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Is it better to have surgery or radiotherapy for early stage prostate cancer?

Prostate cancer is the most common cancer in men with over 47,500 new cases diagnosed every year in the UK.. When it comes to treating prostate cancer, there are two main options: surgery or radiotherapy. In this article, we will discuss the pros and cons of each option to help men make an informed decision about their treatment.

Surgery for prostate cancer

Surgery for prostate cancer involves removing the prostate gland and the surrounding tissue. A procedure known as a radical prostatectomy. This is done under general anaesthesia and typically involves a hospital stay of 1-3 days. The goal of surgery is to remove the cancerous tissue and prevent it from spreading to other parts of the body.

While the procedure can be effective in treating the cancer, there are advantages and disadvantages to consider before undergoing surgery.


  1. Cure rates: Radical prostatectomy can be a highly effective treatment for prostate cancer, with cure rates approaching 90% for men with early-stage cancers.
  2. Improved symptoms: For men with advanced prostate cancer, radical prostatectomy can help improve symptoms such as difficulty urinating or pain.
  3. Fewer treatment sessions: Radical prostatectomy only requires one procedure unlike other treatments such as radiation therapy or chemotherapy.
  4. More accurate staging: Radical prostatectomy allows for more accurate staging of the cancer, which can help determine the best course of treatment.


  1. Incontinence: One of the most common side effects of radical prostatectomy is urinary incontinence, which is usually temporary but in a small proportion of men can be permanent.
  2. Impotence: Radical prostatectomy can also lead to erectile dysfunction, which can be temporary or permanent.
  3. Bowel problems: In rare cases, the procedure can cause bowel problems such as difficulty with bowel movements.
  4. Recovery time: Recovery from radical prostatectomy can take several weeks or months and may involve some initial pain and discomfort.
  5. Risk of complications: As with any surgery, there is a risk of complications such as bleeding, infection, deep vein thrombosis or reaction to anaesthesia.

What are the success rates of surgery for treating prostate cancer?

According to the latest statistics from Cancer Research UK, the overall success rate of surgery for prostate cancer in the UK is quite high. In fact, up to 90% of men who have surgery for prostate cancer are cured of the disease. The success rate of surgery varies depending on the stage of cancer and the type of surgery performed.

There are two main types of surgery for prostate cancer: radical prostatectomy and robotic-assisted laparoscopic prostatectomy. Radical prostatectomy involves the removal of the entire prostate gland, while robotic-assisted laparoscopic prostatectomy is a less invasive procedure that involves the use of a robotic system to remove the prostate gland.

Studies have shown that both types of surgery are highly effective in treating localised prostate cancer. In fact, a study published in the British Journal of Urology International found that both radical prostatectomy and robotic-assisted laparoscopic prostatectomy resulted in a 10-year survival rate of around 95% for men with localised prostate cancer.

Radiotherapy for prostate cancer?

Radiation therapy is a common treatment for prostate cancer, which uses high-energy radiation to kill cancer cells. There are two types of radiation therapy: external beam radiotherapy (ERBT) and brachytherapy. External beam radiotherapy is delivered from outside the body, while brachytherapy involves the placement of radioactive seeds directly into the prostate gland. While radiation therapy can be effective in treating prostate cancer, there are both advantages and disadvantages to consider before undergoing the treatment.


  1. Non-invasive: Radiation therapy is a non-invasive treatment option, which means there is no surgery involved.
  2. Preservation of urinary function: Compared to surgery, radiation therapy has a lower risk of urinary incontinence.
  3. Outpatient procedure: External beam radiation therapy is usually done on an outpatient basis, which means you can return home the same day.
  4. Effective treatment: Radiation therapy is an effective treatment for prostate cancer, with cure rates that are similar to those of surgery.
  5. Shorter recovery time: Compared to surgery, radiation therapy has a shorter recovery time, with most patients able to resume normal activities within a few days.


  1. Side effects: Radiation therapy can cause side effects, such as fatigue, skin irritation, and diarrhoea. These side effects can be managed with medication or lifestyle changes.
  2. Long-term side effects: In rare cases, radiation therapy can cause long-term side effects such as erectile dysfunction, urinary problems, or bowel problems.
  3. Multiple treatments: Radiation therapy usually involves multiple treatments over several weeks, which can be inconvenient for some patients.
  4. Risk of recurrence: Radiation therapy may not completely eliminate all cancer cells, and there is a risk of the cancer returning.
  5. Risk of secondary cancer: Radiation therapy may increase the risk of developing a secondary cancer in the treated area.

What are the success rates of radiotherapy for treating prostate cancer?

The success rate of radiotherapy for prostate cancer can vary depending on a number of factors, such as the stage of the cancer, the aggressiveness of the cancer, the age and overall health of the patient, and the type of radiotherapy used.

According to the National Institute for Health and Care Excellence (NICE), the overall success rate for radiotherapy in treating prostate cancer is around 80%. This means that around 8 out of 10 men who undergo radiotherapy for prostate cancer will see their cancer either disappear completely or shrink in size.

However, the success rate of radiotherapy for prostate cancer can also be measured in terms of disease-free survival and overall survival. Disease-free survival refers to the amount of time after treatment that a patient is free from any signs of cancer. Overall survival refers to the amount of time after treatment that a patient remains alive.

According to the results of the UK Radiotherapy Trials for Prostate Cancer (RT01) study, which followed over 2,000 men with prostate cancer who underwent either EBRT or brachytherapy, the 5-year disease-free survival rate was 78%. The 10-year disease-free survival rate was 63%. The 5-year overall survival rate was 91%, and the 10-year overall survival rate was 64%.

Conclusion – Surgery vs Radiotherapy

It is important to discuss the advantages and disadvantages of surgery and radiation therapy with your urologist, oncologist, specialist cancer nurse and GP and weigh these factors against your individual situation and preferences. Your team can help you understand your risk factors and make an informed decision about whether or not to undergo the treatment. Additionally, following their instructions for pre-treatment and post-treatment care is essential to minimise the risk of complications and ensure a smooth recovery. 

Author: Mr Neil A Haldar MBBS MD FRCS

Consultant Urological Surgeon

The Pelvic Specialists

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