If you’ve been told that both robotic surgery and brachytherapy could be suitable for your prostate cancer, deciding between them can feel difficult. Both treatments aim to control the cancer, but they work in very different ways and the differences in recovery, urinary symptoms, sexual function and follow-up may matter just as much to you as the treatment itself.
Robotic prostate surgery removes the prostate, while brachytherapy treats it from within using radiation. In this guide, we’ll take you through what each option involves, the trade-offs you may want to consider and the questions that can help you have a more useful conversation with your specialist.
Robotic Surgery or Brachytherapy: What Would Be Different for You?
The main difference is that robotic surgery removes your prostate, while brachytherapy treats your prostate with radiation from radioactive sources placed inside it.
Robotic surgery requires a general anaesthetic and recovery from an operation, while brachytherapy usually avoids abdominal surgery and often involves a shorter initial recovery. Your PSA also behaves differently afterwards because your prostate remains in place after brachytherapy.
What Can You Expect During Robotic Prostate Surgery?
Robotic prostate surgery is a form of keyhole surgery in which your surgeon controls robotic instruments to remove your prostate. A camera provides a magnified view, allowing precise movements through small abdominal cuts.
Your surgeon may preserve the nerves linked to erections when it is safe to do so. Your cancer, overall health and the experience of your surgical team can all affect your recovery and results.
What Can You Expect During Brachytherapy?
Brachytherapy treats your prostate cancer using radiation placed inside the prostate. You may have LDR brachytherapy, where small radioactive seeds remain in place, or HDR brachytherapy, where the radiation source is temporary.
Brachytherapy may be used alone for selected prostate cancers or combined with external-beam radiotherapy when this is appropriate for your cancer risk group. The exact approach depends on your cancer and treatment plan.
| Feature | Robotic Radical Prostatectomy | Brachytherapy |
| Main approach | The prostate is surgically removed | Radiation is delivered from inside the prostate |
| Prostate afterwards | Removed | Remains in place |
| Anaesthetic | General anaesthetic | General or spinal anaesthetic may be used depending on the technique |
| Initial recovery | Recovery from major keyhole surgery | Initial procedural recovery is often shorter |
| Catheter | Commonly required for around 1–2 weeks | Usually required for a shorter period, although urinary retention may mean a catheter is needed again temporarily |
| Urinary effects | Urinary leakage and stress incontinence are important risks | Urgency, frequency, burning and a weaker urine flow are more characteristic |
| Bowel effects | Radiation-related bowel irritation is not typical because radiotherapy is not used | Bowel or rectal irritation can occur |
| Erectile function | Erectile difficulties may begin soon after surgery | Changes can develop more gradually |
| Ejaculation | Semen is no longer ejaculated after surgery | Ejaculation may continue, although semen volume and function can change |
| PSA afterwards | Expected to become very low or undetectable | Falls gradually and may temporarily “bounce” |
The details of brachytherapy can vary depending on whether you have low-dose-rate (LDR) permanent seed treatment or high-dose-rate (HDR) temporary brachytherapy. Anaesthetic, catheter use, hospital stay and whether you also need external-beam radiotherapy or hormone therapy can therefore differ between treatment plans.
Could Robotic Prostate Surgery Be Suitable for You?
Robotic prostate surgery may suit you if your cancer can be treated by removing the prostate and you are fit for major surgery. Your specialist will also consider your test results, general health and treatment goals.
- Cancer Characteristics: Your PSA, Grade Group, stage and MRI findings help determine whether surgery may be suitable.
- General Health: You need to be fit enough for a general anaesthetic and recovery from surgery.
- Urinary and Sexual Function: Your current urinary control and erectile function can affect your recovery.
- Personal Preference: You may prefer surgery if you want the prostate removed and examined afterwards.
Your specialist can help you compare surgery with other suitable treatments. This can help you choose an option that matches your health needs and priorities.
Could Brachytherapy Be Suitable for You?
Brachytherapy may be suitable for you if your prostate cancer characteristics are appropriate for this treatment and your prostate size, anatomy and urinary function allow it to be delivered safely. Your cancer risk, prostate size, shape and existing urinary symptoms all matter.
You may need additional assessment if you already have difficulty passing urine or have certain bowel or prostate conditions. Your specialist will consider your individual health and cancer characteristics before recommending brachytherapy.
Does One Treatment Control Prostate Cancer Better?
There is no single treatment that is better for every man. Both radical prostatectomy and brachytherapy can provide effective cancer control when used in appropriately selected patients.
You should consider your PSA, Grade Group, stage and other health factors when comparing your options. Your specialist can explain which treatment is most likely to control your particular cancer while fitting your needs.
