Prostate cancer surgery and radiation have different long-term effects on urinary, sexual, and survival outcomes

by American College of Surgeons

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Men with prostate cancer face different long-term risks depending on whether they choose surgery or radiation therapy, with surgery linked to higher rates of urinary incontinence and erectile dysfunction and radiation linked to higher all-cause mortality, according to a national analysis of more than 20,000 men followed for up to 20 years.

The research was presented at the American College of Surgeons (ACS) Clinical Congress 2026 in Washington, Sept. 26–29.

Prostate cancer is the most common cancer diagnosed in men after skin cancer, with more than 300,000 men expected to be diagnosed this year. For men whose cancer has not spread beyond the prostate, radiation therapy and surgical removal of the prostate, known as radical prostatectomy, are two common treatment options. Choosing between them can involve weighing potential effects on urinary and sexual function and other long-term health outcomes.

"Treatment for prostate cancer can be life-changing for many men, whichever option they choose," said Jeffrey P. Weiss, MD, Ph.D., FACS, professor and chair of urology at SUNY Downstate Health Sciences University and senior author of the abstract. "Both of these treatments can affect urinary and sexual function, though those risks are balanced against the potential for a cure."

Researchers analyzed medical records from more than 20,000 men in the TriNetX Research Network who underwent either radiation therapy or radical prostatectomy (including both open and laparoscopic/robotic surgical approaches). Patients were followed for up to 20 years, with a median follow-up of five years.

Each treatment group included more than 10,000 men, and about 17% of patients were Black, making the study population more reflective of the demographics of men diagnosed with prostate cancer today than many earlier studies, noted Juliana Viola, first author of the study and a medical student at SUNY Downstate College of Medicine.

Researchers also closely matched patients based on demographic and health characteristics to make the two treatment groups as comparable as possible.

Study findings

• Urinary and sexual side effects: Men who underwent surgery had higher rates of urinary incontinence (28.5% vs. 6.1%) and erectile dysfunction (35% vs. 13.9%). Urinary tract infections (7.4% vs. 4.7%) and obstructive urinary complications (3.6% vs. 2.6%) were also more common after surgery.

• All-cause mortality: Men treated with radiation had higher all-cause mortality during follow-up than men who underwent surgery (7.8% vs. 6.5%). In a time-to-event analysis, radiation was associated with a 45% higher rate of death from any cause at any given point during follow-up. Because the study measured deaths from any cause, researchers could not determine whether treatment contributed to the difference.

• Other urinary complications: Men treated with radiation had higher rates of urinary retention (4.4% vs. 4.1%), bladder inflammation (4.3% vs. 3.5%), blood in the urine (11% vs. 10.1%) and inflammation and pain of the prostate gland (0.49% vs. 0.17%).

While researchers closely matched the two treatment groups, other differences between patients may have influenced the results. As an observational study, the research cannot show that the treatments caused the outcomes.

"The treatment choice matters in prostate cancer. Patients should understand how the main options differ before they decide," Weiss said. "Clinicians need to recognize that these treatments differ in significant ways. The specific risks, benefits and side effects should be discussed carefully with each patient."

The authors noted that future research could examine prostate cancer-specific survival, recurrence and other long-term outcomes.

"In prostate cancer, clinicians and patients tend to be driven by avoiding side effects, but we need to better understand the long-term outcomes of each of these treatment options," Weiss said.

Co-authors are Myles Goliger, BS; Robert Adler, BA; Michael Kozlov, BA; Nikolaos Karanikolas, MD, FACS; and Andrew G. Winer, MD, FACS.

More information

Viola J, et al. Radiation Therapy versus Radical Prostatectomy: A Propensity-Matched Analysis of Mortality and Long-Term Urologic Sequelae.

Key medical concepts

Prostate CancerRadical ProstatectomyRadiation TherapyUrinary IncontinenceAll-Cause Mortality

Clinical categories

UrologyMen's healthOncologyCommon illnesses & Prevention Provided by American College of Surgeons Who's behind this story?

Sadie Harley

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