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How To Decide Between Radiation Or Surgery For Prostate Cancer

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Surgery For Prostate Cancer

Prostate Cancer: Surgery vs. Radiation Treatment

A radical prostatectomy is the surgical removal of the prostate. This procedure may be performed through traditional open surgery, which involves one large incision in the abdomen. Laparoscopic surgery using the robotic daVinci® Surgical System is a minimally invasive alternative. Robotic surgery only requires a few small incisions in the abdomen, which may result in reduced pain, lower risk of infection and a shorter hospital stay after surgery.

The technology associated with the robotic surgical system is designed to give the surgeon greater precision and control, which may help spare healthy tissue and one or two of the nerve bundles on the sides of the prostate. This often allows the patient to have better erectile functionin both the short term and long term.

What Affects My Treatment Options

Your treatment options will depend on whether your cancer is contained within the prostate gland , has spread just outside of the prostate or had spread to other parts of the body .

You may have a choice of treatments. Your doctor or specialist nurse will explain all your treatment options, and help you to choose the right treatment for you.

Your treatment options and which treatment you choose may depend on several things, including:

  • how far your cancer has spread
  • how quickly your cancer may be growing
  • the advantages and disadvantages of each treatment
  • what each treatment involves
  • the possible side effects of each treatment
  • practical things, such as how often you would need to go to hospital, or how far away your nearest hospital is
  • your own thoughts about different treatments
  • how the treatment you choose now could affect your treatment options later if your cancer comes back or spreads
  • your general health
  • how long youre expected to live for.

The first treatment you have may affect which treatments you can have in the future, if you need further treatment. Speak to your doctor or nurse about this.

It can help to write down any questions you want to ask at your next appointment. And to take someone to appointments, such as your partner, friend or family member.

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To Cut Or Not To Cut: Radiation Vs Surgery For Prostate Cancer

Ishaan Sangwan Nov 16, 2021 5 hits

Since prostate cancer is a slow growing disease, the value of treatment is often questionable. While many patients can be managed with active surveillance, those who do require treatment often have radiation and surgery presented as their two options. This article discusses the risks and benefits of these two treatments, with unique insights from Dr. Jeff Caddedu on the BackTable Urology Podcast. Weve provided the highlight reel in this article, but you can listen to the full podcast below.

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Factors To Consider Before Treating Prostate Cancer

Your doctor will guide you toward the best treatment plan available at your medical center. One factor to consider is that doctors at other medical centers may provide additional options. ProstateThe prostate is a walnut-sized gland located between the bla… Full DefinitioncancerCancer is a group of diseases where cells grow abnormally an… Full Definition care is constantly advancing, so you may want to consider consulting with another doctor at a different facility for a second opinion before making a final decision.

All men have treatment options. The treatment options your doctor recommends will depend on the risk category your cancer falls into: low, intermediate, high, very high, or advanced disease that has already spread.

Your options will also depend on your age and your current health status. Take, for instance, four men with intermediate risk disease that is still contained within the prostate.

Low Risk Localised Prostate Cancer

How to decide between radiation and surgery for localized ...

The treatments your doctor will offer you are:

  • active surveillance or watchful waiting
  • surgery to remove your prostate
  • radiotherapy either internal or external beam

Your doctor will discuss the possible risks and benefits of each treatment with you.

Radiotherapy and surgery work equally well at curing prostate cancer but have different side effects. Your doctor can explain these to you.

The table below shows that there is very little difference in survival between the treatments. Understanding these and the possible side effects of each treatment can help you and your doctor to make a decision.

The table below shows how many people survive the different treatments for low risk localised prostate cancer after 10 years.

Treatment for low risk localised cancer Percentage of men who survive after 10 years
Active surveillance 98 out of 100
Surgery to remove your prostate 99 out of 100
Radiotherapy aiming to cure cancer 99 out of 100
The table below shows the risk of some of the side effects after 6 months of treatment for low risk localised prostate cancer

Active surveillance Surgery to remove the prostate External beam radiotherapy
39 out of 100 71 out of 100 38 out of 100
Difficulty getting an erection 29 out of 100 66 out of 100 48 out of 100
Problems controlling your bowels 2 out of 100 1 out of 100 5 out of 100

The risk of the same side effects after 6 years of treatment is similar between the different treatment groups.

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Who Was In The Study

The study included 2,550 men from across the United States with localized prostate cancer. All the men started the study within six months of being diagnosed. Of these, 74 percent were white, and 26 percent were other races. The average patient age was 64, and all were younger than 80. Of the surgeries, 76 percent used a laparoscope, a small robotic instrument with a video camera that works through small cuts to the body. Among the men who chose radiation, 45 percent also took medicines to reduce male hormones.

Prostatectomy Vs Radiation What To Choose

In general, there are 2 major treatment options for prostate cancer. On one side you have the surgery, on the other side, I call it The whole other bucket of treatments that include: proton beam, cyberknife that is very advertised that goes in the bucket of radiation. Seed implant, external beam radiation, HIFU, Cryotherapy all of them go into one bucket and surgery goes in the other bucket and you are right at the fork. So, what is the difference, what are the pros and cons, and what are some of the advantages?

