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Is It Better To Have Prostate Removed Or Radiation

An Inclusive Clinical Trial

Which is Better – Surgery vs. Radiation for Prostate Cancer?

The team designed the phase 3 trial to be as inclusive as possible to capture a population that looks like people commonly treated in the community, Dr. Buyyounouski explained. The participants included both people getting radiation immediately after surgery and those who waited until they had rising PSA levels.

Participants who had some invasion of their cancer into nearby tissue were eligible, although those whose cancer had spread to their lymph nodes were excluded. They could also receive up to 6 months of androgen deprivation therapy, a type of hormone therapy, if recommended by their doctor.

Participants were randomly assigned to treatment with HYPORT, consisting of a higher dose of radiation every weekday for 5 weeks or the commonly used, lower dose every weekday for 7 weeks. They were asked about urinary and bowel symptoms before radiation and 6, 12, and 24 months after treatment, using the Expanded Prostate Cancer Index Composite questionnaire.

After prostate cancer treatments, common urinary symptoms can include urine leakage or pain or burning when urinating. Common bowel symptoms can include bowel leakage or urgency. The trial did not measure sexual side effects, such as erectile dysfunction, since these can also be affected by hormone therapy.

About three-quarters of the participants completed all questionnaires. At the end of treatment, people who received HYPORT reported more bowel side effects, although urinary side effects were equivalent between groups.

Surgery Or Radiation: Which Is Better For Early Prostate Cancer

Oct. 3, 2000 — When Hank Porterfield learned he had prostate cancer in 1992, he was faced with a critical choice that more than 100,000 men in the U.S. make each year — whether to treat the cancer with surgery or radiation. Then in his mid-60s, the Illinois man says he was told the treatments were equally effective.

“I was very lucky because I immediately found a support group and started talking to people who had been through treatment,” he tells WebMD. “I was aware of the potential side effects of therapy, so I was better able to deal with them. I decided on surgery, which, at the time, was the best treatment option for me.”

Approximately 180,000 men in the United States are diagnosed with prostate cancer each year, and almost 90% have clinically localized disease, meaning that the cancer has not spread to other parts of the body. While some patients with the cancer localized to the prostate, particularly older men, are advised to take a watch-and-wait approach with no therapy given, most will have to decide between therapeutic options.

NCI researchers studied long-term treatment side effects in close to 1,600 men with localized prostate cancer from all over the country and found that those treated with surgery had more urinary and sexual problems, while those treated with radiation had greater declines in bowel function. None of the patients included in the study had radioactive seed implant therapy.

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Side Effects Of Surgery For Prostate Cancer

The most commonly experienced side effects of surgery for prostate cancer are urinary incontinence and erectile dysfunction.

According to the patient-reported outcomes from men who participated in the ProtecT trial, men who undergo a radical prostatectomy experience more sexual dysfunction and urinary problems than those treated with radiation therapy.

While many reported an improvement in the severity of their symptoms six months after surgery, these men continued to report poorer sexual quality of life six years after surgery compared to those who had radiation therapy.

While men treated with radiation reported experiencing bowel function problems after treatment, the men who had a prostatectomy were generally able to undergo the procedure without experiencing any changes in bowel function after surgery.

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Is It Better To Have Prostate Removed Or Radiation

But its a misconception that you have only one better or safer choice. In most cases, either radiation therapy or surgery is an equally good choice when we look at long-term survival.

What happens to the prostate after radiation treatment?

After radiotherapy or brachytherapy, your PSA should drop to its lowest level after 18 months to two years. Your PSA level wont fall to zero as your healthy prostate cells will continue to produce some PSA. Your PSA level may actually rise after radiotherapy treatment, and then fall again.

Some Things To Consider When Choosing Among Treatments

Postoperative Radiation for Prostate Cancer

Before deciding on treatment, here are some questions you may want to ask yourself:

  • Are you the type of person who needs to do something about your cancer, even if it might result in serious side effects?
  • Would you be comfortable with watchful waiting or active surveillance, even if it means you might have more anxiety and need more frequent follow-up appointments in the future?
  • Do you need to know right away whether your doctor was able to get all of the cancer out ? Or are you comfortable with not knowing the results of treatment for a while if it means not having to have surgery?
  • Do you prefer to go with the newest technology , which might have some advantages? Or do you prefer to go with better proven treatments that doctors might have more experience with?
  • Which potential treatment side effects might be most distressing to you?
  • How important for you are issues like the amount of time spent in treatment or recovery?
  • If your initial treatment is not successful, what would your options be at that point?

Many men find it very stressful to have to choose between treatment options, and are very fearful they will choose the âwrongâ one. In many cases, there is no single best option, so itâs important to take your time and decide which option is right for you.

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Whos Eligible For This Procedure

Permanent implants are relatively low-energy sources, and therefore have limited tissue penetration. A well-done implant treats the prostate and the surrounding few millimeters of adjacent tissue.

