How To Decide Between Surgery and Radiation for Prostate Cancer

Posted on August 12, 2022 in Prostate Cancer

Written by Dr. Ward

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If you have recently been diagnosed with prostate cancer, you may wonder which treatment options are available. Assuming your cancer is localized – meaning it hasn’t spread past the prostate – you will be presented with two choices: either undergo surgery to remove the prostate or receive radiation therapy.

Though both modalities are equally effective in treating localized prostate cancer, they each come with unique risks. To help you make an informed decision regarding your cancer treatment plan, we discuss these risks in more detail below. For a complete guide on Prostate Cancer, download our eBook.

Disclaimer: Staging Affects Treatment Options

Your cancer treatment plan will depend on the stage of your prostate cancer. Your cancer stage refers to its severity. If you have been diagnosed with early-stage, localized cancer, that means the cancer cells are contained within the prostate. In other words, it hasn’t spread to other tissues.

Early-stage, localized prostate cancer can be treated with surgery, radiation, or a combination of the two. However, advanced-stage cancers are more commonly addressed using hormone therapy, chemotherapy, radiation therapy, immunotherapy, or targeted therapy.

Surgery for Prostate Cancer

A radical prostatectomy is the surgical removal of the prostate. This procedure can be performed through traditional surgery, robotically or laparoscopically. Your surgeon will discuss the various techniques. Most patients after prostatectomy are discharged after a short hospital stay, and a catheter is removed shortly after. Most men resume full activity within three weeks.

Pros & Cons of Surgery


Prostatectomy has long been considered the “gold standard” for prostate cancer treatment because it removes cancer at the source.

In some cases, surgeons also perform a pelvic lymph node dissection, which involves removing the lymph nodes that drain the prostate. This procedure ensures that cancer hasn’t spread to the surrounding tissues.

Once the prostate is removed, your prostate-specific antigen (PSA) levels can be monitored by a blood test. PSA is a protein produced by cancerous and noncancerous tissue in the prostate. Four weeks after surgery, your PSA levels should drop to almost zero. A test result above 0.2 ng/ml could indicate that your cancer has returned.


The most commonly reported side effect of surgery is erectile dysfunction. Most men report sexual dysfunction following radical prostatectomy. Though some men recover within 18 months, impotence may persist for years.

Urinary incontinence is also a prevalent problem. Most men who experience a loss of bladder control have symptoms for six to 12 months after surgery. A small percentage of patients never regain full bladder control.

Some men will need radiation after surgery if their PSA is measurable and/or rising. Depending on the stage of your cancer, the risk of needing radiation after surgery ranges from 10-50%.

Because of these risks, men should consider their options carefully prior to treatment.

Radiation Therapy for Prostate Cancer

Radiation therapy is a highly effective cancer treatment modality that uses radiation to target cancer cells.

If you have been diagnosed with prostate cancer, you should consider meeting with a radiation oncologist. The radiation oncologist may suggest external beam radiation therapy (EBRT), brachytherapy, or a combination of the two.

External Beam Radiation Therapy

During EBRT, a machine directs X-ray beams onto the prostate gland from outside the body. Typically, patients receive 28 to 45 doses of radiation over five to nine weeks, from Monday to Friday. Treatments are localized and relatively painless.


Brachytherapy, also called internal radiation, involves placing radioactive pellets in the prostate gland. There are two types of brachytherapy: low dose rate (LDR) and high dose rate (HDR).

LDR Brachytherapy

During LDR brachytherapy, radioactive pellets are placed inside the prostate gland during an outpatient procedure. These pellets remain in the body forever, but only give off radiation for a few months.

HDR Brachytherapy

With HDR brachytherapy, a patient is placed under general anesthesia and thin tubes are inserted into the prostate. Later, during treatment, wires containing radiation are fed through the tubes and left inside the prostate for a few minutes at a time.

Pros & Cons of Radiation


Many men opt for radiation therapy because they want to avoid erectile dysfunction and urinary incontinence – side effects that are more commonly associated with surgery than with radiation.

The risks associated with major surgery are also worth considering. As with any operation, prostate surgery can cause bleeding, blood clots, and infection. If you have serious health problems, it may be best to avoid surgery. Your surgeon will discuss these risks with you.


Although there are advantages to radiation, there are risks as well. These risks are different than surgery. Common side-effects that may occur after radiation include fatigue, frequent urination, urgent urination, a slower urine stream, more frequent or urgent bowel movements.

More significant side effects of radiation such as blood in the urine or bowels are rare. The risk of cancer caused by radiation is well <1%, and patients can help by not smoking during or after radiation. If you’re considering pregnancy, discuss this with your doctor, as sperm can be affected by radiation.

Prostate Cancer Treatment Effectiveness

After receiving a prostate cancer diagnosis, most patients want to know their prognosis: What are the odds that they will fight the disease?

The best data suggests that radiation therapy carries very similar survival and metastatic (cancer spreading) rates when compared to surgery. On the internet, some reports suggest better survival with surgery, but these results are typically because patients who are not healthy enough for surgery often receive radiation, and thus considered ‘biased’. The most robust data suggests the two are comparable for cancer outcomes.

Simply put, both surgery and radiation appear similarly effective in treating prostate cancer.

Which Treatment Is Right for Me?

Since surgery and radiation are equally effective, you may wonder: Which treatment option is right for me? Though your oncologist will make a professional recommendation, your cancer treatment plan is ultimately up to you.

Surgery may be best for you if:

  • You are healthy enough to undergo an operation.
  • Radiation therapy isn’t a good option because you previously received radiation in the pelvic area.
  • You have a serious bowel issue like Chron’s or ulcerative colitis.

Radiation therapy may be best for you if:

  • You want to avoid the side effects of surgery, like erectile dysfunction and urinary incontinence.
  • You aren’t healthy enough to undergo a major operation.
  • You have more advanced disease; in these cases, surgery is often followed by radiation, and there may not be a benefit to both

SERO and Your Journey to Recovery

In the wake of a prostate cancer diagnosis, it’s completely normal to feel overwhelmed by treatment options. Fortunately, SERO is here to offer guidance on your journey to recovery.

At SERO, our radiation oncologists provide high-quality cancer care using cutting-edge technology. But we also support patients by providing them with the resources they need to make informed decisions regarding their cancer treatment plan.

If you want to learn more about how we can support you and your family, call us at 704-333-7376.