Men who opt for less invasive prostate treatment may die sooner than those who undergo surgery, study finds

Men who undergo radiation for prostate cancer are more likely to suffer urinary complications and die earlier than those who opt for surgery, a study has found. 

Meanwhile, those who choose to have their prostate removed are more likely to experience erectile dysfunction and urinary incontinence. 

Prostate cancer is the most common cancer in men, with over 68,000 diagnosed each year in the UK. 

For men whose cancer is caught early and has not spread beyond the prostate, radiotherapy and surgical removal of the prostate are common treatments. 

Surgery is more invasive and involves removing the prostate gland in an effort to cure the disease, and means that men will no longer be able to conceive naturally. 

Radiotherapy, meanwhile, uses high-energy radiation to kill cancer cells without the need for an operation. 

But according to experts at the State University of New York, men who opt for radiotherapy are 45 per cent more likely to die following treatment, than those who undergo surgery. 

‘Treatment for prostate cancer can be life changing for many men, whichever option they choose,’ Dr Jeffrey Weiss, a professor of urology and study lead author, said. 

‘Both of these treatments can affect urinary and sexual function, though those risks are balanced against the potential for a cure.’ 

The team analysed medical records from more than 20,000 men who underwent either radiation therapy or a radical prostatectomy.

Patients were followed for around five years.

Black men – who are up to three times more likely to develop the disease – made up 17 per cent of the cohort, making the study reflective of real-world demographics. 

Researchers found men who underwent surgery had significantly higher rates of urinary incontinence, affecting 29 per cent of patients compared with 6 per cent of those treated with radiation. 

Around a third of men who opted for surgery went developed erectile dysfunction.

Men treated with radiotherapy, meanwhile, had higher all-cause mortality rates during follow-up.

Overall, around 8 per cent of men treated with radiation died during the course of the study, compared with 6.5 per cent of those who underwent surgery. 

Radiation was linked to a 45 per cent higher rate of death from any cause over the study period. 

However, because the study measured deaths from any cause, the researchers could not determine whether the treatment itself contributed to the difference.

Men treated with radiation were also more likely to experience urinary retention – a painful inability to fully empty the bladder – bladder inflammation and blood in the urine. 

But because the study was observational, the researchers stressed it cannot prove cause and effect and more work is needed to better understand the long-term outcomes of both treatments. 

‘The treatment choice matters in prostate cancer,’ Dr Weiss, who will present the findings at the American College of Surgeons’ Clinical Congress, said. 

‘Patients should understand how the main options differ before they decide. 

‘Clinicians also need to recognise these treatments differ in significant ways. 

‘The specific risks, benefits and side effects should be discussed carefully with each patient.’

The authors added that future research should examine prostate cancer-specific survival and recurrence rates.  

The findings come after a major study found that common drugs frequently given alongside radiotherapy could significantly increase the risk of obesity, diabetes and heart problems. 

These drugs – known as androgen receptor pathway inhibitors –  work by reducing the amount of the male sex hormone testosterone cancer cells can use. 

Many prostate cancers rely on testosterone to grow, so cutting off that supply can slow or shrink tumours.

But US researchers believe the treatment could increase the risk of diabetes, obesity and high blood pressure, particularly in older men. 

In turn, these men face a significantly higher risk of heart disease, liver disease, osteoarthritis and other cancers. 

Earlier this year, the National Screening Committee rejected proposals for a national  prostate cancer screening programme.

The committee justified its decision on the basis that expanding screening could lead to over‑diagnosis and over‑treatment, exposing some men to the risks of impotence and incontinence when their tumour was unlikely to cause issues in their lifetime.