(Image attribution: unam, CC BY-SA 4.0 <https://creativecommons.org/licenses/by-sa/4.0>, via Wikimedia Commons)

If you have been diagnosed to have localised prostate cancer (cancer which has not spread), this may be a dilemma that you are facing – whether to get treated with surgery or radiotherapy.

Here are some facts that you can consider in making a choice on treatment for localised prostate cancer:

1. Both surgery and radiotherapy have been shown to be effective treatment for localised prostate cancer. For patients with slow-growing low risk prostate cancer, monitoring the cancer is also an option. One study found the risk of dying after 10 years was about the same no matter what treatment men with localised prostate cancer had. (Hamdy et al, 10-year outcomes after monitoring, surgery or radiotherapy for localised prostate cancer. New England Journal of Medicine, 375(15): 1415-1424)

2. Your doctor will take into account your life expectancy and physical health when recommending whether to go for surgery or radiotherapy.

3. Surgery and radiotherapy have different side effects. Surgery is more likely to lead to erection and urinary leakage problems. Radiotherapy is more likely to lead to bowel problems.

4. If you opt to go for surgery, you can have the assurance that the prostate is physically removed. If you are considering surgery, you need to be physically fit. There is a risk of serious complications such as excessive bleeding, heart attack, blood clot in the arteries of the lung, and infection as a result of surgery. You are likely to have erection and urinary leakage problems after surgery. If the cancer recurs after surgery, you can still get treated with radiotherapy.

5. If you opt to go for radiotherapy, you can avoid the serious complications of surgery. After radiotherapy, you may have diarrhoea and blood in the stool, and increased urge to urinate. You may have erection problems later on. If the cancer recurs after radiotherapy, surgery is more risky and you may be treated with hormonal therapy instead. Radiation may also slightly increase the risk of having another cancer eg. bladder or bowel cancer, later on in life.

6. If you are also recommended to have hormonal therapy (usually together with radiotherapy), you may get side effects of hormonal therapy such as fatigue, hot flashes and loss of bone density.

In summary, both surgery and radiotherapy are good treatment options for prostate cancer. The choice of treatment for you would depend on your goals, your state of health and the side-effects of treatment you are willing to accept.