Which is Better - Surgery vs. Radiation for Prostate Cancer?

PCRI’s Executive Director, Mark Scholz, MD, explains why there has been a controversy over whether surgery or radiation is the better treatment for prostate cancer, describes the pertinent risks and considerations when deciding between the two treatments, and explains why he thinks radiation is usually going to be the preferable option, all things considered.

0:43 The main reason why there is a controversy about whether surgery or radiation is better for treating prostate cancer is that as recently as 10-15 years ago the technology for radiation was significantly less effective and more toxic than it is today. There were also fewer options for salvage therapy after radiation in the event of a relapse. Since then, radiation technology has advanced significantly, but the dialogue has been comparatively mired. Today, radiation can be precisely delivered, and radiation is achieving even better cure rates than surgery.

1:59 Surgeons are constrained by the fact that the bladder and the rectum are within millimeters of the prostate. They cannot cut a margin around the gland. Radiation oncologists are not limited in this way since they are not physically cutting anything out.

2:21 External beam radiation has a cure rate about as good as surgery, and radioactive seed implants have even better cure rates than surgery.

2:33 Most men will live for a very long time after being treated for prostate cancer, and so it is important to consider the side effects of each treatment, especially now that they all have comparable cure rates.

2:54 There is a risk of sexual dysfunction with both surgery and radiation, however, the rate of impotence after surgery is significantly higher than after radiation.

3:15 There is a risk of incontinence with surgery that is almost non-existent with radiation. An operation performed by a top surgeon on an ideal candidate has about a 5-10% risk of causing incontinence, and that is with the best possible conditions. Stress incontinence occurs in around 50% of men, and ejaculation of urine occurs in about 20% of men.

4:00 Rectum burns used to be a concerning side effect of radiation, but that risk has been eliminated with the advent of SpaceOAR, a gel that separates the prostate from the rectum and protects it from radiation.

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The Prostate Cancer Research Institute (PCRI) is a 501(c)(3) not-for-profit organization that is dedicated to helping you research your treatment options. We understand that you have many questions, and we can help you find the answers that are specific to your case. All of our resources are designed by a multidisciplinary team of advocates and expert physicians, for patients. We believe that by educating yourself about the disease, you will have more productive interactions with your medical professionals and receive better individualized care. Feel free to explore our website or call our free helpline at 1 (800) 641-7274 with any question that you have. Our Federal Tax ID # is 95-4617875 and qualifies for maximum charitable gift deductions by individual donors.

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