In the United States, prostate cancer is the
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
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.
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.
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
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
Surgery can eliminate prostate cancer that’s contained in your prostate or nearby tissue.
- 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:
- 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.
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
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.
The risks of prostate surgery are similar to those of other surgeries.
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
- radiation cystitis, which can cause:
- more frequent urination
- burning while urinating
- urinary incontinence
- erectile dysfunction
- swollen lymph nodes
- rectal pain
Doctors almost always combine radiation therapy with a hormone therapy called
ADT lowers the levels of androgens in your body, as these can help prostate cancer grow. Lowering your androgen levels has
- reduced sexual desire
- erectile dysfunction
- decreased penis and testicle size
- growth of breast tissue
- loss of muscle mass
- hot flashes
- mood changes
- low blood count
Radiopharmaceuticals (injected radioactive drugs) can cause:
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.
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 involves using high-energy waves to kill cancer cells. Doctors use
- 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
- 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.
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.
- watchful waiting or active surveillance
- radiation therapy
- hormone therapy
- targeted therapy
- bisphosphonate therapy
Clinical trials are testing other treatments such as:
- photodynamic therapy
- proton beam radiation therapy
- high-intensity-focused ultrasound therapy
Talk with a doctor or healthcare professional to learn more about clinical trials.