Surgery vs. Radiation for Prostate Cancer: Uses, Benefits, Side Effects

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Prostate cancer is the most common form of cancer other than skin cancer in people who have a prostate (an organ that secretes fluid to protect and nourish sperm). Depending upon the stage of the cancer, different treatment options are available. These treatment options include:

This article will review how surgery and radiation are used to treat prostate cancer.  Both can be very effective forms of treatment in men with the disease.  Although they may have the same goals of therapy, there are differences between these treatments. 

Be sure to see your healthcare provider for the diagnosis, so you can receive the best treatment for you.

Healthcare provider discusses treatment options with person who has prostate cancer

The Good Brigade / Getty Images

What to Know About Surgery

Surgical treatment for prostate cancer may be considered when the cancer has not spread outside the prostate.

How Does It Work? 

There are multiple types of surgery that can be used.

Radical prostatectomy (open or robotic-assisted laparoscopic): During this procedure, the prostate is removed from the space between the bladder and urethra. An additional lymph node dissection (removal for lab analysis) can be done during the procedure if the surgeon feels it is needed for accurate staging (determining the amount of cancer and how far it has spread).

An open prostatectomy is done through an incision in either the lower abdomen or in the perineum, which is the area between the rectum and the penis. Most laparoscopic removal (in which multiple small incisions are made and instruments inserted to remove the prostate) is now done with robotic assistance.

Cryoablation: This is a surgical procedure done as primary treatment for prostate cancer or when cancer may return after radiation (salvage). Needles are placed into the prostate to deliver cold fluid that becomes ice balls, which destroy the tissues they contact.

Focal therapy: This is done with probes that deliver cold or hot energy into areas targeted within the prostate. With focal therapy, only select areas of the prostate are ablated (destroyed) to minimize side effects.

Side Effects 

Side effects from prostate surgery can include:

  • Urinary incontinence (impaired control of the flow of urine)
  • Impotence (inability to get or maintain an erection)
  • Shortening of the penis
  • Injury to the rectum and surrounding structures
  • Infertility due to the removal of the vas deferens (the tube that carries sperm) during surgery

Prices and Where to Get It 

The cost of a radical prostatectomy varies depending on insurance status and location of surgery.

Costs may include hospital fees, anesthesia fees, and surgeon fees. The average cost of hospital fees for prostatectomy in the United States is about $34,000. Anesthesiologist and surgeon fees average about $8,000. What out-of-pocket expenses the person being treated incurs will depend on their insurance.

The location of the procedure can be with a local surgeon, or the person being treated may travel to see a regional or national expert.

What to Know About Radiation

Radiation treatment uses high energy X-ray beams directed to cancer cells to kill them.

How Does It Work? 

There are multiple types of radiation treatments that can be used for prostate cancer.

External beam radiation: This treatment is administered through a specialized machine that directs beams of radiation to targeted areas in the prostate. It is usually given in daily doses five days a week for about six weeks.

Stereotactic radiation: This type of radiation uses advanced images of the prostate with a different type of radiation machine. This may also be referred to as Gamma Knife or CyberKnife.

This type of radiation often uses much higher doses than standard external beam radiation. However, it is given in such a way that healthy tissue around the prostate is spared from high doses of radiation. Because of the high doses of radiation, this type of treatment may only need five or fewer treatments.

Brachytherapy: During this type of radiation, radioactive seeds (about the size of a grain of rice) are placed into the prostate. These radiation seeds emit radiation for a period of time and remain in the prostate even after the radiation has left.

How Is It Delivered?

Radiation is typically administered in an outpatient cancer center, although stereotactic radiation may be done in more specialized cancer centers. Brachytherapy seeds are placed under anesthesia in an operating room.

