NEW YORK (Reuters) -- When it comes to treatment for early prostate cancer, radiation therapy is just as effective as surgical removal of the gland -- despite the common perception that surgery is more effective. Therefore, men need to weigh the side effects of both treatments, which can include: incontinence and impotence with surgery; and rectal bleeding with radiation therapy, a new study suggests.
"The bottom line is there is no difference in cancer cure rates between prostate cancer patients who had radiation or surgery," said study co-author Dr. Patrick Kupelian, an assistant staff physician in radiation oncology at the Cleveland Clinic Foundation in Ohio. "[Men] need to discuss with their doctors the side effects of surgery and radiation, and make a decision. Basically, they need to pick their poison because both poisons are equally as effective."
In the new study, 249 patients who received a radical prostatectomy -- a complete surgical removal of the prostate gland -- were compared to 140 men who had radiation treatments to control their cancer.
If blood tests revealed an increase in prostate specific antigen (PSA), the therapy was thought to have failed. After five years, both groups had a success rate of about 75%, according to the study scheduled to be presented this week at the American Society of Therapeutic Radiology and Oncology.
However, the men were not randomly assigned to either treatment, the gold standard for comparing two therapies, noted Kupelian. Therefore, while both groups had the same type and stage of cancer, the median age for those having radiation was 70, compared to 64 for men having surgery.
Some patients are better candidates for radiation because surgery may be riskier to their health, according to Kupelian. "Because of age or medical conditions -- such as a bad heart or lungs, or something not related to prostate cancer -- those patients go with radiation," he said.
Others may opt for surgery because of a psychological fear of having the prostate gland remain in the body.
"Those patients need to go with surgery because they will never be happy or have peace of mind," he said.
And men need to make a personal decision regarding what side effects they are willing to live with, according to Kupelian. Surgery is a one time treatment that carries a high risk of urinary incontinence and impotence.
"With radiation therapy, you don't see any incontinence and the sexual dysfunction rates are lower. However, with radiation there is a long course of treatment -- seven and a half weeks of daily treatments -- and as far as side effects, there is a risk of rectal bleeding that doesn't occur with surgery," Kupelian said. But, the radiation therapy does not cause the nausea, vomiting, or hair loss associated with other types of cancer.
"The bottom line is this is a way to help reassure patients that there is no difference in outcomes," he said. "Their decision should be based on what side effects they are willing to have."
Cancer of the prostate -- the walnut-shaped gland surrounding a male's urethra -- is the second leading cause of cancer death in men. However, in many cases prostate cancer is slow growing and "watchful waiting" -- observation without active treatment -- may be appropriate for those with slow-growing tumors.
