Countless times I’ve had the displeasure of telling a man with loved ones at his side, “Your test results have come back. Unfortunately, you have prostate cancer.” While it is difficult for me as a urologist and prostate cancer surgeon to deliver this news, it dims in comparison to the overwhelming shock and dismay putting men on an unplanned journey they didn’t expect.
After the initial shock, men face another difficulty – what happens now on deciding how to treat it? Prostate cancer treatment is unique, just like every man is unique. It’s never a one-size-fits-all approach for every man. Men diagnosed with a cancerous prostate gland deserve expert evaluation by a skilled and experienced urologist deftly guiding them in choosing the right treatment.
Fortunately, survival rates of prostate cancer have been boosted to 98 percent thanks to improved treatments, new medications, and early detection. In other words, nearly all men will survive it and likely die of another cause.
While the long-term outlook of prostate cancer is overall good, the diagnosis still comes with numerous treatment decisions impacting and influencing a man’s future quality of life.
Once prostate cancer is confirmed, men will be at a fork in the road asking themselves – which treatment is best for me? My advice – choose wisely. Your decision, in conjunction with your doctor, will determine what your life will look like down the road. Before making any decision, I advise men to become as knowledgeable as possible on the various options. The goal, of course, is to cure their cancer and get on with their life. Men, well-equipped with a thorough understanding of the disease before proceeding, is a considerable advantage and not to be overlooked.
Here are some treatment options, starting with active surveillance:
Men, with very slow-growing prostate cancer confined to the prostate gland that is unlikely to spread may be advised to take the conservative option of active surveillance, also known as watchful waiting. This option is more relaxed approach and works well for men who are compliant with regular checkups and testing and can manage the stress of living with cancer in their prostate. But always with the understanding that if the cancer changes, they will need to decide on other treatments for their prostate cancer. These treatments may include various surgery options such as surgically removing the prostate or nonsurgical options that may involve treatment with radiation.
Surgery to remove the prostate gland (robotic radical prostatectomy) and radiation therapy are commonly used elected treatments for prostate cancer. However, like any medical procedure, both treatments have their unique potential for complications and side effects. Still, robotic prostatectomy has proven time and again to be far superior to radiation, offering more benefits with fewer side effects.
A decision of this magnitude should be taken seriously. Men will need to do their homework researching the best treatment for them. By having a thorough discussion with their urologist and/or oncologist, men will learn the pros and cons of both surgery and radiation, helping guide their decision best for them and their overall health.
At the time of diagnosis, every man’s prostate cancer will be staged according to how much cancer is found, if cancer has spread beyond the prostate to surrounding tissues, and what their prostate-specific antigen (PSA) level is.
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. I highly recommend that men choose surgery first and, if necessary, radiation second. If radiation is chosen first before surgery, complications are more likely as I explain in this article.
The advantages of robotic radical prostatectomy include minimal blood loss, less pain, shorter recovery, and hospital stay, and better preservation of urinary and sexual functioning. Radiation advantages include no incisions or hospitalization, no anesthesia, and unrestricted activities; however, disadvantages of radiation may include increased tiredness, rectal soreness, requires frequent treatments, and a higher probability of erectile dysfunction along with bladder or urinary problems.
Let’s look at other comparisons between surgery and radiation treatment:
Within six weeks after a man has a robotic radical prostatectomy, their prostate-specific antigen (PSA) will have dropped to zero. But some men treated with radiation, will have PSA ‘bounces’ – a rise and fall in their PSA blood level after treatment lasting up to two years later. Causes of the PSA bounces could be inflammation, benign prostatic hyperplasia (BPH), cancer, or the radiation itself. For some men, PSA fluctuations can cause tremendous anxiety and may lead to more invasive biopsies.
After surgery, in the unlikely scenario, if cancer returns, then low-dose radiation is possible to fight back the prostate cancer. However, performing surgery after recurrent prostate cancer radiation is very challenging, if not almost impossible. The radiated tissue can become almost like cement, which has attached itself to the rectum and surrounding tissue. Therefore, the risk of incontinence and erectile dysfunction increases significantly. However, some patients may benefit from salvage radical prostatectomy for residual or recurrent prostate cancer after radiation treatment.
Once the prostate is removed after surgery, men will not have to deal with or be affected by BPH. But men, treated first with radiation, may have possible issues of hematuria (blood in the urine), urethral strictures or scar formation, cystitis, and lower urinary tract symptoms such as urinary frequency.
Men who opt for surgery will be at no risk for secondary prostate cancer – it’s a 100% survival rate since the prostate is removed. However, for men who choose radiation over surgery first, a small percentage of those patients will have an increased risk of rectal or bladder cancers. In addition, if prostate cancer has spread beyond the confinement of the prostate gland after radiation, the chances of living longer than five years are less than 30%.
Bottom line, surgery is considered the gold standard for treating localized prostate cancer confined to the prostate gland if the patient’s life expectancy is greater than ten years.
Is the surgery complex? Yes, it is – it takes place in a densely packed area of the male anatomy. But I can tell you that skilled surgeons perform these surgeries successfully every day. I perform this surgery from beginning to end, with the goal of not only leaving the patient cancer-free but I take great care to spare the nerves that control urinary and sexual functioning, with the goal of preserving the quality of life issues for men. I developed my own surgical modifications I’ve called the Samadi Modified Advanced Robotic Technique or SMART surgery which I have performed on more than 7,000 men.
For men deciding 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, they must answer specific questions 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 cancer not returning and what percent of men have issues with urinary incontinence or sexual function after prostate removal? The surgeon should also explain in detail what will happen during the surgery and what to expect afterward 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 themselves and their families. Finding and working with a skilled urologist/oncologist, can be incredibly reassuring for all men regarding what happens after their prostate cancer diagnosis.
Dr. David Samadi is the Director of Men’s Health and Urologic Oncology at St. Francis Hospital in Long Island. He’s a renowned and highly successful board certified Urologic Oncologist Expert and Robotic Surgeon in New York City, regarded as one of the leading prostate surgeons in the U.S., with a vast expertise in prostate cancer treatment and Robotic-Assisted Laparoscopic Prostatectomy. Dr. Samadi is a medical contributor to NewsMax TV and is also the author of The Ultimate MANual, Dr. Samadi’s Guide to Men’s Health and Wellness, available online both on Amazon and Barnes & Noble. Visit Dr. Samadi’s websites at robotic oncology and prostate cancer 911.