Side Effects 

Side effects of radiation therapy can include:

  • Radiation enteritis or proctitis: This is inflammation of the intestine or rectum, with symptoms such as diarrhea, anal leakage, and blood in the stool. This side effect has been reduced by placing a hydrogel spacer between the prostate and rectum before starting radiation.
  • Radiation cystitis: This is inflammation of the bladder, with symptoms such as urinary frequency, blood in the urine, and pain with urination.
  • Fatigue
  • Impotence
  • Incontinence

Prices and Where to Get It 

External beam radiation is typically available at most cancer centers. More specialized centers may provide other forms of radiation such as stereotactic radiation. They are all performed in an outpatient setting, with the exception of brachytherapy, which is done in an operating room.

The costs of radiation therapy vary depending upon the type of radiation given. The average cost of external beam radiation is about $57,000. Stereotactic radiation averages about $50,000, and brachytherapy is about $20,000.

Which Treatment Is Best for You? 

The exact type of treatment that is best for you can depend upon many factors, such as the stage of the cancer, where in the prostate the cancer is located, and individual factors. These are all taken into account by the treating healthcare team when creating a personalized treatment plan.

When you meet with your healthcare provider, they will give you the options that will be the most effective in treating your case of prostate cancer.

For stage 1 prostate cancer, treatment may include:

  • Watchful waiting or active surveillance (no treatment given, but testing and exams are performed to see if the cancer is growing)
  • Hormone therapy
  • Radical prostatectomy
  • Radical prostatectomy with pelvic lymphadenectomy
  • Radiation after surgery
  • External radiation without surgery
  • Brachytherapy

For stage 2 prostate cancer, treatment may include:

  • Watchful waiting or active surveillance
  • Hormone therapy
  • Radical prostatectomy with pelvic lymphadenectomy
  • External radiation given after surgery
  • Brachytherapy

For stage 3 prostate cancer, treatment may include:

  • Watchful waiting or active surveillance
  • Hormone therapy (may be given alone or before or after radiation therapy)
  • External radiation
  • Radical prostatectomy with or without radiation after
  • Transurethral resection of the prostate
  • Brachytherapy

For stage 4 prostate cancer, treatment may include:

  • Watchful waiting or active surveillance
  • Hormone therapy, may be combined with chemotherapy
  • Bisphosphonate therapy
  • External radiation
  • Radical prostatectomy
  • Transurethral resection of the prostate

Can Surgery and Radiation Be Used Together? 

If both surgery and radiation are in the treatment plan for prostate cancer, surgery is usually done before radiation. Radiation may be given to the area around the prostate after removal to help reduce the risk of cancer returning.

This is often done proactively in people in whom staging after surgery shows high-grade disease with a high risk for recurrence.

Coping With the Side Effects

The side effects of both surgery and radiation can vary from mild to more severe and potentially significantly impact someone’s life.

The side effects of urinary and bowel problems can be distressing. There are ways to help manage these, such as with pelvic floor exercise, bladder training, and incontinence products. Other coping strategies include:

  • Urinating every few hours
  • Limiting caffeine intake
  • Talking to your healthcare team about any medications or other interventions that may be helpful

Sexual dysfunction related to prostate cancer treatment can also be an unwelcome side effect. Helpful ways to cope with this can include:

Fatigue is a common symptom of prostate cancer treatment. Ways to manage fatigue include:

  • Exercising regularly
  • Getting adequate nutrition
  • Trying to sleep at night and limit naps during the day
  • Limiting caffeine
  • Prioritizing activities for the day and taking breaks as needed

Summary 

Surgery and radiation are two commonly used treatments for prostate cancer.  Although they are different and how they work, they both have the goal of eliminating or reducing the amount of prostate cancer in the body. Side effects of both treatments can include sexual dysfunction, bowel and bladder problems, and fatigue.

A Word From Verywell

Prostate cancer is a very common and treatable cancer, with many options for care. If you receive a diagnosis of prostate cancer, make sure to talk about all of the treatment options that are available for you with your oncologist (cancer specialist).

No single treatment is right for everyone. It’s also very important to discuss any potential long-term side effects from whatever treatment you received.

8 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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