Survival rates, quality of life improve with surgery vs radiation for prostate cancer


Survival rates, quality of life improve with surgery vs radiation for prostate cancer

Receiving a diagnosis of prostate cancer is difficult for any man to hear.  Questions of “why me” and “why now” along with the stress of knowing cancer is growing inside of you can hinder your outlook on your health and life.  But perhaps even more difficult are the decisions you must make on how to treat it.  Prostate cancer treatment is unique in that it never is a one-size-fits-all approach for every man.  

One of the most important decisions you may have to decide is whether to opt for radiation treatment or have your prostate gland surgically removed.  Surgery to remove the prostate gland (radical prostatectomy) and radiation therapy are two of the most common elected treatments for prostate cancer.  Like any medical procedure, both treatments have their own unique potential of complications and side effects but robotic prostatectomy has proven time and again to be far superior over radiation as it has more benefits with far fewer side effects. 

The decision of this magnitude should not be taken lightly however.  Men will need to do their homework on researching the best treatment for them.  By having a thorough discussion with their urologist and/or oncologist, they can discover the pros and cons of both surgery and radiation, with their physician guiding them on deciding what direction is best for him and his overall health.

Why surgery is superior

At the time of diagnosis, prostate cancer will be staged according to how much cancer is found, if the cancer has spread beyond the prostate to surrounding tissues, and what their prostate specific antigen (PSA) level is.  Surgery will give you a more accurate stage of the cancer, how much cancer is found, what your Gleason score is, and whether it has spread to secondary tissues such as the seminal vesicles or lymph nodes. 

Here are other important reasons why surgery is superior to radiation:

·      Surgery removes all the cancer

·      Surgery also allows for more accurate and precise follow-up. 

·      After surgery, your prostate specific antigen or PSA will drop to zero giving you peace of mind

·      After surgery, careful PSA monitoring will allow for immediate detection if the cancer should return.

·      After surgery, options of radiation and chemotherapy are still available and can be a plan B backup if the cancer were to return

·      After surgery, benign prostatic hyperplasia or BPH, will never occur and continence and sexual function returns to normal

Why radiation should not be a man’s first option for treatment

Some men may believe that radiation would be the better first choice in treating prostate cancer.  But this is not the case.  If the prostate cancer is localized, meaning it has not spread beyond the surrounding tissue of the prostate and is contained within the prostate gland, studies have shown prostate cancer patients with localized cancer do better with surgery versus radiation treatment.  Surgery for the treatment of localized prostate cancer is not only more effective but is also a better option in regards to the long-term prognosis as men with prostate cancer live longer when treated with surgery.

The factor found in these studies of men treated with radiation is that they are twice as likely to die from prostate cancer, and are one-and-a-half times more likely to die sooner than men who had prostate cancer treated with surgery.

In the short-term, men who have radiation over surgery may do well, but long-term, radiation can have many side effects such as the following:

·      With radiation, treatment is based on random biopsies potentially underestimating the amount of tumor present

·      Radiation over surgery may increase the risk of developing a secondary cancer such as bladder or rectal cancer

·      Surgery after radiation is extremely challenging and can result in complications

·      The PSA will never go to zero which can be emotionally upsetting for men

·      Radiation can lead to rectal pain and bleeding along with causing erectile dysfunction

·      Radiation is combined with powerful hormones resulting in a male menopause and a lower quality of life

When a man chooses surgery to treat localized prostate cancer, the prostate is taken out completely which means he will have a 100% survival rate.  However, if a man chooses radiation over surgery first and then finds out the cancer has spread beyond the confinement of the prostate gland, the chances of him living longer than five years is less than 30%.

Finding the right surgeon is key

For men who make the decision to have surgery to remove their prostate, one of the most important first steps to do is to find and choose a qualified and experienced surgeon. 

When meeting with a surgeon, certain questions need to be answered before making the final choice.  Men should ask about their surgical experience – how many successful surgeries have they performed, what is their success rate of the cancer not returning and what percent of men have issues with urinary incontinence or sexual function after removal of the prostate?  The surgeon should also explain in detail what exactly will happen during the surgery and what to expect afterwards with the recovery. 

In conclusion, all men diagnosed with prostate cancer need to find a qualified, experienced urologist/oncologist who will guide them through this journey, providing individualized care and helping them make the best decision for him and his family.