The Harvard Medical School Family Health Guide
Urinary System
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Other Urinary Tract Disorders

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Comparing the Side Effects of Prostatectomy vs. Radiation Therapy

Prostate cancer is the most commonly diagnosed non-skin cancer among men in the United States. When caught early, it is also among the most treatable. Two of the more aggressive — and common — methods of treatment for early stage prostate cancer are radiation therapy and surgery (radical prostatectomy) to remove the prostate gland. Although both options have favorable outcomes, physicians have not reached a consensus on which therapy is more effective. This means that men who are treated with either surgery or radiation can usually expect to live for many more years. The caveat is that they often have to live with the side effects of their treatment. Deciding on a treatment option, then, becomes a question of which side effects are more likely with each therapy, and also which side effects are more tolerable to a particular patient.

A recent analysis of data from the Prostate Cancer Outcomes Study helps to clarify this issue by comparing the side effects of the two therapies in men between the ages of 55 and 74, two years after treatment. The results showed that men in both treatment groups experienced significant decreases in sexual function. Of the men in the surgery group, 80% became impotent, compared to 62% of the men in the radiation group. Age and status of sexual function prior to treatment affected these outcomes. Twelve percent of the men who underwent surgery experienced dripping or leaking urine, compared to only 2% of the men who had radiation therapy. Few men in either group were bothered by bowel problems. Of the men who were affected, however, radiation patients experienced more diarrhea, bowel urgency, and painful hemorrhoids (33%, 30%, and 19%, respectively) compared to surgery patients (22%, 16%, and 10%).

Overall, this study showed that men who opt for surgery can expect to have more urinary and sexual problems, while men who choose radiation are more likely to suffer from bowel disturbances. A man's age and initial health are also important factors in the development and duration of long-term side effects from either treatment. Physicians and their patients should use this information, as well as a discussion of the patient's priorities, preferences, and concerns, to help decide which treatment method is appropriate.
March 2001 Update

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