Diagnosed with Prostate Cancer? Pros and Cons of Surgery versus Radiation

If you’re one of the 230,000 men diagnosed with prostate cancer every year, you’re probably dealing with a dilemma of which treatment option to choose. Your doctor has likely spoken with you about radiation and surgery, but how do you choose?

 Radiation machine in operating room

Radiation machine in operating room

 da vinci robot system in operating room

da vinci robot system in operating room

Patients diagnosed with prostate cancer must weigh their treatment options with their personal treatment goals.  Regardless of therapy, strongly consider physician experience. Choose wisely: it is with the robot that a surgeon completes the surgery, not the robot itself. The experience of the surgeon is one of the most important factors to consider.  Please visit www.roboticoncology.com or  www.smart-surgery.com for more details.

 

SURGERY

  • One-time treatment for 1-2 hours, on average
  • 1-2 night hospital stay, on average

 

 

  • Very accurate: prostate is visualized and removed

 

 

 

  • Anesthesia

 

 

 

 

  • No

 

 

 

  • Very accurate because entire specimen can be analyzed

 

 

 

 

  • Testing begins at 6 weeks  post-op
  • PSA remains <0.1

 

 

 

 

  • Impotence and incontinence

 

 

 

  • Improves with time

 

 

  • Yes: radiation is possible after surgery

 

  • No

 

 

 

LENGTH OF TREATMENT

 

 

 

ACCURACY OF TREATMENT

 

 

 

SIDE EFFECTS DURING TREATMENT

 

 

 

 

HORMONE THERAPY NECESSARY

 

 

 

CANCER STAGING

 

 

 

 

 

PSA FOLLOW-UP

 

 

 

 

 

SIDE EFFECTS AFTER TREATMENT

 

 

RISK OF IMPOTENCE & INCONTINENCE

 

 

SECONDARY THERAPY POSSIBLE?

 

 

INCREASE RISK FOR SECOND CANCER?

Radiation

  • EBRT is typically administered 5 days a week for 5-6 weeks
  • CyberKnife® is typically  done over the course of 1-5 treatments/days

 

  • Not accurate: radiation is targeted at prostate based on imaging data, dosage and location is approximated

 

 

  • Fatigue, skin inflammation, frequent/difficult/uncomfortable urination, rectal bleeding or irritation, hemorrhoids, diarrhea

 

 

  • Lupron is given along with RT, which has its own panel of side effects, similar to menopause

 

 

  • Not accurate: exact type of prostate cancer not known, extensity not known, seminal vesicle and lymph node involvement not known

 

 

  • Testing begins ~2-3 months post-op
  • Will not reach lowest point for 18-24 months
  • Majority of men experience a “PSA Bounce” (a temporary rise in PSA) where the PSA rises ~15% post-treatment, then declines again

 

 

  • Bowel dysfunction
  • Impotence and incontinence

 

 

  • Worsens with time

 

 

  • No: surgery is very difficult to do after radiation

 

  • Yes: a 5% increased risk of rectal or bladder cancer