When it comes to surgery, we are removing the entire prostate, we are removing the sample lymph nodes and the seminal vesicles. You will be able to get a very accurate stage and answers to these questions:

  • How much cancer do I have?
  • What type of cancer is it?
  • Where is it located?

That stage comes with surgery. Radiation wont give you that kind of answer.

The other advantage of surgery is that your PSA after surgery should be zero or undetectable. It is a piece of mind for the family to know that the cancer is gone and you are cured from this disease.

A lot of times after radiation there could be a couple of years, 18 months to 24 months that the PSA can fluctuate and that can be a major source of emotional distress for your family.

With radiation, the prostate still remains in the body so that patient may continue to need some biopsies whereas the person who has had surgery may not need another biopsy.

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Treatment Options For Localized Or Locally Advanced Prostate Cancer

A man diagnosed with localized or locally advanced prostate cancer has 3 major treatment options: Active Surveillance, surgery, and radiation therapy. For patients whose cancer appears more aggressive, combination treatment may be recommended. For example, radiation therapy may be combined with hormone therapy, and surgery may be followed by radiation, sometimes with the addition of hormone therapy.

Choosing the best treatment for localized or locally advanced prostate cancer is generally based on age, the stage and grade of the cancer, the patients general health, and an evaluation of the risks and benefits of each therapy option.

Health care providers think about localized or locally advanced prostate cancer in terms of risk groups, which are assigned before the patient undergoes any treatment. There are 3 general risk groups based on the PSA, DRE, and biopsy, which can further be subdivided to better personalize treatment for each patient.

Learn more about Risk Groups.

The treatment options for each risk group have some differences ask your doctor which risk group you belong to so you can better understand the most appropriate next steps. Deciding between radiation and surgery? Dr. Dan Spratt offers 4 things to consider as you make your choice.

Questions To Ask Your Doctor Or Nurse

Radiation vs. Surgery for Prostate Cancer | Ask a Prostate Expert, Mark Scholz, MD

You may find it helpful to keep a note of any questions you have to take to your next appointment. If youre choosing a treatment, you might find it helpful to ask your doctor or nurse some of these questions.

  • What treatments are suitable for me?
  • How quickly do I need to make a decision?
  • What are the advantages and disadvantages of each treatment? What are their side effects?
  • How effective is my treatment likely to be?
  • Can I see the results of treatments youve carried out?
  • Is the aim to keep my prostate cancer under control, or to get rid of it completely?
  • If the aim of my treatment is to get rid of the cancer, what is the risk of my cancer coming back after treatment?
  • If the aim of my treatment is to keep the cancer under control, how long might it keep it under control for?
  • What treatments and support are available to help manage side effects?
  • Are all of the treatments available at my local hospital? If not, how could I have them?
  • After treatment, how often will I have check-ups and what will this involve? How will we know if my cancer starts to grow again?
  • If my treatment doesnt work, what other treatments are available?
  • Can I join any clinical trials?
  • If I have any questions or get any new symptoms, who should I contact?

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External Beam Radiation Therapy

After completing external beam radiation therapy , urinary and bowel side effects may persist for two to six weeks, but they will improve over time. You may need to continue some medications.

Some patients report continued, though lessening fatigue for several weeks after treatment. Other minor problems may include dry itchy skin, a sensation of heaviness in the perineum, anal and rectal irritation, and flare-up of hemorrhoids. However, patients are usually well enough to continue with normal daily activities.

Surgery Or Radiation: Which Is Better For Early Prostate Cancer

“I was very lucky because I immediately found a support group and started talking to people who had been through treatment,” he tells WebMD. “I was aware of the potential side effects of therapy, so I was better able to deal with them. I decided on surgery, which, at the time, was the best treatment option for me.”

Approximately 180,000 men in the United States are diagnosed with prostate cancer each year, and almost 90% have clinically localized disease, meaning that the cancer has not spread to other parts of the body. While some patients with the cancer localized to the prostate, particularly older men, are advised to take a watch-and-wait approach with no therapy given, most will have to decide between therapeutic options.

So what is the best treatment option for men with early, localized prostate cancer? A new study from the National Cancer Institute doesn’t exactly answer the question, but it does give patients and their doctors a more accurate picture of the incidence of side effects with the two main treatments. And since prognosis is generally good for men with this early-stage cancer, therapeutic choices may often come down to these side effects.

“Their figure of more than 9% total incontinence for men treated surgically was much greater than what we have seen, or what is seen at other centers of excellence,” Eastman tells WebMD. “Our figures are closer to 2%.”

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Active Surveillance And Watchful Waiting

If prostate cancer is in an early stage, is growing slowly, and treating the cancer would cause more problems than the disease itself, a doctor may recommend active surveillance or watchful waiting.

