Comparing Prostate Cancer Treatment Options

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Men with prostate cancer have four main options for treatment: active surveillance, radical prostatectomy, external beam radiation therapy, and brachytherapy. Here’s how they compare.

In active surveillance, you forgo immediate treatment but are closely monitored for progression of the cancer. For most men with low-grade cancer active surveillance is usually the recommended option, as this type of cancer often progresses more slowly than other types. A randomized trial in the New England Journal of Medicine in July 2016 found that men with early prostate cancer lived just as long with active surveillance as with up-front treatment, even though they had a significantly higher risk of developing metastatic disease. Some experts also advise active surveillance for certain types of intermediate-grade cancer.

In radical prostatectomy, a surgeon removes the entire prostate gland, along with some surrounding tissue and two glands called the seminal vesicles.

External beam radiation therapy targets the prostate with beams of radiation, while brachytherapy is a type of radiation therapy in which tiny radioactive pellets are implanted directly into the prostate.

Heres a look at the pros and cons of each option:

Active surveillance

Advantages

  • Avoids side effects from radiation therapy or radical prostatectomy
  • No hospitalization or surgical risks

Disadvantages

  • Requires close monitoring (regular digital rectal exams, prostate-specific antigen (PSA) tests, and prostate biopsy) to monitor for signs of progression
  • May be psychologically stressful to know that you have cancer while waiting to see if it progresses

Radical prostatectomy

Advantages

  • Proven to reduce prostate cancer death rates
  • Removed tissue allows accurate staging
  • PSA levels reliably predict recurrence
  • Fewer bowel/rectal problems than with external beam radiation therapy (EBRT)
  • Less urinary urgency and frequency than with EBRT or brachytherapy

Disadvantages

  • General risks of surgery
  • Hospitalization required
  • Catheter in place for 7-10 days
  • Recovery period: at least 1 month
  • Incontinence: 5-20% (mostly stress incontinence)
  • Erectile dysfunction: 30-50% at 5 years (with nerve preservation surgery)

External beam radiation therapy

Advantages

  • No hospitalization or surgical risks
  • Activities unrestricted
  • Low risk of urinary incontinence (1-2%)
  • Less urinary retention than with brachytherapy

Disadvantages

  • No post-treatment staging information
  • Treatment typically 5 days a week for 6-9 weeks
  • Fatigue is common
  • Erectile dysfunction: 30-50% at 5 years
  • Bowel/rectal problems: 5-10% (urgency, pain, diarrhea, or bleeding) but typically improve after treatment
  • Bladder irritation: 5% (urinary frequency, urgency, discomfort)

Brachytherapy

Advantages

  • No hospitalization or surgical risks
  • Less radiation damage to healthy tissue
  • One treatment
  • Low risk of urinary incontinence (1-2%)

Disadvantages

  • No post-treatment staging information
  • Less favorable option for men with intermediate or high-risk disease
  • Urinary retention, urgency, and frequency more common than with other treatments, especially in men with lower urinary tract symptoms before treatment