Research Insight
A 2020 meta-analysis of 25 comparative studies involving 61,752 patients found biochemical recurrence in 16.8% of patients after radical prostatectomy and 15.9% after brachytherapy, with no statistically significant difference between the groups. Prostate cancer-specific mortality also did not differ significantly. However, only two included studies were randomised, there was substantial variation between studies, and the analysis evaluated radical prostatectomy generally rather than modern robotic prostatectomy specifically. These findings therefore do not prove that the treatments are equivalent for every patient.
How Do Urinary Side Effects Compare?
With robotic surgery, you may experience urinary leakage, especially during your early recovery. Your urinary control often improves with time, although some men continue to experience stress incontinence.
With brachytherapy, you may instead notice urgency, frequency, burning or a weaker urine stream because your prostate can swell and become irritated. Your existing urinary symptoms should therefore be considered when you choose between the treatments.
Evidence Note
In a large prospective cohort study published in JAMA, prostatectomy was associated with worse urinary incontinence than LDR brachytherapy through five years of follow-up. LDR brachytherapy, however, was associated with more urinary urgency, frequency and other irritative symptoms during the earlier period after treatment. These findings describe average outcomes across patient groups and cannot predict exactly how an individual patient will respond to treatment.
How Do the Treatments Affect Erections?
Both treatments can affect your erections, but the timing is different. After robotic surgery, you may notice erectile difficulties immediately, although your erections can gradually recover over months or longer.
With brachytherapy, your erectile function may decline more gradually. Your age, erections before treatment and whether you receive hormone therapy can all affect your sexual function.
Could Brachytherapy Affect Your Bowels?
With brachytherapy, you may experience bowel changes such as looser or more frequent stools, particularly during the earlier period after treatment. You can also develop rectal irritation, which may cause bleeding, mucus or an urge to open your bowels.
Radiation-related bowel irritation is not typical after prostate surgery because radiotherapy is not being delivered to the rectum, although surgery has its own uncommon bowel-related complications. However, you should still discuss the possible risks of both treatments before making your choice.
What Happens to Ejaculation and Fertility?
With robotic surgery, you will no longer ejaculate semen because your prostate and seminal vesicles are removed. You may still have an orgasm, but it will be dry, and natural conception through intercourse will no longer be possible.
With brachytherapy, you may still ejaculate, but your semen volume and fertility can be affected by radiation. If having children is important to you, discuss sperm banking with your specialist before treatment.
How Does Recovery Compare?
Initial physical recovery is often faster after brachytherapy because it does not involve removal of the prostate through abdominal surgery. You may return home the same day or after a short stay, although urinary irritation can continue for weeks or months.
After robotic surgery, you will need more time to recover from the operation. You will usually have a urinary catheter for a period after surgery, commonly around one to two weeks depending on your recovery and your surgical team’s protocol.
Will You Need a Urinary Catheter?
After robotic surgery, you will usually need a catheter for around one to two weeks while your bladder and urethra heal. You may go home with it and experience some urinary leakage after it is removed.
With brachytherapy, a catheter is commonly used during the procedure and may be removed the same day or after a short period, depending on the technique and how well you can pass urine afterwards. However, if your prostate swells and makes urination difficult, you may need one again temporarily.
What Risks Should You Consider?
Robotic prostate surgery is major surgery, so you may face risks such as bleeding, infection, blood clots and complications from the anaesthetic. You may also experience urinary leakage or erectile difficulties.
Brachytherapy avoids abdominal surgery, but you may still experience urinary irritation, difficulty passing urine, erectile problems or bowel symptoms. Your specialist can help you compare which risks are most important for you.
Will You Need Hormone Therapy as Well?
You may need hormone therapy with brachytherapy, depending on your cancer risk and treatment plan. It can be used to shrink your prostate or alongside other radiotherapy for higher-risk cancer.
Hormone therapy can cause hot flushes, tiredness, reduced sexual desire and erectile problems. If you are comparing treatments, ask whether your brachytherapy plan includes hormone therapy so you understand the full effects.
UK Guidance Note
NICE recommends considering brachytherapy in combination with external-beam radiotherapy for people with CPG 2, 3, 4 or 5 localised or locally advanced prostate cancer, and advises against using brachytherapy alone for CPG 4 or 5 disease. For people in CPG 2–5 receiving radical external-beam radiotherapy, NICE recommends six months of androgen deprivation therapy before, during or after treatment, with treatment for up to three years considered for CPG 4 and 5 disease. Your exact plan will still depend on your cancer risk, general health and the type of radiotherapy being used.
How Is PSA Followed After Each Treatment?
After robotic radical prostatectomy, your first PSA is commonly checked several weeks after surgery. Because your prostate has been removed, your PSA should fall to a very low or undetectable level. In UK follow-up guidance, PSA testing after radical treatment is generally carried out no earlier than six weeks after treatment.
