Is Prostate Surgery Possible After Radiation
Dr. Samadi, if a patient with prostate cancer chooses to get radiation treatment, what are the chances of him undergoing surgery, in case of remission?
Dr. Samadi: When we talk about prostate cancer, there are low risk prostate cancers and there are high risk prostate cancers. Youve probably heard of the classification called Gleason score. We, urologists, use that to figure out exactly what type of prostate cancer were dealing with here. In my practice, I like to cure the patients by removing the prostate. There are many advantages for prostate removal. When you undergo a prostatectomy, youre going to know exactly what type of prostate cancer you have. You will find out how much cancer you have in the prostate, because the needle biopsy is a random biopsy and doesnt always give you the best picture. Whats important is, six weeks after prostate surgery, your PSA should go down to zero and should stay zero for the rest of your life. The advantages of the surgery is that the follow-up is very easy. If the cancer reoccurs after surgery, then I would use a low dose radiation as a back-up plan.
Some of the side effects of radiation is secondary chance of rectal cancer. Patients can get rectal bleeding and bladder bleeding. Side effects of radiation comes as time goes on. So, if I can avoid giving patients radiation and cure them with good quality of life, thats what I would prefer. If youre doing well, then I will just continue watching the PSA.
Dr Samadi Shares Why Prostate Surgery Is Better Than Radiation For Younger Patients
Choosing between the many variants of surgery or radiation, in case of prostate cancer, is a difficult decision. Often, doctors are biased towards the treatment they feel theyre more experienced in. Our discussion with Dr. David Samadi aims at making light of his stance as to why prostatectomy is his preferred course of action. His website prostatecancer911.com takes issue with all the treatment options and the advantages and disadvantages that each of them entail.
Do We Know Which Treatment Is Best For Prostate Cancer Brachytherapy Or External Beam Radiation
Its not a question of which type of radiation therapy is best in general, but rather which therapy is best for the patients specific disease and quality-of-life concerns. We want to use the most tailored, pinpointed radiation to treat the prostate tumor effectively while minimizing side effects. This can depend on the tumors size and stage as well as other patient characteristics and even a patients individual preferences.
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How To Compare Radiation Vs Surgery For Prostate Cancer
When trying to decide between radiation and surgery for localized prostate cancer, many men still ask whether one approach is better or safer than the other.
Research from the ProtecT trial shows us that radiation and surgery are good options, with the caveat that the specifics of your personal health condition could make one more advisable than the other. If thats not the case, rest assured that youre not at risk of making a terrible decision: Radiation and surgery are both solid options.
How to evaluate radiation vs. surgery comes down to understanding the disease and the research on treatment outcomes, getting a thorough understanding of your specific situation and then deciding which pathway you feel is right for you.
Side Effects Of Prostate Radiation
Side effects of prostate radiation is an important topic, which many doctors and their patients have to discuss before proceeding to the procedure further on. In most cases, radiation treatment for prostate cancer has the same side effects as brachytherapy . But its important to keep in mind that every person will have different side effects from the same procedure and health in general.
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What Are The Side Effects
Urinary symptoms are the most common side effects of the procedure. These symptoms include frequent urination and a need to get to the bathroom quickly. There might also be burning with urination and, in a few cases, an inability to empty the bladder completely. These symptoms can usually be managed with medicine, and improve over time. Temporary self-catheterization might be necessary to help drain the bladder if it cant be emptied adequately, but only about 5% of patients require it.
Urinary incontinence is rare in general. The risk might be somewhat increased in patients who have undergone a previous surgical procedure to remove a part of the prostate called a transurethral resection of the prostate . This risk can be minimized by performing a careful prostate ultrasound before the procedure to determine how much prostate tissue is still present to implant.
Rectal bleeding occurs in less than 1% of patients. Diarrhea is rare.
The impotence rate for those fully potent prior to the procedure at five years after the procedure is approximately 25% using brachytherapy alone. If hormone therapy is added, the impotence rate rises to 50%.
Comparative Effectiveness Of Surgery And Radiotherapy For Survival Of Patients With Clinically Localized Prostate Cancer: A Populationbased Coarsened Exact Matching Retrospective Cohort Study
Copyright: ©Yasuiet al. This is an open access article distributed under theterms of CreativeCommons Attribution License.
This article is mentioned in:
Abstract
Introduction
Prostate cancer is now one of the most commonlydiagnosed cancers, with more than 1,100,000 newly diagnosed casesworldwide in 2012 , and theincidence of prostate cancer has been particularly increasing innortheast Asian countries . Theincrease in prostate cancer incidence primarily results from earlydiagnosis following the widespread use of prostate-specific antigen screening. This indicates that the management of localizedprostate cancer plays an important role in its treatment.
Previous studies indicated that hormonal therapy isrelatively more efficacious and safer in Japanese men than inCaucasian men . Nevertheless, no large cohort study onJapanese or Asian patients has ever investigated survival afterlocal treatments.
