Diagnosed with Prostate Cancer? Pros and Cons of Surgery versus Radiation

If you’re one of the 230,000 men diagnosed with prostate cancer every year, you’re probably dealing with a dilemma of which treatment option to choose. Your doctor has likely spoken with you about radiation and surgery, but how do you choose?










Length of Treatment
  • One-time treatment for 1-2 hours, on average
  • 1-2 night hospital stay, on average
  • EBRT is typically administered 5 days a week for 5-6 weeks
  • CyberKnife® is typically  done over the course of 1-5 treatments/days
Accuracy of Treatment
  • Very accurate: prostate is visualized and removed
  • Not accurate: radiation is targeted at prostate based on imaging data, dosage and location is approximated
Side Effects During Treatment
  • Anesthesia
  • Fatigue, skin inflammation, frequent/difficult/uncomfortable urination, rectal bleeding or irritation, hemorrhoids, diarrhea
Hormone Therapy Necessary?
  • No
  • Lupron is given along with RT, which has its own panel of side effects, similar to menopause
Cancer Staging
  • Very accurate because entire specimen can be analyzed
  • Not accurate: exact type of prostate cancer not known, extensity not known, seminal vesicle and lymph node involvement not known
PSA Follow-Up
  • Testing begins at 6 weeks post-op
  • PSA remains <0.1
  • Testing begins ~2-3 months post-op
  • Will not reach lowest point for 18-24 months
  • Majority of men experience a “PSA Bounce” (a temporary rise in PSA) where the PSA rises ~15% post-treatment, then declines again
Side Effects After Treatment
  • Impotence and incontinence
  • Bowel dysfunction
  • Impotence and incontinence
Risk of Impotence and Incontinence
  • Improves with time
  • Worsens with time
Secondary Therapy Possible?
  • Yes: radiation is possible after surgery
  • No: surgery is very difficult to do after radiation
Increased Risk for Second Cancer?
  • No
  • Yes: a 5% increased risk of rectal or bladder cancer



Patients diagnosed with prostate cancer must weigh their treatment options with their personal treatment goals.  Regardless of therapy, strongly consider physician experience.  Choose wisely: it is with the robot that a surgeon completes the surgery, not the robot itself.  The experience of the surgeon is one of the most important factors to consider.  Please visit www.roboticoncology.com or www.smart-surgery.com for more details.

David Samadi, MD - Medical Contributor

View posts by David Samadi, MD - Medical Contributor
Dr. Samadi is a board-certified urologic oncologist trained in open and traditional and laparoscopic surgery and is an expert in robotic prostate surgery. He is chairman of urology, chief of robotic surgery at Lenox Hill Hospital and professor of urology at Hofstra North Shore-LIJ School of Medicine. He is a medical correspondent for the Fox News Channel's Medical A-Team. Learn more at roboticoncology.com. Visit Dr. Samadi's blog at SamadiMD.com. Follow Dr. Samadi on Twitter, Instagram, Pinterest, and Facebook.
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