In the United States, prostate cancer is the most common cancer in men other than skin cancer. The American Cancer Society estimates 268,490 new diagnoses were received in 2022. It also estimates that 34,500 people will die from prostate cancer in 2022.

Improvements in screening and treatment have led to very high survival rates for people whose cancer is limited to their prostate or surrounding tissue. The 5-year relative survival rate for men with localized prostate cancer is higher than 99%. It drops to 31% when the cancer has spread to distant areas.

Surgery and radiation therapy are two of the most common treatment options for prostate cancer.

Doctors use surgery to remove the prostate gland and possibly surrounding tissue for people in good overall health.

Radiation therapy uses high-energy waves to destroy cancer cells. A doctor may use it along with surgery or on its own as the primary treatment.

In this article, we compare radiation therapy and surgery for treating prostate cancer.

Language matters

Sex and gender exist on spectrums. This article uses the term “men” to reflect a term that has been historically used to gender people. It’s important to note that not everyone assigned male at birth identifies with the label “man.”

While we aim to create content that includes and reflects the diversity of our readers, specificity is key when reporting on research participants and clinical findings.

Unfortunately, the studies and surveys referenced in this article didn’t include data on, or include, participants who were transgender, nonbinary, gender nonconforming, genderqueer, agender, or genderless.

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If a doctor gives you a diagnosis of prostate cancer, it’s important to discuss your options with a treatment team. Doctors recommend certain treatments based on factors such as:

  • how far your cancer has progressed
  • your age and overall health
  • how your cancer cells look under a microscope
  • your personal preference

A doctor may make additional recommendations based on factors such as your ethnicity. In the United States, African American men are twice as likely to die from low-grade prostate cancer than people of other ethnicities, so doctors may be more hesitant to recommend active surveillance.

You can learn more about your treatment options by stage.

If both surgery and radiation are options for you, you’ll want to consider the following:

  • Cure rate: Is one method more effective than the other at eliminating the cancer?
  • Side effects: What are the risks and side effects of both procedures?
  • Procedure: Are you more comfortable with one procedure over the other?
  • Cost: Are there differences in out-of-pocket costs between the two procedures?

Let’s take a look at each consideration.

Radiation therapy and surgery are two of the most common treatment options for prostate cancer. Each is potentially curative. The 5-year relative survival rate for all stages of prostate cancer is 98%.

Surgery can eliminate prostate cancer that’s contained in your prostate or nearby tissue.

Doctors use radiation therapy:

  • as the primary treatment for slow-growing cancer contained to your prostate gland
  • along with hormone therapy for cancer growing into nearby tissue
  • along with surgery if they can’t completely remove the cancer or if it comes back
  • to slow the growth of advanced cancer and treat symptoms

A doctor may suggest radiation therapy after surgery to destroy any cancer cells that remain.

In a 10-year study, researchers found no significant difference in the outlook for people with prostate cancer who received:

  • surgery
  • radiation
  • active surveillance (waiting to see how cancer progresses before starting treatment)

All treatments were associated with low 10-year mortality rates. Surgery and radiation were associated with less spread to distant tissues than active monitoring.

Most doctors believe that the treatments are equally effective. Surgery may offer a slightly higher long-term cure rate than radiation. But several factors influence the success rate, including the grade and stage of the cancer and your age and medical history.

A 2022 review of 23 studies found that people with localized prostate cancer who received external radiation had lower overall survival than those who had surgery to remove their prostate. But the study also found that combining external radiation with brachytherapy (internal radiation) had a similar success rate to surgery.

Both treatments decrease the risk of cancer spreading to distant organs compared with active monitoring.

Both surgery and radiation therapy come with risks and serious side effects. As some people never experience symptoms, about 60% of people with low-risk prostate cancer choose active surveillance to avoid the serious side effects of these treatment options. If treatment is the best option for you, it’s important to be aware of the risks.

The side effects of prostate cancer treatment that concern most people are sexual dysfunction and urinary incontinence. It’s important to note that both are also symptoms of prostate cancer. People who don’t get treatment may also experience these symptoms.

