Tips to Decide, “Why Prostatectomy?”

With all of the different options for the treatment of prostate cancer, men must often wonder why prostatectomy compared to other forms of treatment.

The complete removal of the cancer.  Surgery is the only way to completely remove the cancer.  Occasionally a tiny portion of tumor is left behind (a positive margin), but surgeons know when this happens it can tailor the patients disease management differently.  Additionally, surgeons remove the lymph nodes, which are involved with cancer in a small proportion of patients. 

Better knowledge of the cancer.  The only information doctors have of the prostate cancer prior to treatment is from the prostate biopsy and CT or bone scans, which are known to be inaccurate.  Often, the prostate cancer is different than the biopsy, which would have led to either too much or too little treatment if that were the only piece of information. 

Different side effects.  Following radiation, it is not uncommon for men to develop diarrhea and bleeding from the rectum, which is because the rectum also receives radiation. In conjunction the patient may also develop problems with erections. Men also can feel the need to urinate all the time, and sometimes cannot urinate at all, requiring a catheter in the bladder for a long period of time.

Easier post-operative cancer monitoring.  The PSA test is a very sensitive marker of prostate cancer. After surgery, it should drop to zero.  If a recurrence occurs, the PSA will start to go up, physicians will know about it very quickly.  With other treatments, the PSA does not go to zero, and it’s difficult to know if increases in PSA are due to recurrences or not.  This can lead to quicker treatment of recurrences, improving the chance of cure.

Easier treatment of recurrences.  In the unfortunate event that the prostate cancer comes back after surgery, it is much easier to treat than after other treatments.  For example, it is easy to give radiation to the prostate bed after surgery, but surgery after radiation is very difficult.  Such surgery has high rates of side effects and complications, especially incontinence.

Risk of second cancers.  Although radiation is used to treat cancer, it is also known to cause cancer in normal tissue. Studies show higher rates of bladder, rectal and lung cancer in men who received radiation for their prostate cancer than in those who had surgery.

For these reasons and others, it’s sometimes better to take a step back and look at your options on a broader spectrum. Radical prostatectomy and surgical outcomes is as good as the experience of the surgeon behind it. So take the time, do the research and find the most committed and experienced surgeon who can commit to your case and help successfully cure you of prostate cancer.

I would add that surgical outcome is as good as the experience of the surgeon behind it. So pick the surgeon who is committed to your case and pick the most experienced one.

David Samadi, MD - Medical Contributor

View posts by David Samadi, MD - Medical Contributor
Dr. Samadi is a board-certified urologic oncologist trained in open and traditional and laparoscopic surgery and is an expert in robotic prostate surgery. He is chairman of urology, chief of robotic surgery at Lenox Hill Hospital and professor of urology at Hofstra North Shore-LIJ School of Medicine. He is a medical correspondent for the Fox News Channel's Medical A-Team. Learn more at Visit Dr. Samadi's blog at Follow Dr. Samadi on Twitter, Instagram, Pinterest, and Facebook.
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