Choosing a Prostate Cancer Treatment
For men with prostate cancer that requires treatment, the choices depend largely on the stage and characteristics of the cancer. For cancer confined to the prostate, the major options often include surgery or radiation.
Both can provide excellent cancer control for appropriately selected patients, but their side effects and impact on quality of life can differ.
Age, overall health, cancer aggressiveness, urinary and sexual function, and personal priorities all matter. For many men, getting opinions from both a urologic surgeon and a radiation oncologist can be valuable.
Surgery
A radical prostatectomy removes the prostate and seminal vesicles. Many prostatectomies today are performed robotically.
Surgery removes the prostate and allows the cancer to be fully examined. After surgery, PSA should fall to a very low or undetectable level, making follow-up relatively straightforward.
The major potential side effects are urinary incontinence and erectile dysfunction. Risks vary with age, health, function before surgery, the cancer's location, and whether nerves involved in erections can be preserved.
The experience of the surgeon and medical center is important.
Radiation Therapy
Radiation therapy uses high-energy radiation to destroy cancer cells. Major approaches include external beam radiation and brachytherapy, in which radioactive material is placed inside the prostate.
Radiation avoids surgery and generally has a lower immediate risk of urinary incontinence. Erectile function may decline gradually, and some men experience urinary irritation or bowel symptoms.
For higher-risk cancers, radiation may be combined with androgen-deprivation (hormone) therapy.
As with surgery, the experience of the treatment team is important.
Focal Therapy
Focal therapy treats the area containing the cancer rather than the entire prostate. Techniques include high-intensity focused ultrasound (HIFU) and cryotherapy.
It may be an option for carefully selected men with localized prostate cancer when imaging and biopsy identify a specific area of significant cancer.
The potential advantage is fewer urinary and sexual side effects. However, prostate tissue remains, so continued monitoring with PSA, MRI, and sometimes repeat biopsy is necessary. Long-term evidence is less extensive than for surgery and radiation.
Comparing Side Effects
Both surgery and radiation can successfully treat localized prostate cancer, but their side effects tend to differ.
Urinary control: Incontinence is more common after surgery. Radiation is less likely to cause significant incontinence but can cause urinary frequency, urgency, or irritation.
Sexual function: Erectile dysfunction can occur after either treatment. It may occur immediately after surgery and develop more gradually after radiation.
Bowel function: Bowel problems are uncommon after surgery but can occur after radiation, although modern techniques have reduced this risk.
For many men, the choice involves balancing cancer control with the side effects that matter most to their quality of life.
Treatment for Advanced Prostate Cancer
Men whose prostate cancer has spread beyond the prostate may need other treatments, including hormone therapy, chemotherapy, targeted treatments, radiopharmaceuticals, or immunotherapy.
Sipuleucel-T (Provenge) is an immunotherapy used for some men with metastatic castration-resistant prostate cancer. Pembrolizumab (Keytruda) may be used for a small subset of prostate cancers with particular genetic characteristics, including MSI-H or dMMR.
Learn More
An overview of treatment options for prostate cancer.
Video
PCRI compares surgery and radiation for localized prostate cancer, including effectiveness, side effects, and factors that may help patients choose between them.