Introduction: Two Proven Options for Prostate Cancer Treatment
For men diagnosed with localized prostate cancer, two of the most common treatments are robotic prostatectomy and radiation therapy. Both approaches are highly effective in controlling cancer, but they differ in how the treatment is delivered, what recovery looks like, and the potential impact on urinary, sexual, and bowel function.
What Is Robotic Prostatectomy?
Robotic-assisted laparoscopic prostatectomy (RALP) is a minimally invasive surgical procedure in which the prostate gland, and sometimes nearby lymph nodes, are removed. The surgeon controls robotic instruments through small incisions, providing precision and enhanced visualization.
How it works:
Before surgery, imaging and biopsy results are carefully reviewed to guide the procedure. The surgeon then makes several small incisions to remove the prostate and reconnect the bladder and urethra. Most men remain in the hospital overnight, and a catheter is placed temporarily to assist with healing. After surgery, the removed tissue is examined by a pathologist to confirm the cancer's grade, stage, and margins.
Benefits of robotic prostatectomy:
Complete removal of the prostate with full pathology results.
PSA levels drop quickly to nearly zero, making follow-up straightforward.
If cancer returns, radiation can still be an option.
Potential side effects:
Urinary leakage is common early but often improves with time and pelvic floor therapy.
Erectile function can be affected, with recovery depending on nerve-sparing, baseline function, and age.
Risks such as bleeding or infection are possible but generally low in experienced hands.
Ejaculation will not occur after prostate removal, resulting in a "dry" orgasm.
What Is Radiation Therapy?
Radiation therapy uses targeted energy to destroy cancer cells. It can be delivered as external beam radiation therapy (EBRT), which involves daily treatments over several weeks, or brachytherapy, which places radioactive seeds directly into the prostate. Some patients receive both approaches, and higher-risk cases may include hormone therapy (ADT) for added effectiveness.
How it works:
Planning begins with imaging to precisely define the prostate and protect surrounding organs. External beam radiation therapy (EBRT) is delivered in short daily sessions over the course of several weeks. Brachytherapy, on the other hand, is typically performed as a one-time outpatient procedure. After treatment, PSA levels decline gradually over a period of months to years.
Benefits of radiation therapy:
Non-surgical with no incisions or hospital stay.
Well-suited for men who are not good candidates for surgery.
Effective for a wide range of risk levels, especially when combined with ADT.
Potential side effects:
Urinary frequency, urgency, or burning may occur during treatment.
Temporary bowel changes such as loose stools or rectal irritation are possible.
Erectile dysfunction can develop gradually over time.
Surgery after radiation is possible if cancer returns, but it is more complex and carries a higher risk.
Comparing Robotic Prostatectomy and Radiation Therapy
Factor |
Robotic Prostatectomy (RALP) |
Radiation Therapy (EBRT or Brachytherapy) |
Approach |
One-time minimally invasive surgery |
Non-surgical; daily sessions (EBRT) or one-time brachytherapy |
Pathology |
Provides full specimen for review |
No specimen; relies on imaging and PSA |
PSA Levels |
Drop quickly to near zero |
Decline slowly over months or years |
Urinary Function |
Leakage is common early; it improves with time |
Irritative symptoms are possible; incontinence is less common |
Bowel Function |
Rarely affected |
Loose stools or rectal irritation may occur |
Sexual Function |
Often affected early, may recover gradually |
Declines more slowly, sometimes years after treatment |
Future Options |
Radiation remains available if needed |
Salvage surgery is more difficult |
Time Commitment |
One-time procedure, short recovery |
Multiple outpatient visits or a single brachytherapy procedure |
Recovery and Quality of Life
Urinary control:
Robotic prostatectomy often causes temporary leakage, but most men regain control with time and pelvic floor exercises. Radiation therapy usually does not cause significant incontinence, though urinary urgency and frequency may occur.
Sexual function:
Surgery can affect erections immediately, with gradual recovery possible if nerves are preserved. Radiation-related erectile dysfunction often develops more slowly, sometimes years later.
Bowel health:
Robotic prostatectomy rarely impacts bowel function. Radiation therapy may cause temporary rectal irritation, though modern techniques and protective spacers reduce long-term risks.
Psychological factors:
Some men prefer the certainty of surgery, knowing the prostate is removed and pathology is available. Others prefer radiation because it avoids surgery and hospitalization.
Cancer Control and Long-Term Outcomes
Both robotic prostatectomy and radiation therapy are proven to provide excellent cancer-specific survival for localized prostate cancer. The best choice often depends on your risk category:
Low-risk (Gleason 6): Surgery, radiation, focal therapy, or active surveillance are all reasonable options.
Favorable intermediate-risk (Gleason 7, 3+4): Surgery, radiation, or focal therapy in carefully selected cases.
Unfavorable intermediate or high-risk (≥ 4+3): Surgery with lymph node assessment or radiation plus ADT.
The Role of Focal Therapy
Although this article focuses on robotic prostatectomy and radiation therapy, focal therapy is emerging as an option for some men. Pulsed Electric Field (PEF) Ablation uses non-thermal electrical pulses to selectively destroy cancer cells while protecting surrounding tissue. For men with low-volume, MRI-visible prostate cancer, focal therapy can provide effective treatment while preserving urinary and sexual function.
How to Decide Between Surgery and Radiation
When choosing a treatment, consider:
Risk category: Based on Gleason score, PSA, MRI, and biopsy results.
Personal goals: Do you value definitive removal and full pathology, or do you prefer to avoid surgery?
Health status: Are you fit for anesthesia and surgery, or do other medical conditions make radiation a safer option?
Future flexibility: Surgery leaves radiation as a backup option, while radiation makes surgery more complex.
Time and logistics: Surgery requires short-term recovery, while EBRT requires weeks of daily visits.
Conclusion: Personalizing Your Prostate Cancer Care
There is no single "best" treatment for localized prostate cancer. Both robotic prostatectomy and radiation therapy are excellent, evidence-based options with high cure rates. The right choice depends on your cancer's characteristics, your overall health, and your personal priorities.
Schedule a consultation today at Atlanta Prostate Center to find the path that fits your goals.
