Information about Advantages and Disadvantages of Various Treatments for Prostate Cancer

Treatment Option: Active Surveillance

Advantages of active surveillance include:

  • Avoids side effects from radiation therapy or radical prostatectomy
  • No hospitalization or surgical risks

Disadvantages of active surveillance include:

  • Requires close monitoring (regular digital rectal exams, PSA tests and prostate biopsy) to monitor for signs of progression
  • May be psychologically stressful knowing that cancer will not be actively treated until it progresses

Treatment Option: Radical Prostatectomy

Advantages of radical prostatectomy:

  • Proven to reduce prostate cancer death rates
  • Removed tissue allows accurate staging
  • PSA levels reliably predict recurrence
  • Fewer bowel/rectal problems than with EBRT
  • Less urinary urgency and frequency than with EBRT or brachytherapy

Disadvantages of radical prostatectomy

  • General risks of surgery
  • Hospitalization required
  • Catheter in place for 1–2 weeks
  • Recovery period: at least 1 month
  • Incontinence: 5 to 20 percent (mostly stress incontinence)
  • Erectile dysfunction: 30 to 50 percent at 5 years (with nerve preservation)

Treatment Option: External beam radiation therapy (EBRT)

Advantages of EBRT:

  • No hospitalization or surgical risks
  • Activities unrestricted
  • Low risk of urinary incontinence (1 to 2 percent)
  • Less urinary retention than with brachytherapy

Disadvantages of EBRT:

  • No post-treatment staging information
  • Daily treatments for 6 to 8 weeks
  • Fatigue may occur when treatment ends
  • Erectile dysfunction: 30 to 50 percent at 5 years
  • Bowel/rectal problems: 5 to 10 percent (urgency, pain, diarrhea, or bleeding) but typically improve after treatment
  • Bladder irritation: 5 percent (urinary frequency, urgency, discomfort)

Treatment Option: Brachytherapy

Advantages of brachytherapy

  • No hospitalization or surgical risks
  • Less radiation damage to healthy tissue
  • One treatment
  • Low risk of urinary incontinence (1 to 2 percent)

Disadvantages of brachytherapy:

  • No post-treatment staging information
  • Less favorable option for men with intermediate-or high-risk disease
  • Urinary retention, urgency, and frequency more common than with other treatments, especially in men with lower urinary tract symptoms before treatment

Publication Review By: H. Ballentine Carter, M.D.

Published: 21 Jun 2011

Last Modified: 11 Aug 2014