What Is the Best Option for Prostate Cancer, Surgery or Radiation?

When prostate cancer is detected early and before it has spread to other organs, your chances of survival are good. The best treatment for prostate cancer depends on where the cancer is located, whether it is localized or metastasized, and how early it is diagnosed. Treatment options include watchful waiting, surgery, radiation, cryotherapy, hormonal therapy, chemotherapy, immunotherapy, and others.

Prostate cancer is a cancer caused by cells in the prostate growing out of control. The prostate is a gland in men involved in producing semen. 

Because of routine screening tests, prostate cancer is often detected early, before the cancer has spread to other organs and it is not usually fatal. When detected early, there are a number of treatment options and a good chance of a cure. 

Treatment for prostate cancer depends on whether cancer is in part or all of the prostate, if the cancer has spread (metastasized) to other parts of the body, and the age and overall health of the patient.

Watchful Waiting

Men who have low-risk localized cancer may choose watchful waiting (active surveillance) instead of surgery, radiation, or other treatment options. Men whose cancer has spread (metastasized) outside the prostate to other parts of the body may also consider other treatments. 

Surgery & Radiation

For men who have prostate cancer that is localized and has not spread out of the prostate, there are two main treatment options: surgery and radiation therapy. Both treatments can be effective and determining which is the best option for treating localized prostate cancer depends on the patient’s goals, life expectancy, and any other underlying medical issues. 

• With both surgery and radiation, the chance of the cancer spreading following treatment is low and men who have either treatment have a low risk of dying from prostate cancer
• Side effects of both treatments include bladder, bowel, and erection problems
  • Radiation therapy is more likely to cause bowel problems, such as rectal pain, diarrhea, blood in the stool, and rectal leakage
  • Surgery is more likely to cause urinary incontinence or erection problems
• Surgery that involves removing the entire prostate and some nearby tissue is a treatment choice for men with early-stage prostate cancer 
  • Surgery may be the best option for:
    • Men younger than 70 and in good health
    • Men who want to avoid radiation
    • Men who want the prostate removed to completely remove the cancer
    • Men who are able to accept there might be serious side effects
    • Men who are able to accept that radiation therapy may still be needed after surgery
• Radiation therapy, which may be internal radiation (brachytherapy) or external beam radiation, is a good choice for many men with early-stage prostate cancer
  • Radiation therapy may be the best option for:
    • Older men or those with other underlying health conditions that do not allow them to have surgery
    • Men who want to preserve sexual function since radiation is less likely to cause problems with erections 
    • Men who are able to go for treatment 5 days a week for up to 9 weeks
    • Men with high-risk cancer that is less likely to be cured by surgery alone

Other treatment options for prostate cancer may include one or more of the following:

• Cryotherapy (also called cryosurgery or cryoablation)
  • Uses very cold temperatures to freeze and kill prostate cancer cells and most of the prostate
• Hormone therapy
  • Androgen deprivation therapy (ADT) uses surgery or medicines to lower the levels of androgens made in the testicles
  • Orchiectomy (surgical castration)
  • Luteinizing hormone-releasing hormone (LHRH) agonists (also called LHRH analogs or GnRH agonists) are drugs that lower the amount of testosterone made by the testicles (also called medical castration)
    • Goserelin (Zoladex)
    • Histrelin (Vantas)
    • Leuprolide (Lupron, Eligard)
    • Triptorelin (Trelstar)
  • LHRH antagonists
    • Degarelix (Firmagon) 
    • Relugolix (Orgovyx) 
• Chemotherapy 
  • Cabazitaxel (Jevtana)
  • Docetaxel (Taxotere)
  • Estramustine (Emcyt)
  • Mitoxantrone (Novantrone)
• Immunotherapy 
  • Cancer vaccine (doesn’t stop prostate cancer from growing, but may help men live several months longer): Sipuleucel-T (Provenge) 
  • Immune checkpoint inhibitors
  • PD-1 inhibitor: pembrolizumab (Keytruda) 
• Targeted therapy 
  • PARP (poly(ADP)-ribose polymerase) inhibitors
    • Olaparib (Lynparza) 
    • Rucaparib (Rubraca) 
• Treatments for prostate cancer spread to bones
  • Bisphosphonates: zoledronic acid (Zometa) 
  • Denosumab (Xgeva) 
  • Corticosteroids
  • External radiation therapy
  • Radiopharmaceuticals
    • Radium-223 (Xofigo)
    • Samarium-153 (Quadramet)
    • Strontium-89 (Metastron)
  • Surgery
    • Kyphoplasty: stabilizes a painful collapsed bone in a spine that is weakened by prostate cancer
  • Pain medicines