What’s the first thought that comes into a person’s head when told they have cancer? In shock, I suspect most people think, “I don’t want to die, I want to live.” Things like paying off the mortgage, hating the boss, planning a European vacation, getting the car to the mechanic—the bubble of things that seemed to matter suddenly pops. In that moment, what matters most is getting rid of the cancer.

However, in most cases of newly diagnosed prostate cancer, the news is thankfully not quite so dire. If localized prostate cancer is diagnosed when it is low- to favorable-intermediate risk, treatment success is nearly 100% at five years regardless of the treatment choice. Even at 10 years, for low-risk disease success is 98-99%, whether the patient had prostatectomy, radiation, or was on Active Surveillance.^[i]

What will your quality of life be?

Thus, when it comes to choosing a treatment for early-stage prostate cancer, chances are good that the patient is not going to die from his cancer. At that point, a second goal becomes apparent: quality of life after treatment.

Healthcare related quality of life refers to the impact of side effects after treatment. Possible common aftereffects of treatment lessen a man’s enjoyment of life and his identity:

• Urinary incontinence (inability to control urine)
• Sexual dysfunction (inability to have erections sufficient for penetration)
• Bowel problems.

If side effects occur, they may resolve quickly on their own, or they may last as long as 12 months or longer. In a minority of cases, they are permanent. Side effects may also necessitate doctor appointments to correct them or hasten their resolution. Here again, quality of life suffers from these practical considerations.

Patients report side effects from their treatment choice

One can turn to published literature to obtain treatment side effect statistics. Another source, though, and one that carries a lot of weight, is what patients themselves report.

The journal Nature, founded in 1869, is a premier weekly international journal covering all fields of science and technology. It is widely considered authoritative. In July 2026, Nature published a Chinese study titled “Impact of different treatment modalities for localized prostate cancer on patient-reported quality of life outcomes in an Asian Cohort.”^[ii] The authors’ goal was to provide a 5-year comparison of patient-reported side effects for various treatments.

There were 866 patients in the study, and all received treatment for localized prostate cancer. The treatments included were radical prostatectomy, radiation, focal therapy and Active Surveillance. Before treatment (baseline) all patients completed the standard EPIC-questionnaire (Expanded Prostate Cancer Index Composite). The EPIC tool includes scores for the following:

• Urinary incontinence (leaking, use of pads, etc.)
• Urinary irritation and obstruction (frequency, weak flow, pain/burning)
• Bowel habits (urgency, leaking, bleeding, pain, etc.)
• Sexual function (erection quality, sexual activity, etc.)
• Hormonal/vitality (hot flashes, breast tenderness, depression, low energy, etc.)

EPIC was administered at baseline prior to treatment, and once a year after for 5 years. Patients were followed until the most recent EPIC, loss to follow-up, or death. Also, clinical factors such as age, body mass index, Gleason grade group, etc. were taken into account. The following table shows what patients reported in terms of quality of life:

Treatment	Quality of life impact
Prostatectomy	Results in the worst outcome in urinary continence and sexual function in the first year, as compared to Active Surveillance
Radiation	Early decline in bowel function and hormonal dysfunction (most severe at 1-3 years) but both functions had recovered eventually
Focal therapy	Favorable functional preservation in most domains compared to prostatectomy and radiation, though sexual function gradually declined from baseline. However, no significant differences in sexual function were seen between focal therapy and Active Surveillance beyond 1 year.

In short, the authors demonstrated that different treatments result in “distinct functional outcomes profiles.” This has been consistently shown in virtually all research comparing health related quality of life outcomes after various prostate cancer treatments.

The bottom line is this: given that focal treatment has been shown to have comparable cancer control to whole-gland treatments, there is no comparison when it comes to quality of life. Thus, when a newly diagnosed localized prostate cancer patient is pondering which treatment to choose, he can now take into account not only quantity of life, but also quality of life.

NOTE: This content is solely for purposes of information and does not substitute for diagnostic or medical advice. Talk to your doctor if you are experiencing pelvic pain, or have any other health concerns or questions of a personal medical nature.

References

[i] Hamdy FC, Donovan JL, Lane JA, Mason M et al. 10-Year Outcomes after Monitoring, Surgery, or Radiotherapy for Localized Prostate Cancer. N Engl J Med. 2016 Oct 13;375(15):1415-1424.
[ii] Lee YHA, Chan KY, Kwok MC, Hui HL et al. Impact of different treatment modalities for localized prostate cancer on patient-reported quality of life outcomes in an Asian Cohort. Sci Rep. 2026 Jul 13.