was previously treated with surgery.

Possible side effects of external beam radiation include diarrhea, cystitis (bladder irritation), lymphedema and fatigue. Urinary incontinence and erectile dysfunction are not common immediately after external beam radiation, but may develop gradually in the years following treatment, particularly in older men. 

Newer, more precise radiation delivery methods have reduced the risk of side effects.

Internal radiation uses rice-sized radioactive pellets implanted directly into the prostate. The most common side effects of prostate seed implants are urinary frequency and urgency. Urinary incontinence is rare unless a surgical transurethral resection of the prostate was previously performed.

Proton therapy is the most advanced form of radiation therapy available today with the benefit of very limited side effects.

Ackerman Cancer Center offers all radiation therapy modalities and reviews the options that are best for a patient’s individual case. 

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