After brachytherapy, the pattern is different because your prostate remains in place. Your PSA does not normally fall to zero and it can take around 18 months to three years to reach its lowest level, known as the PSA nadir. You may also experience a temporary rise followed by another fall, known as a “PSA bounce”, which does not automatically mean that your cancer has returned.
What Happens If the Cancer Comes Back?
If your PSA begins to rise after radical prostatectomy and there is no evidence that the cancer has spread elsewhere, radiotherapy to the area where the prostate was removed may be considered as salvage treatment. Whether you need additional treatment will depend on factors such as your PSA pattern, previous pathology results, scans and overall risk of the cancer progressing.
If cancer returns after brachytherapy, your options depend on whether the recurrence is confined to the prostate or has spread elsewhere. In carefully selected patients, further local treatments may be possible, while hormone therapy may be considered in other situations. Treatment after previous radiotherapy can carry a higher risk of side effects, so your specialist team will need to assess which options are appropriate for you.
How Do Your Age, Health and Prostate Size Affect the Choice?
Your age, overall health, urinary and sexual function, and prostate size can all affect which treatment is suitable for you.
Robotic surgery requires you to be fit enough for a major operation, while brachytherapy may be less suitable if you have a very large prostate or significant urinary problems. Your specialist will consider these factors alongside your cancer before discussing which treatment options may be most suitable for you.
Which Treatment Has Less Impact on Everyday Life?
You will usually recover physically faster after brachytherapy, although urinary frequency, urgency or tiredness may still affect your daily routine.
After robotic surgery, you may need more time away from work and strenuous activities while you recover. In the longer term, surgery may have a greater impact on urinary continence, while brachytherapy can cause ongoing urinary or bowel symptoms. A 2025 observational study found greater long-term urinary continence deterioration after prostatectomy and less sexual-function decline after brachytherapy, although the surgery group had open rather than robotic prostatectomy.
How Should You Choose Between Robotic Surgery and Brachytherapy?
You should first confirm that both treatments are suitable for you and your cancer. Then compare their expected cancer control, side effects and recovery based on your PSA, Grade Group, stage and MRI findings.
You should also consider your existing urinary and sexual function, work, fertility and preferences. Speaking with a urologist or urological surgeon and a clinical oncologist can help you understand the different treatment options and which approach may suit you best.
Myth vs Fact
| Myth | Fact |
| Robotic prostate surgery is always better than brachytherapy. | Neither treatment is automatically better for every man. The most suitable option depends on your cancer risk, general health, urinary function, prostate size, treatment priorities and personal preferences. |
| Brachytherapy cannot control prostate cancer as effectively as surgery. | Both treatments can provide effective cancer control when appropriately matched to your cancer. Comparative evidence does not establish one treatment as universally superior for all men with localised prostate cancer. |
| Robotic surgery means you will definitely keep normal erections. | Nerve-sparing surgery may help preserve erectile function in suitable patients, but erectile difficulties can still occur. Your age, erectile function before treatment and cancer characteristics also influence recovery. |
| Brachytherapy has no urinary side effects because there is no major surgery. | Brachytherapy can cause urinary frequency, urgency, burning, a weaker stream or temporary difficulty passing urine because the prostate may become swollen or irritated after treatment. |
Key Takeaways
- Robotic prostate surgery removes the prostate, while brachytherapy treats the prostate with radiation delivered from inside it.
- Both treatments can provide effective cancer control for appropriately selected localised prostate cancer, so neither option is automatically better for everyone.
- The trade-offs are different rather than simply involving “more” or “fewer” side effects. Surgery tends to have a greater effect on urinary continence early on, while brachytherapy is more likely to cause urgency, frequency or a weaker urine flow, with bowel irritation possible in some men.
- Your PSA, Grade Group, cancer stage, MRI findings, prostate size, existing urinary and sexual function, general health and personal priorities should all be considered when choosing treatment.
Frequently Asked Questions
1. Is Robotic Prostate Surgery Better Than Brachytherapy?
Neither treatment is automatically better for every man with localised prostate cancer. Your cancer risk, general health, urinary function, sexual priorities, prostate size and personal preferences all help determine which treatment may suit you.
2. What Is the Main Difference Between Robotic Surgery and Brachytherapy?
Robotic prostate surgery removes your prostate and usually the seminal vesicles, while brachytherapy treats the prostate with radiation delivered from radioactive sources placed inside it. This difference affects your recovery, side effects and how your PSA behaves afterwards.
3. Which Treatment Has Better Cancer Control?
Both robotic surgery and brachytherapy can provide strong cancer control when they are appropriately matched to your prostate cancer. Your PSA, Grade Group, cancer stage, MRI findings and other health factors should be considered rather than assuming one treatment is better.