A 2017 study of 2,550 men with localized prostate cancer found that those who had surgery experienced worse sexual function and urinary incontinence after 3 years than those who had radiation therapy. A similar 2018 study of 2,117 men found similar results for men with low-risk prostate cancer but no significant difference for men with high-risk prostate cancer.

A 2020 study found that most differences resolve after 5 years. But participants who had surgery still reported worse incontinence when compared with those who had radiation.


The risks of prostate surgery are similar to those of other surgeries. General surgical risks include:

If the surgeon removed your lymph nodes as part of the surgery, you might develop lymphedema. This is a buildup of lymph fluid in your body.

According to the American Cancer Society, death is extremely rare during prostate surgery.

Radiation therapy

Possible side effects of radiation therapy include:

Doctors almost always combine radiation therapy with a hormone therapy called androgen deprivation therapy (ADT). Studies show that ADT increases the success rate of radiation therapy. But ADT also has some serious side effects.

ADT lowers the levels of androgens in your body, as these can help prostate cancer grow. Lowering your androgen levels has similar effects as lowering your testosterone levels. They include:

  • reduced sexual desire
  • erectile dysfunction
  • decreased penis and testicle size
  • growth of breast tissue
  • loss of muscle mass
  • hot flashes
  • mood changes
  • osteoporosis
  • low blood count

Radiopharmaceuticals (injected radioactive drugs) can cause:

People treated with radiation therapy also have a higher risk of developing rectal cancer and acute myeloid leukemia.

Experts think that the risk is related to the dose.

Here’s a look at some of the different types of surgery and radiation therapy doctors use to treat prostate cancer.


The main surgery for prostate cancer is called radical prostatectomy. During this surgery, the surgeon removes your entire prostate gland. They may also remove nearby tissues, such as seminal vesicles.

Surgeons use three techniques to perform this procedure:

  • Open surgery: A surgeon makes an incision in your lower abdomen or between your anus and scrotum to access your prostate.
  • Laparoscopic surgery: A surgeon makes several small incisions in your abdomen. They perform the surgery with a long, thin tube called a laparoscope and other small tools.
  • Robot-assisted laparoscopic surgery: The procedure is similar to laparoscopic surgery, but the surgeon uses a robotic arm to perform the surgery while guiding it from a computer.

Most people only need to stay in the hospital for one night after a radical prostatectomy.

Learn more about radical prostatectomy.

Other surgeries used to treat prostate cancer include:

  • Pelvic lymphadenectomy: A surgeon removes the lymph nodes around your pelvis.
  • Transurethral resection of the prostate: During transurethral resection, a surgeon removes part of your prostate by inserting a thin tool through the head of your penis via the urethra. They sometimes use this method to treat cancer before starting another treatment.

Radiation therapy

Radiation therapy involves using high-energy waves to kill cancer cells. Doctors use three main types of radiation therapy to treat prostate cancer:

  • External beam radiation therapy (EBT): A machine aims beams of high-energy waves at your prostate gland. You usually receive treatment 5 days a week at an outpatient center for at least several weeks.
  • Brachytherapy: Brachytherapy involves implanting radioactive pellets that are about the size of grains of rice into your prostate. Most commonly, you receive pellets for weeks or months that release a small amount of radiation. Less commonly, you may receive pellets that release high amounts of radiation for a few minutes.
  • Radiopharmaceuticals: A healthcare professional injects these radioactive drugs into your blood. Radiation from these drugs can kill cancer cells, but they can also damage healthy cells around your body.

Learn more about radiation therapy for prostate cancer.

A 2020 study found that the average 1-year costs of treatment were similar between surgery and radiation.

The cost of radiation therapy will depend on the type of radiation. For example, the study found brachytherapy to be less costly than a type of EBT called stereotactic body radiation therapy.

The study also found that both surgery and radiation were more than twice the cost of active surveillance.

Medicare or your private insurance will usually cover most of your prostate cancer treatment costs. Check with your insurance provider to learn more about what your out-of-pocket costs may be.

The National Cancer Institute lists eight standard treatments for prostate cancer:

Clinical trials are testing other treatments such as:

Talk with a doctor or healthcare professional to learn more about clinical trials.