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Radiation Therapy vs. Robotic Prostatectomy

Updated: Jan 3, 2020


Radiation for Prostate Cancer
Radiation Therapy

Patients with localized prostate cancer have many options for treatment. Choosing the best option can be challenging as each treatment modality is associated with specific risks and side effects. A urological surgeon trained in Robotic Surgery, who has access to most or all treatment options is the best consultant to guide a patient down the most appropriate path. Two of the most commonly used options for localized prostate cancer are radiation therapy and surgery (Radical Prostatectomy). Robotic prostatectomy is currently the most widely used and recommended initial therapy for localized prostate cancer for majority of patients. Urologists who do not perform this procedure or do not have a partner in their practice who does, tend to offer radiation therapy to their patients more readily. Therefore, patients have to be aware of all risks and side effects of these two types of therapy.



Surgery

Radical prostatectomy is a surgical procedure where the cancerous prostate gland and sometimes surrounding lymph nodes are removed. Robotic Assisted Radical Prostatectomy is the most widely used approach as this is a minimally invasive procedure that has been shown to reduce post-operative recovery time and improves outcomes. Once the prostate has been removed, your surgeon can determine if any additional treatments are needed based on the pathologist’s assessment of your cancer. Your PSA should fall to undetectable levels a few weeks after surgery. This blood test is used to monitor your cancer for recurrence.

Risks of surgery are infection, bleeding, and damage to surrounding structures and are dependent on your surgeon’s skills and experience with this procedure. Most patients experience a brief period of urinary incontinence, which improves and usually resolves within the first 3 months.


The benefits of surgery are that the cancer is removed from your body and follow up is much more predictable. Your surgeon can also remove your lymph nodes to ensure that cancer has not spread to these areas. Studies have shown that patients who elect surgery live longer.


Radiation

Radiation for prostate cancer can be done in two ways. External beam radiation refers to therapy that is aimed at sending beams of radiation from outside to the prostate in the hope of killing cancer cells from the outside-in. All organs in the path of the radiation may be exposed to harm including your bladder and rectum. Internal radiation therapy refers to radioactive “seeds” that your surgeon places inside your prostate in the hope of killing the cancer from the inside-out. This form of radiation may also expose patients to urinary difficulties and damage to surrounding structures. Approximately 33% of patients experience acute symptoms of inflammation of their bowels and bladder during radiation therapy. Approximately 10% of patients will sustain permanent symptoms of irritable bowel syndrome and rectal or bladder bleeding. Unfortunately, if someone develops these symptoms, they are often irreversible.


Summary

Although both radiation therapy and surgery are good options for carefully selected individuals, most experts would agree that Robotic Prostatectomy is a superior option for localized prostate cancer in otherwise healthy individuals with fast post-operative recovery and great long-term outcomes. As a matter of fact, a 2016 systematic review and meta-analysis in the journal of European Urology showed that “Radiotherapy for prostate cancer is associated with an increased risk of overall and prostate cancer-specific mortality compared with surgery." Therefore, most experts use radiation therapy as a backup if the final pathology results are unfavorable. Discuss all risks and benefits of various therapies with your urologist. Get a second opinion from a urologist who performs Robotic Prostatectomy and has access to radiation therapy.


 

As always, the information above is meant to be informative and does not replace your physician's recommendations or judgement. Each individual case has to be evaluated carefully to determine the best course of action. Call or use our contact page to request an appointment to further discuss your unique case.

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