After being diagnosed with prostate cancer, the wide variety of treatment options can be confusing for even the most educated of patients. Advice comes from all angles_ your doctor, friends and family, reports in the news, and even doctors' advertisements, making it difficult to know which is the best treatment for you. I'll walk you through the most important issues in your decision-making process.
1) Cancer Cure. Almost every patient I see tells me that their primary goal is to cure their prostate cancer. Fortunately, this is possible in over 90 percent of patients. Only two treatments have demonstrated long-term cure rates: surgery and radiation. At this time, all other treatments are considered experimental. Recent evidence suggests that radiation may be associated with increased rates of metastases when compared to surgery. This may be related to two benefits of surgery: the complete removal of all prostate tissue and the removal of lymph nodes. After surgery, the PSA (a blood test that is an excellent indicator of cancer progression in patients known to have cancer) should drop to zero. Subsequent rises in the PSA can trigger immediate action to stop its spread. Following PSA after radiation is much more complicated, which can lead to a dangerous delay in treatment. In addition, a small but significant percentage of patients have prostate cancer in their lymph nodes. These are removed during surgery, but typically are not treated by radiation.
2) Side Effects. Despite what you may hear, any treatment for prostate cancer has its side effects. Radiation and surgery both can result in erectile dysfunction, or difficulty obtaining an erection, and changes to your urination. However, there are surgical "nerve-sparing" techniques that can reduce the risk of erectile problems. Radiation irritates the tissues around the prostate, namely the bladder and rectum. Because of this, it can make it difficult to urinate, or seem like one needs to urinate frequently. Incontinence, or leakage, can also be an issue. After surgery, most men will leak urine for a period of time, although this usually will resolve. Leakage of stool can occur after radiation.
3) Surgery: Open vs. Robotic? Another point of debate and confusion surrounds the two types of surgery. It does not need to be so complicated. In experienced hands, either will cure prostate cancer equally well. The side effects are similar, although patients undergoing robotic surgery are much less likely to need blood transfusions, will spend less time in the hospital after surgery and will have smaller incisions. The key, however, is that the surgeon be experienced. Numerous studies have demonstrated that skilled, busy surgeons have better outcomes - both in cancer control and side effects - than those with less experience. This is true of both open and robotic surgeons. Confusion occurs when the results of inexperienced robotic surgeons are compared with those from experienced open surgeons. When choosing a surgeon, you should always ask what his (or her) experience is and what his outcomes are. The robot is simply another tool that a surgeon uses: the surgeon is the important part!
Prostate cancer is a complex issue: I hope you found this post helpful. A few parting thoughts: be sure to bring a list of questions to ask your doctor, thoroughly explore all available options, and consider traveling to have your treatment. Side effects from poor radiation or surgery can last a lifetime, so you should do everything in your power to minimize them! For further information please visit roboticoncology.com.
David B. Samadi, MD is the Chief of Robotics and Minimally Invasive Surgery at Mount Sinai School of Medicine in New York City. As a board-certified urologist and an oncologist specializing in the diagnosis and treatment of urologic diseases, kidney cancer, bladder cancer, and prostate cancer, he also specializes in many advanced minimally invasive treatments for prostate cancer, including laparoscopic radical prostatectomy and laparoscopic robotic radical prostatectomy. His Web site, Robotic Oncology, has been translated into six different languages and is one of the most popular urology sites on the Internet.