What options are there for prostate cancer treatment?
Medical Director, Radiation Oncology, SNMH Community Cancer Center
Men diagnosed with prostate cancer often seek an opinion from a radiation oncologist, like me, about treatment options. Since September is Prostate Cancer Awareness month, I would like to address some commonly asked questions:
Question Does early stage prostate cancer need to be treated?
Answer Almost no other cancer affords an opportunity to defer treatment. However, many prostate cancers progress slowly and are diagnosed later in life, so an older man will likely die from other causes.
Studies are now underway comparing observation versus treatment. This “active surveillance” strategy requires PSA checks every three months and repeat prostate biopsies every one-three years until disease progression is documented at which point treatment is advised.
In theory such close surveillance will detect cancer progression while it is still curable, but the studies must be completed to prove this.
Question If treatment is needed, which one is best?
Answer Surgical removal or radiation of the prostate are the most effective and time tested treatments with the least risk to a man’s potency. Freezing the gland (cryotherapy) does not have comparable long-term follow-up and nearly always causes impotency since the sexual nerves adjacent to the cancerous gland are frozen as well.
Question Is robotic prostatectomy better than standard surgery?
Answer Remotely controlled robotic surgery removes a prostate through tiny incisions and has been reported to have less blood loss and shorter recovery time.
However, improvements in standard surgical techniques have made this difference negligible. What is lost by the more complex and expensive robotic surgery is the surgeon’s ability to feel where the cancer extends, which is often invisible even with the higher magnification afforded by robotic instruments.
Dr. Patrick Walsh, who pioneered nerve sparing prostatectomy at Johns Hopkins, cautions against robotic surgery for this reason. He worries that without feeling the prostate, the robotic surgeon cannot fully appreciate disease extension beyond the gland which risks leaving cancer behind. Indeed, a recent review of robotic prostatectomy found twice as many surgical failures compared to the standard operation.
Question Is proton radiation better than what is available at Sierra Nevada Memorial Hospital?
Answer Proton radiation concentrates the dose around the prostate while reducing it around the adjacent bladder and rectum. It is available at only a handful of centers nationally because it is much more expensive to deliver. Newer technology like intensity modulated radiation yherapy is equally effective and is available at our Cancer center at much lower cost.
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