Navigating prostate cancer treatment choices: Radiation vs surgery

After receiving a diagnosis of prostate cancer, you may have a lot of questions. Prostate cancer is often slow-growing and has a five-year survival rate of >99% for localized prostate cancer, meaning more 99% of men with early-stage prostate cancer are still alive five years after being diagnosed.

Whether you've experienced symptoms or not, there are several options for treatment, including:

Radiation therapy is a common treatment plan for those diagnosed with prostate cancer. This option offers you the ability to tailor your treatment to your Gleason score, pre-existing conditions, and overall wellness needs.

There are several forms of radiation therapy:

• External beam radiation uses focused radiation from a machine outside the body to target the prostate and treat early-stage cancer and more advanced cases or relieve symptoms like bone pain. Most treatments are given five days a week at an outpatient center over the span of several weeks.
• Brachytherapy (internal radiation) places tiny radioactive seeds directly into your prostate and is usually used for early-stage, lower-risk prostate cancer. It may be combined with external radiation for higher-risk cases but isn't ideal for men with urinary issues, large prostate glands, or a history of transurethral resection of the prostate (TURP).
• Radiopharmaceuticals are radioactive drugs injected into a vein that then travel through the bloodstream to target and kill cancer cells throughout the body. They deliver focused radiation to limit side effects and can treat cancer wherever it has spread.

What are the common side effects of radiation therapy for prostate cancer?

Side effects depend on the type of radiation therapy you and your care team choose. However, some include:

• Urinary problems
• Diarrhea or constipation
• Fatigue
• Erectile dysfunction
• Nausea
• Loss of appetite
  

Surgical intervention for prostate cancer is done through a radical prostatectomy. This procedure removes the entire prostate gland and any affected tissue to help limit the spread.

Your surgeon will take one of two approaches to remove the gland:

• Open prostatectomy
• Laparoscopic prostatectomy

What is an open prostatectomy

During an open prostatectomy, your surgeon (urologist) will place you under general anesthesia, possibly paired with epidural anesthesia, before beginning the procedure.

Your care team will choose to take a retropubic approach, where an incision is made from your belly button to your pubic bone, or a perineal approach, where an incision is made between your anus and your scrotum. While both approaches are typically successful, the perineal approach is less common as it can result in erectile dysfunction despite its shorter procedure length.

In either approach, a catheter is placed after the removal and left in for one to two weeks to assist with urination during recovery. After a brief hospital stay, you will be sent home to heal.

What is a laparoscopic prostatectomy?

A laparoscopic prostatectomy is performed through several small cuts in the abdomen. During this procedure, the surgeon will place a laparoscope, a long tube with a small camera attached to the end, through one of the cuts to help see inside the body. Thin surgical tools are placed in the remaining incisions to perform the removal.

There are two approaches to a laparoscopic prostatectomy:

• Laparoscopic radical prostatectomy, a less frequently used approach, involves the surgeon manually controlling long instruments to remove the prostate.
• Robotic prostatectomy, where the surgeon controls precise instruments from a console to operate a robotic system in removing the prostate.

"As a surgeon, I am constantly looking for ways to make treatment more effective without elongating your list of symptoms or possible complications," Tracy says. "These less invasive approaches to prostatectomy are now a gold standard, surprising patients with the ease of care."

The robotic approach delivers the same long-term results as a laparoscopic and open prostatectomy and is now the most common surgical method for removing the prostate in the U.S. due to its short-term advantages, such as:

• Less blood loss during surgery
• Reduced post-operative pain
• Shorter hospital stays
• Faster recovery
• Less time with a catheter
• Lower risk of complications

Choosing your treatment path depends on several factors, such as age, overall health, and lifestyle. At UI Health Care, we will walk you through your options and support you through every step.