4. Which Treatment Has a Faster Recovery?
Brachytherapy generally involves a shorter initial recovery and avoids the abdominal surgical recovery required after radical prostatectomy. Robotic prostate surgery usually requires a longer recovery period, including time with a urinary catheter and restrictions on strenuous activities.
5. Is Urinary Incontinence More Common After Robotic Surgery?
Urinary incontinence is generally more common after radical prostatectomy than after brachytherapy. You may experience stress incontinence after your catheter is removed, although your urinary control often improves during recovery.
6. Can Brachytherapy Cause Urinary Problems?
Yes, brachytherapy can cause urinary frequency, urgency, burning or a weaker urine stream. These symptoms can occur because the prostate becomes temporarily swollen or irritated following treatment.
7. Which Treatment Is More Likely to Affect Erections?
Both treatments can affect your erections. Erectile difficulties may occur earlier after robotic surgery, while changes following brachytherapy can develop more gradually, with your age, pre-treatment erectile function and hormone therapy also affecting your outcome.
8. Can You Have Children After Robotic Surgery or Brachytherapy?
Both treatments can affect fertility. After robotic prostate surgery, you will no longer produce a normal ejaculation, while brachytherapy may reduce semen production and affect fertility, so discuss sperm banking with your specialist before treatment if future fertility is important to you.
9. Will You Need Hormone Therapy With Brachytherapy?
You may need hormone therapy depending on your cancer risk and the type of brachytherapy or additional radiotherapy being planned. Your specialist should explain whether hormone therapy is recommended and how it may affect your sexual function, energy levels and other aspects of your health.
10. How Should You Choose Between Robotic Surgery and Brachytherapy?
Start by confirming that both treatments are genuinely suitable for your cancer. You can then compare their expected cancer control, urinary, bowel and sexual side effects, recovery time and possible future treatments. Your PSA, Grade Group, stage, MRI findings, prostate size, existing urinary function and personal priorities should all be considered. Speaking with a urologist or urological surgeon and a clinical oncologist can help you understand the different treatment options and make a more informed decision.
Final Thoughts: Choosing Between Robotic Prostate Surgery and Brachytherapy
If both robotic surgery and brachytherapy are suitable options for your prostate cancer, the decision is rarely about finding one treatment that is universally “better”. What matters is how your cancer behaves, what each treatment is likely to involve for you and which trade-offs you feel most comfortable accepting.
Before deciding, make sure you understand how each option may affect your urinary control, erections, fertility, recovery and possible future treatment choices. It can also be helpful to ask what the published evidence means for someone with your particular PSA, Grade Group, MRI findings and existing urinary or sexual function.
If you are considering robotic prostate surgery in London and would like specialist advice, you can contact our team at Prostate Clinic London to discuss your treatment options and arrange a consultation tailored to your individual needs.
References:
- British Association of Urological Surgeons (BAUS) (no date) Brachytherapy treatment for prostate cancer (permanent seed brachytherapy). Available at: https://www.baus.org.uk/patients/information_leaflets/111/brachytherapy_treatment_for_prostate_cancer_permanent_seed_brachytherapy
- British Association of Urological Surgeons (BAUS) (no date) Robotic-assisted radical prostatectomy (RARP). Available at: https://www.baus.org.uk/patients/information_leaflets/180/roboticassisted_radical_prostatectomy_rarp
- Hoffman, K.E. et al. (2020) ‘Patient-reported outcomes through 5 years for active surveillance, surgery, brachytherapy, or external beam radiation with or without androgen deprivation therapy for localized prostate cancer’, JAMA, 323(2), pp. 149–163. Available at: https://jamanetwork.com/journals/jama/fullarticle/2758599
- National Institute for Health and Care Excellence (NICE) (2019, updated 2021) Prostate cancer: diagnosis and management. NICE guideline NG131. Available at: https://www.nice.org.uk/guidance/ng131
- NHS (2025) Treatment for prostate cancer. Available at: https://www.nhs.uk/conditions/prostate-cancer/treatment
- Zamora, V. et al. (2025) ‘Twenty-year patient-reported outcomes after surgery, radiotherapy, or brachytherapy for localized prostate cancer’, European Urology Open Science, 82, pp. 160–167. Available at: https://www.sciencedirect.com/science/article/pii/S2666168325014375
- Zhang, P. et al. (2020) ‘Radical prostatectomy versus brachytherapy for clinically localized prostate cancer on oncological and functional outcomes: a meta-analysis’, Translational Andrology and Urology, 9(2), pp. 332–343. Available at: https://pmc.ncbi.nlm.nih.gov/articles/PMC7215023