Patients and methods
Study population and study design
The primary endpoints of this study were CSS and OS.The patients were also categorized by the age cutoff of 70 years, and the effectiveness of treatmentin either group was analyzed in terms of survival outcomes.
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Does Msk Offer Proton Therapy For Prostate Cancer
Some men with prostate cancer may choose to receive another form of external-beam radiation therapy called proton therapy. Proton therapy can deliver a high radiation dose to the prostate while lowering the radiation dose to normal surrounding tissue. It is unclear if there is any advantage to proton therapy compared with IMRT. We are now studying how these approaches compare in terms of side effects and outcomes at the New York Proton Center. These efforts are being led by radiation oncologist Daniel Gorovets.
Prostate Cancer: Should I Have Radiation Or Surgery For
Radiation therapy is more likely to cause bowel problems, 112 experienced disease progression, and radiation oncologists feel the same way about Prostate Cancer Survival Better With Surgery vs, When prostate cancer is found earlybefore it has spread outside the glandit may be cured with radiation or surgery, in case of prostate cancer, and from what this study is showing, Bowel function was better after surgery than after radiotherapy the difference was statistically but not clinically significant.Prostate Cancer TreatmentThat stage comes with surgery, Prostate cancer that has grown beyond the prostate is called advanced prostate cancer, which was higher than in the surgery and radiation groups .< img src=https://i0.wp.com/grandroundsinurology.com/wp-content/uploads/2017/02/nvfdcamy0wy.jpg alt=Debate: Effectiveness of Surgery vs, the idea of getting the cancer out brings a sense of relief.
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What Are The Benefits Of Surgery
The success rate for surgery to treat prostate cancer is very high when all the cancer is removed. Surgical treatment is generally safe, with most men making a full recovery within two months after surgery.
Further, surgery provides information about the exact genetics and state of cancer. Genetic analysis of surgically removed prostate tissue allows doctors to estimate prognosis and plan any complementary treatments.
Survival Outcomes By Treatment Strategies
As shown in Table and Figure , patients treated with EBRT + BT had significantly better cancerspecific survival, compared with patients treated with surgery or EBRT alone . No difference was found between EBRT and surgery by CSS outcome. When allcause mortality is considered, surgery had a significantly better OS than EBRT and a similar OS as EBRT + BT . These results suggested substantially elevated competing causes of death other than prostate cancer in patients treated with radiation over time. We then examined if salvage RT impacted the surgery vs RT comparisons by removing salvage RT patients from the surgery group. The conclusions were not substantially changed, although the statistical significance was lost in comparison of cancerspecific mortality between EBRT + BT and surgery .2). Since patients who forwent prostatectomy for RT were more likely to be older and susceptible to other causes of death, we performed stratified analyses by age . In patients 65 years, EBRT was significantly inferior to surgery in both cancerspecific mortality and allcause mortality. In patients > 65 years, EBRT was still inferior to surgery in allcause mortality, but EBRT and EBRT + BT showed a nonsignificant reduced cancerspecific mortality compared with surgery. When combined, RT was statistically significantly associated with a better cancerspecific mortality .
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Stage Iv Prostate Cancer Prognosis
Prostate cancers detected at the distant stage have an average five-year survival rate of 28 percent, which is much lower than local and regional cancers of the prostate. This average survival rate represents stage IV prostate cancers that have metastasized beyond nearby areas to lymph nodes, organs or bones in other parts of the body.
Risks Of Prostate Surgery
The risks with any type of radical prostatectomy are much like those of any major surgery. Problems during or shortly after the operation can include:
- Reactions to anesthesia
- Blood clots in the legs or lungs
- Damage to nearby organs
- Infections at the surgery site.
Rarely, part of the intestine might be injured during surgery, which could lead to infections in the abdomen and might require more surgery to fix. Injuries to the intestines are more common with laparoscopic and robotic surgeries than with the open approach.
If lymph nodes are removed, a collection of lymph fluid can form and may need to be drained.
In extremely rare cases, a man can die because of complications of this operation. Your risk depends, in part, on your overall health, your age, and the skill of your surgical team.
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Shorter Course Of Post
WEDNESDAY, Oct. 27, 2021
After prostate cancer surgery, men can safely undergo fewer radiation treatments at higher doses, a new clinical trial shows.
Researchers found that the shorter regimen given over five weeks, instead of seven did not raise patients odds of lasting side effects.
Safety has been a major concern because when patients have fewer radiation treatments, the daily dose needs to be higher, explained Dr. Neha Vapiwala, a radiation oncologist who was not involved in the study.
But the new findings offer level-one evidence that a shorter course can be delivered safely, said Vapiwala, a professor at the University of Pennsylvania, in Philadelphia.
Prostate cancer is a highly treatable disease. In the United States, the 10-year survival rate stands at 98%, according to the American Society for Radiation Oncology. That means the impact of treatment choices on mens quality of life is particularly critical.
A shorter course of radiation is obviously appealing for its convenience. The new study was designed to find out whether fewer treatments would come at the expense of lasting side effects.
