Study shows side effects are lower after radiation therapy compared to surgery in prostate cancer

Men with localised prostate cancer are often faced with the choice of treating the disease with surgery or radiation. Both methods are equally effective in curing the cancer, but the extent of potential side effects varies. A long-term study shows that sexual function deteriorates significantly more, and for more patients, following surgery. Urinary incontinence issues were also much more common in this group.

The study ‘Radical prostatectomy versus stereotactic radiotherapy for clinically localised prostate cancer: results of the PACE-A randomised trial’, published in European Urology, examined patients’ perceived quality of life after treatment. The study focused on side effects such as urinary incontinence, sexual function and bowel issues.

Men with localised prostate cancer treated at eight clinics in the UK were randomly assigned to two groups: one received stereotactic body radiation therapy with five radiation treatment sessions and the other underwent surgery. Conducted between 2012 and 2022, the study followed patients for an
average of over five years.

Results show that radiation therapy leads to significantly fewer side effects in terms of sexual function and urinary incontinence compared to surgery. Radiation was associated with slightly higher rates of bowel problems, albeit in mild forms. Two years after treatment, 50 per cent of surgical patients used incontinence pads, compared to 6.5 per cent of those treated with radiation.

According to the researchers, the study is a step towards being able to provide patients with better guidance and enabling them to make informed treatment decisions based on facts that include long-term side effects.

Since treatments in the study were carried out, radiotherapy technology has evolved significantly. It is now possible to control the radiation’s target area with millimetre precision in real time.

Micropos Medical has developed the RayPilot system, which provides real-time tracking of the prostate’s position, in relation to the radiation field, during radiation therapy.

“It is highly reasonable to assume that if the study had been conducted using the technology available today, the radiation-treated patients would have experienced even fewer side effects,” said Micropos Medical managing director Thomas Lindström.

“It is high time to start focusing on the quality of life for prostate cancer patients after treatment. Both radiation and surgery are effective in curing early stage prostate cancer, but the differences in terms of side effects are significant and must be taken seriously. That is why this study is so essential. The results are highly relevant for healthcare providers and patient organisations, and it is important that this knowledge also reaches patients,” Lindström added.

Picture: Micropos Medical’s RayPilot system provides real-time prostate tracking.

Read this report on page 16 of the February 2025 issue of RAD Magazine.