Radiation Therapy as Effective as Surgery for Prostate Cancer
Sep 09, 2021 Nicole Levine
Prostate cancer is the most common cancer among men. It's usually detected early and often doesn't need to be treated right away—and when and how to screen for prostate cancer is a personalized process that men need to discuss with their doctors.
These are basic facts most men know about prostate cancer. Far fewer men are aware that radiation and surgery are equally effective at curing prostate cancers, says Dr. Benjamin King, a radiation oncologist at Cedars-Sinai.
"Most men with prostate cancer are diagnosed by urologists—who are also surgeons," he says. "So, they often hear about surgical options, but fewer have lengthy discussions about radiation options. Both radiation and surgery are equally effective treatments to cure prostate cancer."
The choice of which treatment is best is up to individual patients and their care teams, Dr. King says.
"Make sure you talk with a surgeon and a radiation oncologist before you make your decision. It's important to have all of the information before committing to the right course of treatment for you."
Considering the options
Roughly 13 out of every 100 American men will get prostate cancer during their lifetime, according to the Centers for Disease Control and Prevention. Of those, two to three will die of the disease—though Black men are twice as likely to die from prostate cancer.
Most of the time, prostate cancer is detected at an early stage. Low-risk prostate cancer tends to be less aggressive in growth and spread, which can allow it to be monitored closely with active surveillance. In active surveillance, doctors regularly monitor the cancer with PSA tests and biopsies, then patients and doctors determine together when an intervention is necessary to address the tumor.
For patients with more aggressive prostate cancer, more immediate treatment is often recommended and necessary. The two standard types of treatment considered are surgery and radiation therapy.
"A lot of people feel that if they have a tumor, cutting it out would always be better than anything else," Dr. King says. "And people have some preconceived notions about what radiation is."
Younger men tend to opt for surgery, while those who are at higher risk for surgery because of their age or other medical problems tend to choose radiation. Radiation is a good option for most prostate cancer patients, regardless of age, whose disease has progressed to a point where intervention is necessary, Dr. King says.
Surgery vs. radiation: Weighing the similarities and differences
Any treatment is going to have some down time and side effects to consider, Dr. King says.
The rate of erectile dysfunction related to surgery and radiation is about the same, he says. The nerves and blood vessels involved in erectile function pass behind the prostate, and either treatment may affect them. However, for many patients, erectile function returns or can be successfully treated after addressing their cancer, says Dr. King.
Another frequent concern patients have is whether treatment will affect continence. Many people experience some incontinence or leakage following surgery for prostate cancer. However, in most cases, they regain continence.
Incontinence is not typically a side effect of radiation therapy, Dr. King says. However, some patients do have rectal irritation with radiation.
The other difference is time spent at the hospital. Surgery routinely requires an inpatient stay, while radiation can be done on an entirely outpatient basis. While surgery and the related recovery can be a more intense experience for patients, that time is generally compressed into a few weeks. Radiation treatments are given over a course of seven to nine weeks.
Radiation isn't what people imagine, he says. Often, people's perception of radiation comes from what they've read in the news about nuclear power disasters or the atomic bomb.
"Those are very different from the reality of radiation therapy," he says. "These treatments are precisely targeted. They're personalized based on your body and your specific cancer."
With equal cure rates, choosing the best treatment for each person can rest on many factors—a patient's specific cancer, needs, risk, other health conditions and lifestyle all play a role in determining the best treatment for them.
"Make sure you talk with a surgeon and a radiation oncologist before you make your decision," Dr. King says. "It's important to have all of the information before committing to the right course of treatment for you."