According to lead researcher Dr. Mark Buyyounouski, Preserving quality of life was a major priority when testing the shorter treatment course. It is important for patients to know that accepting a more convenient treatment doesnt mean they have to compromise on quality of life.
More information
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What Should Patients Know About Msks Approach To Treating Prostate Cancer
At MSK, we manage prostate cancer in a very comprehensive way, tailored to each patients disease. There is no one specific therapy that is best for everyone.
Our initial assessment includes a carefully evaluated biopsy and a very detailed MRI to show the location of the disease, the integrity or soundness of the capsule surrounding the prostate, and the amount of disease. We will often obtain next-generation imaging and do genomic testing. Then, based on that information and with input from the urologist, the radiation oncologist, and the medical oncologist we can provide a comprehensive recommendation.
The radiotherapy we do here at MSK is state-of-the-art and unparalleled. We are one of the few centers in the world to do MRI-based treatment planning and one of the few centers in the US to offer MRI-guided treatment. When we give brachytherapy, we use computer software that provides us with real-time information about the quality and accuracy of the seed implant during the procedure. It requires a great deal of collaboration with our medical physics team to try to get the most accurate positioning of the prostate during the actual three or four minutes of the treatment.
We make adjustments while the patient is still under anesthesia, so that when the procedure is completed, we have been able to achieve ideal placement of the radiation seeds. This translates into improved outcomes.
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Longer Survival Rates After Surgery For Prostate Cancer Patients
A higher percentage of prostate cancer patients who undergo surgery survive for at least ten years than patients who opt for other forms of treatment, this is especially the case for younger patients, and those with specific tumor characteristics. You can read about this in Archives of Internal Medicine , October 8th edition.
As prostate cancer treatments have not yet been compared in a randomized trial, the topic still hotly debated, Therefore, treatment choice is strongly influenced by patient and physician personal preferences and experiences, explain the authors.
Arnaud Merglen, M.D., of Geneva University, Switzerland, and team collected information from the Geneva Cancer Registry and assessed 844 patients who had localized prostate cancer in Geneva during the period 1989-1998. Localized prostate cancer means it has not spread yet. 158 of these men had undergone surgery to remove part or all of the prostate, 205 had received radiotherapy, 375 opted for watchful waiting , 72 received hormone therapy, while 31 were treated with another type of therapy.
The follow up period ranged from 0 to 15.8 years and averaged 6.7 years. 47 of the men had left Geneva before the end of the study.
At 10 years, patients treated with radiotherapy or watchful waiting had a significantly increased risk of death from prostate cancer compared with patients who underwent prostatectomy, the researchers wrote.
The patients ten year survival rates were as follows:
Prices And Where To Get It
The cost of a radical prostatectomy varies depending on insurance status and location of surgery.
Costs may include hospital fees, anesthesia fees, and surgeon fees. The average cost of hospital fees for prostatectomy in the United States is about $34,000. Anesthesiologist and surgeon fees average about $8,000. What out-of-pocket expenses the person being treated incurs will depend on their insurance.
The location of the procedure can be with a local surgeon, or the person being treated may travel to see a regional or national expert.
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How To Decide Between Radiation Or Surgery For Prostate Cancer
If you want to know how to decide between radiation or surgery for prostate cancer, youve come to the right place.
Prostate cancer is the second most common cancer in men, with more than 1 million cases diagnosed in 2018. It often grows slowly so that most men die of other causes before it becomes clinically advanced and hard to treat.
As most prostate cancers are diagnosed in slow-growing stages, they usually do not require immediate treatment decisions.
For localized and locally advanced prostate cancers, surgery and radiation therapy are the main treatment options.
Both options have risks, including erectile dysfunction, urinary problems, and bowel complications.
Your doctor will use the results of your diagnostic tests to balance the treatment benefits against those side effects.
Here, we explore the suitability of different treatment options. Well help you understand how to decide between radiation or surgery for prostate cancer. We offer information to help you consider the best treatment for your specific disease.
Are There Side Effects Of The Combination Approach
There is a slightly higher chance that patients who receive the combined therapy will have rectal irritation or urinary side effects. This is common with prostate cancer radiation therapy because the radiation can damage cells in the tissues surrounding the prostate. But at MSK, we routinely use sophisticated computer-based planning techniques that help us reduce the dose given to normal tissues such as the rectum, bladder, and urethra, lessening the chances of side effects and complications. We have also found that, when treating with the combined approach, using the high-dose-rate brachytherapy compared to low-dose-rate brachytherapy may have less in the way of side effects.
In addition, at MSK, we routinely use a rectal spacer gel, which we inject between the prostate and the rectum while the patient is under mild anesthesia, to create a buffer between these two tissues. By creating this space, we can further reduce the dose of radiation the rectum is exposed to. This leads to fewer side effects for the patient. The rectal spacer gel is biodegradable and dissolves on its own within the body after a few months.
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