Comparison of the risks and benefits of different treatment approaches for localized prostate cancer

	Surgery	EBRT	Brachytherapy	Active surveillance
Requirements	Must be fit for surgery	May be easier for patients with multiple comorbidities	Must be fit for anesthesia	For low, good intermediate risk only
Anesthesia	Yes	No	Yes	No
Prognosis from surgical specimen	Predictions of prognosis can be more precise, based on pathology in the removed prostate and lymph nodes	No	No	N/A
Time for treatment	Usually 1 to 2 days in the hospital with 6 week recovery	Daily outpatient treatments for 7 to 8 weeks	One day	Different follow up schedules for PSA testing and repeat prostate biopsy, often at least once a year
PSA after therapy	PSA should be undetectable after RP, relapse easy to detect	PSA will vary over time or even flare, relapse more difficult to define
Urinary incontinence	Worse postoperatively, improves over time, by 1 to 2 years may have only stress incontinence	Usually not a problem for several years		N/A
Erectile dysfunction	Worse postoperatively, may improve over time	Gets worse over time		N/A
Dry ejaculate	Immediate and permanent	May slowly develop over time		N/A
Urinary and bowel dysfunction	Urinary incontinence	Acute and chronic bladder/bowel problems Hematuria or rectal bleeding due to radiation damage to small blood vessels		N/A
Penile shortening	Possible	Possible		N/A
Penile curvature	Possible	Possible		N/A
Second malignancy	No	Very small long term risk for bladder cancer		N/A

N/A: not applicable; PSA: prostate-specific antigen; RP: radical prostatectomy.

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