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: 5צ20 percent (mostly stress incontinence)
- Erectile dysfunction: 30㫊 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 (1–2 percent)
- Less urinary retention than with brachytherapy
Disadvantages of EBRT:
- No post-treatment staging information
- Daily treatments for 6–8 weeks
- Fatigue may occur when treatment ends
- Erectile dysfunction: 30–50% at 5 years
- Bowel/rectal problems: 5–10 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 (1–2 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