The best candidates for this procedure are patients with a cancer within or near the prostate. Patients with prostate cancer thats invading nearby structures like the bladder or rectum arent appropriate for this technique.

Side Effects Of Radiation For Prostate Cancer

The primary potential side effects of radiation treatment for prostate cancer include bowel problems, urinary problems and sexual function issues.

According to patient-reported outcomes measuring quality of life from men who participated in the 10-year, randomized Prostate Testing for Cancer and Treatment trial, men who were treated with radiation reported little increase in urinary leakage after radiation therapy. They also reported less sexual dysfunction when compared to men who were treated with surgery. However, men treated with radiation reported a higher incidence of bowel problems, such as loose and bloody stools. These side effects are often short-term for most patients, but some experience long-term side effects.

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Helping People Imagine Their Future

The hardest thing we can do as physicians is help patients envision their future selves, Dr. Buyyounouski said. So patient-reported outcomes are very helpful, because you can tell patients exactly what side effects people had, and the frequency and bother of those side effects at points in time.

For many, he added, the trade-off in more side effects right after treatment will be worth it for a shorter treatment duration.

Unless youve been a patient, its hard for folks to imagine all the things that need to happen for somebody to go and get treatment every for weeks, Dr. Buyyounouski said.

Theres transportation costs, gas, parking, co-pays. And there are costs associated with the things youre not doing, like time away from work or responsibilities at home. Its more than just the medical bills.

I think people are itching to shorten the treatment because there are a lot of patients for whom its a barrier to getting treatment. And radiation therapy is a potentially curative treatment, added Dr. Citrin. So, making it easier for patients without increasing the long-term side effects is a huge win.

However, a less-intensive standard course of radiation will still likely appeal to some people, she added, especially if they are experiencing ongoing side effects from surgery.

Surgery Vs Radiation For Early Prostate Cancer

Side Effects of Surgery Vs Radiation for Prostate Cancer

Analysis of 19 studies suggests surgery has an edge in survival, but experts say each case may be different

HealthDay Reporter

TUESDAY, Dec. 15, 2015 — Men with prostate cancer that’s still confined to the organ are more likely to survive if they have surgery rather than radiation therapy, a new Canadian study suggests.

This type of “localized” prostate cancer is the most common form of the disease, accounting for about 80 percent of cases, said a team led by Dr. Robert Nam of the Odette Cancer Centre at Sunnybrook Research Institute in Toronto.

The most common treatments for localized prostate cancer are surgery and radiation therapy.

But which works best to keep the disease at bay?

To find out, Nam’s team looked over data from 19 studies that included a total of nearly 119,000 men with localized prostate cancer.

Findings from 15 of the studies showed that those who received radiation therapy were twice as likely to die from prostate cancer as those who had surgery.

Findings from 10 of the studies also showed that men who had radiation therapy were 50 percent more likely to die sooner of any cause, compared to those who had surgery.

The results of the analysis were published Dec. 14 in the journal European Urology.

But prostate cancer treatment is never a one-size-fits-all matter, he added.

“There are times when radiotherapy may be more appropriate than surgery, so it is important that a patient discusses treatment options with his clinician,” Nam said.

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Are There Side Effects Of The Combination Approach To Prostate Cancer Radiation Therapy

When it comes to early stages of disease, patients very frequently do well with either brachytherapy or external beam radiation. Success rates of around 90% or higher can be achieved with either approach. When the disease is somewhat more advanced based on the PSA level, Gleason score, extent of visible disease on magnetic resonance imaging we have learned over the years that higher doses of radiation are critical to achieving better results. Some evidence, including a large trial, suggests that for patients with intermediate- or high-risk prostate cancer, a combined approach using brachytherapy along with external beam radiation may be best compared to standard dose external beam radiation therapy alone.

Does Prostate Shrink After Radiation

Radiation therapy can be an effective treatment for prostate cancer. It can shrink a tumor, relieve symptoms, and delay or halt the growth of cancer cells. A therapist may target a tumor with an intense beam of radiation from an external machine, or they may implant or inject radioactive materials into the body.

What should PSA be after radiation treatment?

Recent studies have shown that for optimal results, PSA levels should be lower than 1 ng/ml, and even lower than 0.5 ng/ml. Levels that are above 1 or 2 ng/ml 12 to 18 months following completion of radiation treatments are very worrisome, because they indicate that the cancer may not have been eradicated.

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Radiotherapy After Surgery For Prostate Cancer

Surgical removal of the prostate has a high chance of cure when prostate cancer is confined to the prostate. High-risk features found at the time of surgery increase the risk of the cancer recurring. Recurrence of cancer might show up as an abnormal blood test ), local recurrence at the site of the prostate, or distant spread .

Radiotherapy, using external X-rays directed where the prostate was in the pelvis, has the potential to kill any prostate cancer cells left behind, and improve the chance of cure. On the other hand, it may cause problems with bladder, bowel or sexual function. In some men it may be futile if the prostate cancer cells have already spread beyond the pelvis. This review looked at whether radiotherapy given after surgery for prostate cancer with these high risk features was effective in reducing the risk of prostate cancer recurring, whether it made men live longer, and what the side effects were.

