Surgery vs Radiation Treatment for Prostate Cancer
Clearly, when one sits down after making the diagnosis of prostate cancer, the goal of the discussion with the physician is to outline the different treatment modalities that are available. Clearly, active surveillance is one modality that can be used for treating patients with prostate cancer. Radiation therapy is another modality and then surgical intervention is a third modality. When one sits down typically with a physician, whether it's a radiation oncologist to talk about radiation or a surgeon to talk about surgical intervention, the goals and objectives of the treatment need to be outlined very clearly. When one looks at outcomes, we look at curing patients with their prostate cancer; we look at continence as an outcome measure and are they able to hold their urine and potency. Those are the three markers that we look at typically in patients that undergo prostate cancer surgery and indeed all of these three markers play or outcomes play an extremely sensitive role in making a final decision.
When you look at the outcomes with surgical intervention versus radiation, in most cases, surgical intervention will have better outcomes, but only in some cases slightly better outcomes. You know couple percentage points difference and the average patient would not see much of a difference. Clearly, if you are younger patient and you have got moderately aggressive disease, you want to be more aggressive in your treatment modality and one might choose surgery rather than radiation.
On a flip side, if you have an older patient that has much more advanced disease, one might choose radiation because the chance of curing the patient may be significantly less. I like to tell patients to think of the prostate as an orange. When one develops cancer and the juice you bit to the orange, the treatment has to be directed at not only the juice you bit to the orange, but also the orange peel and surgical intervention does address that. The question is does the disease extend outside that orange peel.
Now, we do not have any blood test, we do not have terrific x-ray tests that can tell us whether microscopic disease is outside. We now are using MRI testing, magnetic resonance imaging to try to give us an understanding of the diseases outside the prostate itself, the capsule of the prostate, but this is the decision whether one chooses radiation or surgical intervention, it is made after a discussion with the appropriate physician and the patient and his family. Some prostate cancers are high risk, aggressive, and more likely to spread. Others are low risk, least likely to have bad outcomes. The biopsy says cancer, but current diagnostic tools provide limited information about how aggressive a man's individual disease is, so most men decide to treat prostrate cancer immediately. Once treated, many men experience serious long-term side effects like incontinence and sexual impotence.
Immediate treatment is not always needed, but right now a man can't be sure if his cancer is the kind that is likely to require treatment or if he is okay to wait for now. What if there was a test that could determine how aggressive prostate cancer is. Genomic health is developing a new test to do just that. By reviewing the underlying biology of the tumor and using genes from multiple biologic pathways, the test can predict the aggressiveness of prostate cancer when diagnosed, allowing a man to make a more informed treatment decision with confidence, taking care of himself with more information and greater peace of mind.
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