Prostate cancer treatment options: Comparing radiotherapy and surgery

Many men diagnosed with localised prostate cancer find themselves weighing surgery or radiotherapy for prostate cancer control. Both can cure the disease, yet their routes to that goal look and feel distinctly different. This guide distils the essentials, blending recent UK and international evidence with insights from Santis Health, one of the UK’s leading centres for robotic radical prostatectomy, so you can enter your next clinic discussion with clarity.

Understanding radiotherapy for prostate cancer

Radiotherapy uses finely targeted, high‑energy X‑rays to damage cancer cells inside the prostate. Modern techniques, including intensity‑modulated radiotherapy (IMRT) and stereotactic body radiotherapy (SBRT), aim to shape the beam to millimetre precision, sparing nearby bladder and bowel tissue.

Most men will also require hormone therapy alongside radiotherapy, particularly those having external beam radiotherapy and all radiotherapy for higher‑risk prostate cancer. This temporarily lowers the testosterone levels (which fuel prostate cancer growth) to improve the effectiveness of radiotherapy. Hormone therapy usually starts a few weeks before treatment and continues for 3 months to 2-3 years, depending on individual risk.

• Course length:
  
  
  • IMRT typically runs from Monday to Friday for 4 to 7 weeks, with weekends off for normal life activities.
    
    
  • SBRT condenses the full dose into as few as 5 outpatient sessions, appealing to men who live far from a radiotherapy centre or juggle demanding schedules.
    
    
• Who may benefit?
  Men with intermediate‑ to high‑risk disease who wish to avoid surgery, patients taking blood‑thinning medication that cannot be paused safely, or those keen to sidestep a hospital stay are common candidates.

Ten‑year cancer‑specific survival after modern radiotherapy now tops 98% for low‑ and intermediate‑risk tumours according to NICE. Ongoing trials such as PACE A are exploring whether ultra‑short courses can match these outcomes with even fewer side‑effects.

The process

Your first visit is a CT or MRI planning scan. Tiny skin marks, or stick‑on markers, let therapists reproduce the beam position precisely each day. About a week later treatment begins: arrive with a comfortably full bladder, slip into a gown, and lie still while the machine sweeps around for a few painless minutes. Most men leave within half an hour and can drive home. Tiredness or a stronger urge to urinate may build gradually and usually fades a few weeks after the final session. Daily check‑ins plus a PSA test 3 to 6 months later confirm you’re healing on track.

Common side‑effects

By week 3, some men describe “a tiredness that sneaks up mid‑afternoon,” while others notice looser bowel movements. The good news is that for most, these symptoms ease within 3 months of completing treatment. Longer‑term effects, such as erectile difficulties or mild rectal bleeding, affect a minority and can often be managed with medication or minor procedures — though ongoing follow-up may be required. Men on hormone therapy may also experience hot flushes, mood changes, or reduced libido, all of which are usually reversible once treatment ends.

Understanding surgery for prostate cancer

Surgery removes the prostate gland, and therefore the tumour, in a single operation. At Santis Health, the procedure is performed robotically through a single keyhole incision. The surgeon sits at a console, controlling articulated instruments while a 3D camera magnifies the anatomy ten‑fold.

• Ideal candidates:
  
  
  • Tumours confined to the prostate (stage T1–T2).
    
    
  • Patients fit enough for a general anaesthetic who prefer a one‑time curative approach.
    
    
  • Men who want to keep radiotherapy in reserve as a future safety net.

Research shows cancer and functional (bladder and sexual) outcomes that correlate with surgical experience and peak at 99% continence at 1 year, with 80% of previously-potent non-diabetic men under the age of 70 who have full nerve preservation achieving erections sufficient for intercourse with or without tablets from the Viagra family.

The process

On the day of surgery, you’ll arrive early to meet your surgeon, anaesthetist and nursing team. Once ready, you’ll be accompanied to the operating theatre and placed under a general anaesthetic. Most patients will also opt to have an injection in their back ( a ‘spinal’ anaesthetic) before they go to sleep to ensure that they are comfortable when they wake at the end of the procedure. 

Through a single 4 cm incision and using the da Vinci Single Port robot, the surgeon removes the prostate, seals vessels and when safe, preserves the nerves that protect continence and erections. The bladder is re‑joined to the urethra around a soft catheter. 

2 to 3 hours later you wake in recovery, usually comfortable thanks to the spinal anaesthetic. Patients are out of bed after breakfast the following day and are discharged after 1-2 nights in hospital with simple catheter‑care advice. 2 weeks later the catheter is removed in the outpatient department and the pathology results are reviewed at 4 weeks, when your wound healing and progress is also discussed.

Life the week after surgery

Expect 1-2 nights (depending on the distance between the hospital and home) on the ward, sipping tea and texting family by early evening. Walking for at least 30 minutes per day (this doesn’t have to be done in one go) is encouraged. Patients typically stop taking anti-inflammatory drugs such as Brufen after 1 week and stop paracetamol after a fortnight.

Learn more about what to expect during and after robotic radical prostatectomy.

Radiotherapy vs surgery for prostate cancer: Key differences

Table 1. Outcome comparison drawn from NICE NG131 evidence and national registry data.

When is radical prostatectomy preferred over radiotherapy?

Although both treatments control cancer effectively, your multidisciplinary team may lean towards radical prostatectomy vs radiotherapy when:

1. Younger age & good general health – Surgery removes the gland outright, delivering an undetectable PSA and leaving radiotherapy available should recurrence occur decades later.
   
2. Desire for definitive pathology – Examining the removed prostate yields a precise map of tumour grade and margin status, allowing truly tailored follow‑up.
   
3. Avoiding radiation‑induced side‑effects – Men with inflammatory bowel disease or previous pelvic radiation often steer clear of further exposure.
   
4. Higher‑risk pathology needing multimodal (combination) therapy – Surgery followed by selective postoperative radiotherapy can target residual cancer while sparing many men from pelvic radiation altogether.

Briefly put, surgery removes the cancerous prostate; radiotherapy damages it in place. In practice, surgery offers immediate removal, whereas radiotherapy relies on DNA damage and an immune response that unfolds over weeks.

Santis Health’s dedicated focus on robotic prostatectomy translates into shorter operative times and refined nerve‑sparing techniques. Our consultants perform almost 200 procedures a year, well above national averages associated with better functional outcomes.

This depth of experience allows Santis to deliver consistently shorter operative times, advanced nerve-sparing, and tailored aftercare focused on recovery, function, and long-term confidence.

Choose the right path for you

Is radiotherapy better than surgery for prostate cancer? The honest answer is: it depends on your health, tumour characteristics, and personal priorities. Both boast cure rates above 95% at 10 years. Robotic prostatectomy offers immediate removal, ultra‑low PSA, and the option of salvage radiotherapy later, while modern radiotherapy provides a non‑invasive route with minimal downtime and excellent long‑term control.

If you are weighing radiotherapy vs surgery for prostate cancer, book a consultation with Santis Health – the UK’s specialist centre for robotic prostatectomy. Our surgeons will guide you through personalised statistics, demonstrate advanced nerve‑sparing techniques, and support you at every step, including arranging a second opinion if desired.