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Prostate Cancer Treatment - Is Surgery Right for You? (Part 2)

Posted Sep 02 2010 12:00am

There is no easy way to answer whether surgery is right for prostate cancer patients. In part that's because prostate cancer, for most men, is actually a chronic condition rather than a short-term, life-threatening event. However, many men, regardless of age, feel strongly that they want to get the cancer out of their bodies before it might do more harm. If you are among such individuals, then surgery is worth exploring, but so is radiotherapy.

Scientists have concluded thus far that either approach offers the same outcomes in terms of a cancer cure and quality of life issues like continence and sexual potency. In various surveys as many as 90% of patients who choose radiation or surgery are happy with the results achieved. This is particularly the case when both the benefits and risks of each approach are adequately presented by urologists in advance of such treatments.

Proton beam therapy is another modality to consider, as most patients who decide to have this highly concentrated form of radiation appear to be pain-free and fully  functional. But more study is needed to determine if that’s true for all concerned.

Even proton beam therapy, with its precise, extremely expensive technology, can have its down-side in terms of weakening bone structure in the area of your hips. And more than a few proton beam therapy patients have had to go on to prostate cancer surgery later on due to complications. The same is true for HIFU treatment,-  High Intense Frequency Ultrasound, and other treatment modalities. Beyond this, no matter which treatment a man chooses, ejaculation will no longer be possible. This is the case even if your erectile functioning and capacity to orgasm remain intact.

Having said this I concede I have a bias in favor of prostate cancer surgery, for at least three reasons: Once the prostate is removed, a post-op biopsy can determine how advanced the cancer is at that point. Surgery is the only way you can be 100% certain how advanced your prostate cancer tumor is and whether your prostate, once removed, has positive or negative margins.

If the margins are negative (with no indication of malignant cells on the prostate's periphery), you’ll know there’s little likelihood you’ll get prostate cancer again. But if the margins are positive it's more likely malignant cells escaped into the prostate bed. Knowing one way or another will add reassurance, on one hand, or insure greater caution on the other hand.

A second reason for preferring surgery over radiation is that it’s always possible to use radiation after surgery in case of cancer recurrence. But after initial radiation, surgery is virtually impossible:  A surgeon will not be able to remove your prostate, should another tumor be diagnosed at a later date.

The third reason to prefer surgery is that once the patient's pelvic area is accessible, it makes it possible to complete secondary surgery on the bladder neck, which frequently needs repair work. Apart from the surgical removal of my cancerous prostate, my bladder neck had to be reconstructed so I would not become a urologic cripple. The net result is that I now have a 3 1/2  year old bladder neck. Trust me, due to surgery, I'm extremely content with my continence!

Please note, though, that the trauma of surgery has a greater likelihood of causing ED (in up to 70% of prostatectomy patients vs. up to 50% of radiation patients) within 5 years after treatment. A smaller proportion of men subjected to these treatments can experience permanent incontinence (7 to 16% of patients). However for most prostate cancer survivors both ED and incontinence are treatable.

I wish I could offer a straightforward “Yes!” or “No!” when trying to answer whether surgery is right for any given prostate cancer patient. As you can tell, there is no way to give a simple response without first reviewing the alternatives. Hopefully I have given you enough food for thought so you and every newly diagnosed patient can make a decision that is best for him, given his circumstances and needs.

--Rabbi Ed

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