For men with localised prostate cancer that needs treatment, the two main options that aim for a cure are surgery and radiotherapy. For many men, the chances of cure are similar. The decision often comes down to side effects, recovery, general health and personal priorities. Knowing which questions to ask makes the choice clearer.
How each treatment works
Surgery removes the whole prostate and seminal vesicles. In the UK, this is usually done by robotic prostatectomy, a keyhole technique where the surgeon controls precise instruments from a console. Lymph nodes may be removed at the same time.
Radiotherapy uses high-energy X-rays to destroy cancer cells. External beam radiotherapy is given in a series of sessions over several weeks. Brachytherapy places radioactive sources inside the prostate. Radiotherapy is often combined with hormone therapy for intermediate or high-risk cancer.
Comparing the two
- Treatment time: surgery is a single operation with a few weeks of recovery. External radiotherapy usually involves daily sessions for several weeks, often with hormone therapy for months beforehand and afterwards.
- Urinary effects: surgery commonly causes leakage at first, which improves over months. Radiotherapy is less likely to cause leakage but can irritate the bladder, causing urgency and frequency.
- Bowel effects: uncommon after surgery. Radiotherapy can cause bowel urgency, loose stools or bleeding in some men.
- Erections: both can affect erections. After surgery, the effect is immediate and may improve with time. After radiotherapy, changes tend to develop gradually.
- Pathology: surgery provides the whole prostate for examination, giving precise information on grade and stage.
- Follow-up: after surgery, PSA should become almost undetectable, making any return easy to spot. After radiotherapy, PSA falls more slowly.
- Further treatment: radiotherapy can be given after surgery if needed. Surgery after radiotherapy is possible but more complex.
Questions to ask yourself
- How would I feel about an operation and a few weeks of recovery?
- How important is it to avoid urinary leakage, even short-term?
- How would I feel about possible bowel side effects?
- Can I manage daily hospital visits for several weeks?
- Would I want the reassurance of having the whole prostate examined?
- Do I have other health conditions that affect fitness for surgery?
Questions to ask your specialists
It is good practice to talk to both a urologist and a clinical oncologist before deciding. You might ask:
- Are both treatments suitable for my cancer?
- What are my chances of cure with each?
- What side effects are most likely for someone like me?
- Will I need hormone therapy, and for how long?
- How many of these treatments do you carry out each year?
- What support is available if I have side effects?
Our article on essential questions to ask your prostate cancer surgeon has more ideas, and our guide to the multidisciplinary team explains how recommendations are made.
Where evidence helps
Large studies, including the UK ProtecT trial, have compared surgery, radiotherapy and active monitoring for localised prostate cancer. They found that survival was very high with all three, while side effects differed. NICE guidance on prostate cancer sets out which options should be offered for each risk group.
Other options
For some men, other approaches may be suitable:
- Active surveillance: for low-risk cancer. Our guide to active surveillance explains how it works.
- Focal therapy: treating only part of the prostate, in selected cases.
Making the decision
There is usually time to think. Many men find it helpful to talk to others who have had each treatment. Prostate Cancer UK can put you in touch with trained volunteers.
Professor Prokar Dasgupta can discuss whether surgery suits you and how it compares with other options at The London Clinic. Please contact the clinic to arrange a consultation.