One trial with longer follow up showed improved survival with adjuvant radiotherapy but this improvement did not exist at 5 years follow up. Radiotherapy reduced the number of men whose cancer spread to other parts of the body . We found that radiotherapy improved local control in the prostate bed and did reduce the risk of cancer recurring. Radiotherapy reduced the number of men with an abnormal PSA blood test, but the importance of this is uncertain. Radiotherapy does increase the risk of side effects, affecting bladder and bowel function.

Survival Outcomes By Treatment Strategies

Psa 5.7 Prostate Cancer

As shown in Table and Figure , patients treated with EBRT + BT had significantly better cancerspecific survival, compared with patients treated with surgery or EBRT alone . No difference was found between EBRT and surgery by CSS outcome. When allcause mortality is considered, surgery had a significantly better OS than EBRT and a similar OS as EBRT + BT . These results suggested substantially elevated competing causes of death other than prostate cancer in patients treated with radiation over time. We then examined if salvage RT impacted the surgery vs RT comparisons by removing salvage RT patients from the surgery group. The conclusions were not substantially changed, although the statistical significance was lost in comparison of cancerspecific mortality between EBRT + BT and surgery .2). Since patients who forwent prostatectomy for RT were more likely to be older and susceptible to other causes of death, we performed stratified analyses by age . In patients 65 years, EBRT was significantly inferior to surgery in both cancerspecific mortality and allcause mortality. In patients > 65 years, EBRT was still inferior to surgery in allcause mortality, but EBRT and EBRT + BT showed a nonsignificant reduced cancerspecific mortality compared with surgery. When combined, RT was statistically significantly associated with a better cancerspecific mortality .

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Treatment For Cpg 1 Localised Prostate Cancer

You might not have treatment straight away. Instead, your doctor recommends monitoring your cancer closely and then discussing treatment if the cancer begins to grow. This is called active surveillance.

If you decide to have treatment, it might include:

  • surgery to remove your prostate or
  • external radiotherapy

Robotic Prostatectomy Vs Radiation

For men diagnosed with prostate cancer, deciding on whether to opt for radiation treatment or have their prostate gland surgically removed can be difficult. Surgery to remove the prostate gland and radiation therapy are two of the most commonly elected treatments for prostate cancer. Both treatment options are associated with a variety of potential complications and side effects but robotic prostatectomy has a host of benefits with far fewer side effects associated with radiation therapy.

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A Large Role For Radiation Therapy

People diagnosed with localized prostate cancerthat is, disease that hasnt spread outside the prostate regionhave many potential treatment options, depending on the stage and grade . Some may have surgery alone. Others may only have radiation therapy.

And some may have a combination of the two. This often happens when theres concern that surgery hadnt removed all the tumor tissue. Or, if someones prostate-specific antigen levels start to rise months or years after surgery, radiation therapy may be recommended even if imaging hasnt been able to identify tumor growth.

Hypofractionated radiation therapy is already an accepted treatment option for some people undergoing radiation therapy alone to treat prostate cancer. But whether this type of radiation therapy is appropriate for use after surgery has been unclear.

When radiation is used after surgery, its delivered to a larger area of the body, including sensitive areas in the bladder and rectum, Dr. Buyyounouski explained. This raises the possibility that the higher doses used in hypofractionation may cause long-term side effects that could outweigh the benefit of two fewer weeks of treatment for these patients.

And a lot of people do have some urinary complications after surgery, said Dr. Citrin. So even a small increase in urinary or bowel symptoms that persist after treatment with one regimen versus the other could be quite impactful in terms of quality of life.

Is Prostate Surgery Possible After Radiation

How Radiation Affects The Prostate | Mark Scholz, MD

Dr. Samadi, if a patient with prostate cancer chooses to get radiation treatment, what are the chances of him undergoing surgery, in case of remission?

Dr. Samadi: When we talk about prostate cancer, there are low risk prostate cancers and there are high risk prostate cancers. Youve probably heard of the classification called Gleason score. We, urologists, use that to figure out exactly what type of prostate cancer were dealing with here. In my practice, I like to cure the patients by removing the prostate. There are many advantages for prostate removal. When you undergo a prostatectomy, youre going to know exactly what type of prostate cancer you have. You will find out how much cancer you have in the prostate, because the needle biopsy is a random biopsy and doesnt always give you the best picture. Whats important is, six weeks after prostate surgery, your PSA should go down to zero and should stay zero for the rest of your life. The advantages of the surgery is that the follow-up is very easy. If the cancer reoccurs after surgery, then I would use a low dose radiation as a back-up plan.

Some of the side effects of radiation is secondary chance of rectal cancer. Patients can get rectal bleeding and bladder bleeding. Side effects of radiation comes as time goes on. So, if I can avoid giving patients radiation and cure them with good quality of life, thats what I would prefer. If youre doing well, then I will just continue watching the PSA.

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