Localized Prostate Cancer Treatment Comparison
Understand your options.
When prostate cancer is caught early, there are several effective ways to treat it – and the right choice depends on your health, goals, and priorities.
This side-by-side comparison outlines how each treatment works, what recovery looks like, and what to expect long-term – so you can feel more confident discussing your options with your urologist.
|
PROCEDURE/ CRITERIA |
PROSTATECTOMY |
RADIATION |
NANOKNIFE (IRE) |
HIFU |
|---|---|---|---|---|
|
METHOD/TECHNOLOGY |
Surgical removal of the prostate, typically via robotic or open surgery |
External beam radiation or brachytherapy to destroy cancer cells |
Focal ablation using electrical pulses to induce irreversible electroporation of cancerous cells |
Focal ablation using high-intensity ultrasound waves to destroy cancerous tissue |
|
HOSPITAL STAY |
1-2 days |
Outpatient |
Outpatient or 1 day |
Outpatient |
|
ANAESTESIA |
General |
None required |
Local or General |
Local or Spinal |
|
DURATION |
2-4 hours |
5-10 minutes per session, total treatment lasting several weeks |
1-2 hours |
2-3 hours |
|
COVERED BY OHIP |
Yes |
Yes |
No |
No |
|
SEXUAL FUNCTION PRESERVATION |
35-50%¹,² depending on nerve-sparing technique |
40-75%³ depending on radiation dose and technique |
80-97%⁷˒⁸˒⁹ depending on tumor location |
70-95%⁵ depending on tumor location |
|
CONTINENCE PRESERVATION |
70-85%⁶ achieve continence after recovery |
70-95%⁴ depending on radiation dose and technique |
98%⁷˒⁸˒⁹ retain continence |
88-98%⁵ retain continence |
|
RECOVERY TIME |
6-8 weeks |
Fatigue may persist for several weeks |
2-4 weeks |
1-2 weeks |
|
TREATMENT AREA |
Whole prostate |
Whole prostate |
Focal – cancer location only with a margin of safety |
Focal – cancer location only with a margin of safety |
|
FDA/HEALTH CANADA APPROVED |
Yes |
Yes |
Yes |
Yes |
|
SIMULTANEOUS |
No |
No |
Yes |
Yes |
¹ Capogrosso P, Vertosick EA, Benfante NE, et al. Are we improving erectile function recovery after radical prostatectomy? Analysis of patients treated over the last decade. Eur Urol. 2018;75(2):221–228. doi:10.1016/j.eururo.2018.08.039. Published online September 17, 2018. Available in PMC: February 1, 2020.
² Barocas DA, Alvarez J, Resnick MJ, et al. Association between radiation therapy, surgery, or observation for localized prostate cancer and patient-reported outcomes after 3 years. JAMA. 2017;317(11):1126–1140. doi:10.1001/jama.2017.1704.
³ Le Guevelou J, Sargos P, Ferretti L, et al. Sexual structure sparing for prostate cancer radiotherapy: A systematic review. Eur Urol Oncol. 2024;7(3):332-343. doi:10.1016/j.euo.2023.11.006
⁴ Guillaumier S, Solomon E, Jenks J, et al. Radiotherapy is associated with reduced continence outcomes following implantation of the artificial urinary sphincter in men with post-radical prostatectomy incontinence. Urol Ann. 2017;9(3):253–256. doi:10.4103/UA.UA_25_17. PMID: 28794592. PMCID: PMC5532893.
⁵ Fiard G, Chowdhury A, Potter AR, Pook CJ, Kelly D, Emberton M, Yap T. Detailing sexual outcomes after focal therapy for localised prostate cancer: A systematic review and meta-analysis. Prostate Cancer. 2022;8(4):926–941. doi:10.1016/j.prca.2022.05.005.
⁶ Breyer BN, Kim SK, Kirkby E, Marianes A, Vanni AJ, Westney OL. Updates to Incontinence After Prostate Treatment: AUA/GURS/SUFU Guideline (2024). Journal of Urology [Internet]. 2024 Oct 1 [cited 2025 Apr 1];212(4):531–8.
⁷ E. Guenther, N. Klein, S. Zapf, S. Weil, C. Schlosser, B. Rubinsky, M. K. Stehling, “Prostate cancer treatment with Irreversible Electroporation (IRE): Safety, efficacy and clinical experience in 471 treatments.”, 2019.
⁸ Zhang, K., Stricker, P., Löhr, M. et al. A multi-center international study to evaluate the safety, functional and oncological outcomes of irreversible electroporation for the ablation of prostate cancer. Prostate Cancer Prostatic Dis 27, 525–530 (2024). https://doi.org/10.1038/s41391-023-00783-y
⁹ Blazevski A, Scheltema MJ, Yuen B, et al. Oncological and functional outcomes of focal irreversible electroporation as primary treatment for localized prostate cancer. PLoS One. 2019;14(4):e0215093. doi:10.1371/journal.pone.0215093