Sperling Prostate Center

Radiation For PCa Has More Complications Than Prostatectomy

UPDATE: 6/16/2023
Originally published 7/23/2015

The blog below addressed longer term side effects (toxicities) after external beam radiation therapy (EBRT) Radiation can result in late onset side effects because of cumulative tissue damage, as we reported below. It is now eight years later, and a new study out of the Department of Urology at University of California San Francisco (UCSF) underscores this. An 8-year analysis of 1,744 men who had EBRT assessed their general health, sexual, urinary and bowel function since their treatment. It explored the impact of any toxicity on their quality of life (QOL). Here are the reported numbers:

  • The average time to the onset of toxicity including urinary pad usage was 4.3 years
  • The most frequent toxicity was cystitis (bladder inflammation) which still affected 5.9% at 8 years. The onset of cystitis was linked with change in general health over time.
  • Gastrointestinal problems still affected 2.7% at 8 years
  • Urethral stricture (scarring that makes passing urine difficult) still affected 2.4% at 8 years

The authors wrote, “EBRT for prostate cancer is associated with distinct treatment-related toxicities which can occur many years after treatment and can affect quality of life.” They note the importance of helping patients understand the long-term implications of treatment decisions.[i]


Beam radiation has long been a mainstay in the arsenal of weapons against prostate cancer (PCa). Over 50 years ago, when more powerful radiation equipment allowed deeper penetration into the body, patients who could not have surgery began to be treated with “megavoltage radiation”. The past three decades have seen advances in the ability to deliver 3D conformal beam radiation, intensity modulated radiation therapy, and proton beam radiation—all improvements in focusing the radiation dose in order to be more effective against the cancer while doing less damage to nearby structures.

Radiation functions very differently than ablation (destruction) of tumors with thermal energy. Perhaps the biggest difference is that radiation, unlike extremes of heat or cold, does not kill cancer all at once. Cancer cells, which are more susceptible to radiation, fail to reproduce over time because the constant exposure to radiation damages the cells’ DNA. The most important fact is that the exposure has to occur over a reasonably long period. This is why patients undergoing beam radiation have to come 5 days a week for 4-5 weeks for short bursts of exposure; and it’s why radioactive seed implants (brachytherapy) are placed in the gland and left there for the rest of the patient’s life as the radiation gradually diminishes. The duration of exposure to radiation scatter is also a reason why radiation patients have a greater chance of eventually developing secondary cancers such as rectal or bladder cancer.

Even with technologic improvements, ALL radiation has some scatter effect and ALL radiation will have more or less of an impact on healthy tissue. This results in a higher rate of cumulative damage leading to side effects than radical prostatectomy (RP). In fact, a new study presented at the 70th annual Canadian Urological Association meeting (Ottawa, Canada, June 27-30) cited side effect statistics in comparison with RP.[ii] Dr. Christopher Wallis and colleagues from the University of Toronto shared findings based on analysis of data from the SEER Medicare registry. They had access to records of 60,476 men aged 65-79 years who either had RP or radiation therapy (beam or seeds). After adjusting for differences, the team discovered the following:

RP (14,492 men) Radiation (60,476 men)
Slightly higher rate of major surgical procedures for complications 25% greater risk of post-treatment minimally invasive urologic procedures for complications
  40% greater risk of rectal/anal procedures
  80% greater risk of hospital admissions after treatment

For both treatments, the complication rates reached their highest point within two years after treatment, but in both complications continued at a steady rate for the next 10 years. Until something better comes along, radiation will have a place for those who can’t have or don’t want surgery. Even so, patients considering radiation deserve transparent discussions of the risks they face.

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.

[i] Lonergan PE, Baskin A, Greenberg SA, Mohamad O et al. The long-term incidence and quality of life outcomes associated with treatment-related toxicities of external beam radiotherapy for prostate cancer. Urology. 2023 May 25:S0090-4295(23)00444-2.
[ii] http://www.renalandurologynews.com/canadian-urological-association/complications-more-likely-after-radiotherapy-vs-surgery-for-pca/article/423271/


About Dr. Dan Sperling

Dan Sperling, MD, DABR, is a board certified radiologist who is globally recognized as a leader in multiparametric MRI for the detection and diagnosis of a range of disease conditions. As Medical Director of the Sperling Prostate Center, Sperling Medical Group and Sperling Neurosurgery Associates, he and his team are on the leading edge of significant change in medical practice. He is the co-author of the new patient book Redefining Prostate Cancer, and is a contributing author on over 25 published studies. For more information, contact the Sperling Prostate Center.

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