Active surveillance. Prostate cancer treatments may seriously affect a person’s quality of life. These treatments can cause side effects, such as erectile dysfunction, which is when someone is unable to get and maintain an erection, and incontinence, which is when a person cannot control their urine flow or bowel function. In addition, many prostate cancers grow slowly and cause no symptoms or problems. For this reason, many people may consider delaying cancer treatment rather than starting treatment right away. This is called active surveillance. During active surveillance, the cancer is closely monitored for signs that it is worsening. If the cancer is found to be worsening, treatment will begin.

ASCO encourages the following testing schedule for active surveillance:

  • A PSA test every 3 to 6 months

  • A DRE at least once every year

  • Another prostate biopsy within 6 to 12 months, then a biopsy at least every 2 to 5 years

Treatment should begin if the results of the tests done during active surveillance show signs of the cancer becoming more aggressive or spreading, if the cancer causes pain, or if the cancer blocks the urinary tract.

Considering Prostate Cancer Treatment Options

How to decide between radiation and surgery for localized ...

For most men diagnosed with prostate cancer, the cancer is found while it’s still at an early stage — it’s small and has not spread beyond the prostate gland. These men often have several treatment options to consider.

Not every man with prostate cancer needs to be treated right away. If you have early-stage prostate cancer, there are many factors such as your age and general health, and the likelihood that the cancer will cause problems for you to consider before deciding what to do. You should also think about the possible side effects of treatment and how likely they are to bother you. Some men, for example, may want to avoid possible side effects such as incontinence or erection problems for as long as possible. Other men are less concerned about these side effects and more concerned about removing or destroying the cancer.

If you’re older or have other serious health problems and your cancer is slow growing , you might find it helpful to think of prostate cancer as a chronic disease that will probably not lead to your death but may cause symptoms you want to avoid. You may think more about watchful waiting or active surveillance, and less about treatments that are likely to cause major side effects, such as radiation and surgery. Of course, age itself is not necessarily the best reason for your choice. Many men are in good mental and physical shape at age 70, while some younger men may not be as healthy.

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Should You Get Screened For Prostate Cancer We Break Down The Latest Advice

The authors performed a multivariable analysis to identify factors associated with treatment regret. They found that moderate or substantial sexual dysfunction was the most commonly cited factor associated with decision regret, mentioned by 39 percent of men with regret. The only other significant factors were moderate or substantial bowel function bother, and concerns about rising PSA levels.

Older age at cancer diagnosis and informed treatment decision making had inverse associations with regret, the authors reported.

This story was originally published by MedPage Today. Hoffman disclosed no relevant relationships with industry. One or more co-authors disclosed relationships with Blue Cros & Blue Shield, Astellas, Dendreon, Medivation, and royalty/patent interests.

Does Radiation Shorten Your Life

According to the studys authors, findings showed that: chemotherapy, radiation therapy and other cancer treatments cause aging at a genetic and cellular level, prompting DNA to start unraveling and cells to die off sooner than normal.

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How We Approach Prostate Cancer Treatment At Ctca

When you come to CTCA for a diagnostic consultation or second opinion, your case is reviewed by a multidisciplinary team of genitourinary cancer experts before you arrive for your first appointment. This team may include a medical oncologist, a urologist or urologic oncologist and a radiation oncologist.

If we determine you need additional diagnostic evaluations, such as imaging or genomic testing, we schedule those procedures for you before your arrival.

Well also schedule appointments for you with our integrative care providers, who work to prevent and manage side effects of cancer and its treatment.

Together, we develop a treatment plan thats based on your unique needsusually within two to three days. Our goal is to give you and your caregivers a clear understanding of your options to empower you to make an informed decision about your care.

At CTCA, we strive to treat our patients as we would want our own loved ones to be treated: with compassion, dignity and respect. Its the basis of our foundation, and we call it the Mother Standard® of care.

Choosing A Prostate Cancer Treatment: Surgery Versus Radiation

Which is Better – Surgery vs. Radiation for Prostate Cancer?

Although many treatment options are available, patients with newly-diagnosed prostate cancer often narrow down the choices to two surgical removal of the prostate or radiation therapy. Since many factors influence this decision, choosing which treatment to use can be daunting.

The biggest advantage to radiation therapy is that it is easier to undergo than surgery. Even with robotic technology, its small incisions are not as small as the openings made by a couple of dozen needles inserted into the skin behind the scrotum when radiation seeds are implanted. General recovery from robotic prostatectomy is usually 2-3 weeks, whereas recovery from radioactive seed implantation is 1-2 days. Many patients who choose the radiation route will also undergo daily external beam treatments for 6-7 weeks.

The biggest advantage to surgical removal is the information learned that is not available through other treatment methods. Once the prostate is removed, it can be fully analyzed to determine the extent, location, and grade of the disease within the prostate and seminal vesicles . More important, the ability to monitor a patient for possible recurrence is dramatically enhanced. When the prostate is removed, the PSA blood test should become undetectable within six weeks if all the cancer cells have been successfully eliminated. Prostate cells are the only source of PSA, a protein made by these cells and partially released into the blood stream.

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