April 5, 2021

Choice between radical surgery or radiotherapy?

Unless you are not a candidate for either option, there are generally no strict rules for deciding whether radical surgery or radiotherapy is preferable as a treatment. If your cancer is really confined to your prostate, it can be cured with surgery or radiation therapy. However, to benefit from a cure, your life expectancy must be of 10 to 20 years from the time of your diagnosis. This is because many prostate cancers grow slowly, and men will sometimes die from other causes before succumbing to their cancer.

Treating your prostate cancer is a very personal decision. The choice between radiotherapy versus radical surgery (radical prostatectomy) is often based on the advantages and disadvantages of these options. In a situation where there is no right choice and these two options being equivalent in terms of years of survival, getting the right information is essential. To feel confident and to be actively involved in your choice, it is important to be seen by a urologist and a radiation oncologist to have both points of view.

Have the following three questions ready to start the discussion with the two specialists:

  • What is my life expectancy and the risk of my cancer progressing without treatment?
  • What is my life expectancy and the risk of my cancer progressing with radical surgery? What about radiotherapy?
  • What are the risks or side effects associated with radical surgery versus radiotherapy?

Risk of your prostate cancer progressing

Know that before making a recommendation, your doctor will assess your risk of progression or recurrence: do you have low-risk, intermediate-risk or high-risk of cancer progression?

For this assessment, which may influence the therapeutic approach, consideration is given to the clinical stage, your PSA level and Gleason score. For example, your doctor may suggest more aggressive treatment if your risk of recurrence is high. Conversely, if your risk of progression is low, you may be offered active surveillance without immediately receiving treatment.

You not a candidate for active surveillance? Usually, radical surgery or radiation therapy is sufficient when the tumor does not extend beyond the prostate. Both of these treatments are very effective with a similar cure rate 5 to 10 years after treatment. Several studies show that after one year, the quality of life is comparable for the two treatments (taking into account side effects and complications).

Understanding the side effects of your treatment

Whether we are talking about radical surgery or radiotherapy, these treatments can have consequences on your urinary, erectile or intestinal functions. These side effects are caused by the proximity of your erectile nerves, your bladder - and the fact that your prostate surrounds your urethra, the e channel that passes your urine - and your rectum. They vary from person to person depending on the degree of illness, age and state of health. The good news is that there are many strategies that can help you manage them. Do not hesitate to talk to your doctor.

Regardless of the treatment chosen, you will need to get involved and collaborate with your urologist, radiation oncologist, nutritionist or physiotherapist to recover your continence, your erections, and manage your urinary or intestinal problems. All of this requires patience, perseverance and resilience. Do not hesitate to talk to your doctor before, during and after your treatment.


Take the time to visit each of our pages on this website, as well as our YouTube channel, in order to get familiar with the disease with our expert lectures, our section on available resources, the support that is offered to you.

Do you have any questions or concerns? Above all, do not hesitate. Contact us at 1 855 899-2873 to discuss with a nurse specializing in uro-oncology. It's simple and free, like all our services.

Pages that might interest you
Want to know more? Just click on one of the links below.
Prognosis and survival
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Written by PROCURE. © All rights reserved - 2021

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