Surgery vs radiotherapy in prostate cancer; differences in complications

This article compares the risk of complications following different treatment for prostate cancer; namely surgery and radiotherapy.

Prostatectomy is surgery to remove all or part of the prostate gland, and is one of the main treatments for prostate cancer.  Radiotherapy is also often used, and this uses radiation to control or kill rapidly growing cells like those found in the prostate in prostate cancer. Radiation is generally used when the tumor is confined to one area of the body as there can be a risk of damage to surrounding healthy tissues. Complications following both treatment types vary but mainly centre on urological problems (for instance loss of bladder control) and erectile dysfunction (inability to maintain an erection for sex).

The aim of this study was to evaluate complications following prostate surgery or radiotherapy for prostate cancer. The study involved a total of 36,984 men who received treatment for localized prostate cancer (confined to the prostate) and were followed-up for at least 5 years. 42.9% underwent surgery, 12.2% underwent surgery followed by radiation and 44.9% underwent radiation only. 

Urological procedures were the most common complication overall. 34% of those who underwent surgery, 42.4% of those who underwent surgery followed by radiotherapy and 30% of those who underwent radiotherapy alone required a urologic procedure during the 5 years post-treatment. However, these procedures were considered low-risk.

7.2% of those who underwent surgery, 12.6% of those who underwent surgery followed by radiotherapy and 20.4% of those who underwent radiotherapy alone required an anal or rectal procedure during the 5 years post-treatment. 1.3% of those who underwent surgery, 3% of those who underwent surgery and radiotherapy and 3.7% of those who underwent radiotherapy alone experienced a secondary malignancy during the 8 years post-treatment. Secondary malignancies are cancers that arise as a result of previous cancer treatment.

Compared to those who had surgery with or without radiation therapy, those who underwent radiation therapy alone were estimated to have a 60% increased risk of a secondary malignancy and over twice the risk of having to undergo some form of urologic procedure at 5 years post-treatment.

The authors concluded that though radiation after surgery increases the rates of complications, these rates remain lower than in patients treated with radiation alone.

In the surgery plus radiation group, the study was not able to differentiate between whether radiation was given to enhance surgical treatment, or as further treatment when surgery had failed to control the disease.

When you are considering treatment options there are a number of factors to take into consideration including disease outcome, treatment complications and health-related quality of life. Discussing all of these issues with your doctor will help him/her to the best treatment plan for your particular case.