CAREFULLY CONSIDER THE OPTIONS
TO TREAT PROSTATE CANCER
I
n the United States, approximately
192,000 men will be diagnosed with
prostate cancer in 2020. The average
age at diagnosis is 66 and most men live
to an average age of 78.6 years. That is
over a decade men must live with the side
effects of prostate cancer treatment. When
choosing between surgery or radiation for
prostate cancer, it is important to know that
these treatments provide similar cure rates,
however the side effects vary.
Historically both surgery and radiation have
put men at risk of:
• Urinary incontinence (leakage)
requiring the use of a pad or diaper
• Erectile dysfunction
• Bladder and/or bowel damage
Many physicians have attributed the side
effects listed above to older treatment
techniques, so a newer study, comparing
up-to-date radiation and surgical techniques
was needed. Dr. Hoffman and colleagues
recently published a study in JAMA looking
at the difference in outcomes and side effects
between modern day surgery and radiation
treatments.
52 • PROGRESS 2020
This was a large study of 1386 men with
favorable-risk prostate cancer and 619 men
with unfavorable-risk prostate cancer. (Note:
your oncologist can tell you which “risk”
category you fall in.) This first table shows
the number of men in each group and the
treatment they received.
The men in the favorable risk group, had less
cancer in their prostate gland and were able
to be treated with either:
• Prostatectomy, surgery to remove
prostate, “nerve-sparing” refers to
the surgical technique attempting
to avoid the nerves that control
erections.
• EBRT, conventional external beam
radiation therapy, using a technique
called “IMRT” where the patient lies
on a treatment table and receives
daily radiation, typically 4-8 weeks.
• LDR brachytherapy- a type of
internal radiation, where a patient is
taken to the OR and radioactive seeds
are inserted into the prostate gland.
The seeds radioactively decay over
the next 3 months and deliver the
necessary radiation to kill the prostate
•
cancer.
Active surveillance, no treatment,
just follow up visits and tests. This
is an option for men with a low
volume of cancer confined to the
prostate gland. These men have a
low risk of the cancer ever spreading
(metastasizing) and causing a
problem so treatment is avoided to
prevent side effects.
The men in the unfavorable risk group
have more cancer in their prostate gland
and there is concern that there even could
be cancer outside the prostate gland.
Consequently, these patients received either
EBRT, as described above, along with ADT,
or androgen deprivation therapy. ADT
is a series of injections that lower a man’s
testosterone and help treat the prostate
cancer throughout the body.
While the researchers focused on side effects,
it’s important to note that their data did not
show any difference between surgery and
radiation cure rates. This is reflected in the
table below if you look at the estimated 5-year
disease-specific survival. The good news for