Radiation Or Surgery As First Treatment?

Receiving a prostate cancer diagnosis can be life-changing, and needing to immediately pivot to making treatment decisions can be overwhelming. Like all medical therapies, different treatment options carry different risks and benefits along with them. These factors may also change from person to person based on age, stage of cancer, extent of spread, personal beliefs, and more.

In order to find out more about life with prostate cancer, we conducted our 2020 Prostate Cancer In America survey. More than 1,000 people with prostate cancer completed the survey and provided insight into treatment planning. A number of survey participants also provided first-hand accounts of their treatment decisions.*

What are the common first options for treatment?

Each person’s situation will be different when it comes to their prostate cancer and its treatment. One of the main factors involved is the stage of a person’s cancer. The stage of a person’s prostate cancer is determined by how far their cancer has spread and how aggressive it is thought to be based on their Gleason score at diagnosis.¹

Surgery and radiation are often options across all stages. Those with earlier-stage cancer, such as stage 1, may be able to practice watchful waiting (observation instead of treatment). As a person’s cancer stage increases, other options can be added into the mix, including hormone therapy, chemotherapy, and drugs to treat bone pain or metastases.¹

Making the choice and beginning treatment

The most common dilemma first faced by someone newly diagnosed is deciding between surgery or radiation. Over 75 percent of respondents said their doctor discussed radiation as a treatment option at diagnosis, while 73 percent reported that surgery was discussed. Hormone therapy and active surveillance were the next most common options discussed at diagnosis, with 52 and 42 percent presented with these choices as well.

Ultimately, the most common treatment option utilized by survey participants was surgery, with 45 percent choosing this path. Radiation therapy was the first treatment option chosen by about 25 percent of all survey participants, and active surveillance was chosen by 15 percent.

The vast majority – almost 90 percent – of participants started whichever treatment they chose within the first 6 months of diagnosis. More specifically, 25 percent started treatment within 1 month, and just over 40 percent started between 1 and 3 months of diagnosis.

The most common surgical procedure reported by survey participants was radical prostatectomy, with 47 percent using this option. Over 40 percent did not have any form of surgery as part of their prostate cancer treatment. For radiation, the most common type used was external beam radiation (EBRT). About 20 percent of respondents with prostate cancer used this option. However, about 50 percent reported not using any radiation at all.

Community feedback: Starting with radiation

“My first thought was ‘Get this crap out of me.’ I was 12 of 12 all above 70 percent, 3+4 or 4+3. So, I elected surgery, because it is safer to do surgery first and radiation second. After radiation, the prostate and the colon surface can become difficult to separate. Also, the colon can be damaged by radiation during treatment of the prostate, making it weaker for a period of time. However, in my case, there is no urethra under my prostate. That made it unsafe to remove my prostate. Radiation was my best option at that point. In hindsight, given that the end results are pretty much the same, I think I might have chosen radiation to begin with. Radiation was 12 months ago. Still waiting for hormone therapy to wear off, although I am much better. Not thinking I will do that again.”

“I was diagnosed July 13. PSA 6.02, and the biopsy came back with a Gleason score of 3X7=7. I am 61. Did the research – over 100 hours – and talked to a surgeon and a radiation oncologist with a 3T MRI and had a second opinion. My wife and I made the decision. I will do 15 treatments of EBRT (radiation) followed with brachytherapy. This is what I determined would work best for me. Through the research, I watched a video that stuck in my mind. The doctor interviewed made the statement, ‘2 identical twin men could come into his office and have the same stage of prostate cancer. One would pick surgery and the other radiation, and they both would be right.’ The only thing I can tell you is when you make your decision, go forward with a positive attitude knowing you are doing the right thing for you.”

Community feedback: Starting with surgery

“I am 55, Gleason score of 9. I had the surgery in April. I am on hormone therapy and wrapping up day 10 of 35 of radiation. I was diagnosed with stage 3, which meant my cancer was slightly outside the prostate. I don’t regret my decision; I did my homework and checked all the options and focused on what gave me the best chance for the long-term. My quality of life has not diminished, it just needs to be done at a slower pace and is so far relatively easy to handle. I am weaker and a little more fatigued at this stage, but I accept it as a part of the therapy. The most important thing I have is my mental attitude. I made it a point to rely on my faith and prepare for every phase during treatment (Kegels, diet, exercise, etc.). Every situation is different, so I urge you to do as much research and ask as many questions as you can.”

“I weighed my treatment plan heavily in the year of active monitoring. I was told that there is only 1 door to open when it comes to treatment. My major hang-up was what if the radiation does not cure it? They cannot go back and remove the prostate. I would have been stuck with more radiation or something else. I opted for surgery and had it removed. I am doing well in the over 2 years since. I still leak a tad when coughing hard or wait too long to urinate. I do wear a pad when going for long car rides just in case. I cannot get a full erection, but it is better than it was since surgery. I am blessed! There are a lot of men a lot worse off than me, and I feel for them. This cancer robs people of a pleasant life!”

*Member comments are based on personal preference and experience and have been edited for clarity.

The 2020 Prostate Cancer In America survey was conducted online from November 2019 through April 2020. The survey was completed by 1,162 people.