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Prostate cancer > Treatment options for prostate cancer that has not spread beyond the gland

Surgery or radiotherapy?

Ultimately, when you have weighed up the pros and cons with your urologist, the choice will be yours and that of your immediate family.   The risks associated with radical prostatectomy or radiotherapy and a summary of the pros and cons of each are shown in the tables below.

Risks associated with radical prostatectomy and radiotherapy
	Men who die as a result	Men who become impotent as a result	Men who suffer mild to severe incontinence
External beam radiotherapy	Less than 0.1%	30%–50%	1%–2%
Brachytherapy	Less than 0.1%	30%–50%	2%
Radical prostatectomy	Less than 0.6%	30%–70%	2%–15%

 

The pros and cons of radical prostatectomy versus radiotherapy

Radical prostatectomy

Pros

Offers a cure for tumours confined to the prostate Allows the doctor to stage your tumour accurately Coexisting BPH is treated Your PSA level should become undetectably low You are likely to feel reassured about your condition after the operation Monitoring the cancer reappearance is easy Radiotherapy can be given afterwards if the cancer returns

Cons

Major surgery Small risk of severe bleeding associated with operation Success/side effects depend on the skill of the urologist Possible side effects (see text)

Radiotherapy/brachytherapy

Pros

Offers a potential cure Avoids prolonged catheterisation and surgery Given on an out–patient or short–stay basis Hormone therapy can increase the chance of success

Cons

Treatment is prolonged (6 weeks in external–beam radiotherapy) Is relatively difficult to assess whether the treatment has been successful Accurate staging is not possible Coexisting BPH is untreated You may feel more concerned about the possible chance of success afterwards Your PSA level may not drop to very low levels Repeat radiation treatment is not possible Surgery after radiotherapy carries greater risks and is only suitable for selected cases Possible side effects (see text)

How do I make the choice?

Until the results of ongoing studies are available, it will not be known for certain which is the safest and most effective treatment for localized prostate cancer.   Until then, there will be a choice of treatments, which the patient must decide for himself.   Critical to this choice is the confidence that you feel in your doctor and his team, so it is important to find a good specialist team and weigh up the pros and cons with them, before deciding for yourself which treatment is right for you.

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