Radiation or Surgery? In Early-Stage Prostate Cancer, the Patient Decides

(PhysOrg.com) -- For men with early stage prostate cancer, the "right" treatment approach often boils down to a patient's personal choice, not a one-size-fits-all medical approach.

Oncologists will give advice based on the particular patient’s situation, but the ultimate decision on treatment approach resides with the patient based on what he feels most comfortable pursuing, says UC Health radiation oncologist William Barrett, MD.

"Patients react very differently to a cancer diagnosis. Some have an urgent desire to remove the cancer as soon as possible, others are fearful of potential side effects from surgery like impotence or incontinence and gravitate toward a less invasive treatment,” explains Barrett chair of radiation oncology for the UC College of Medicine and a radiation oncologist with UC Health Barrett Cancer Institute.

Early stage prostate cancer can be managed several ways, including watchful waiting/observation, surgery, external radiation therapy or implantable radiation "seed” therapy. Most men with localized prostate cancer choose surgery, external radiation or radiation seed therapy, according to Barrett.

In the latter, radiation oncologists implant tiny radiation "seeds” (known as brachytherapy) directly into the prostate to gradually deliver targeted radiation to the tumor from inside the body. The procedure is done in an outpatient setting under anesthesia. With prostate cancer surgery (known as radical prostatectomy), urologists frequently use robot-assisted techniques to remove the entire prostate gland and a margin of surrounding tissue.

Barrett says radiation seed therapy and surgery have comparable effectiveness in patients with localized prostate cancer. Direct outcome comparisons for the two therapies, however, are difficult to make.

"We measure prostate cancer recurrence through PSA (prostate specific antigen), but the PSA patterns differ following the different treatment modalities. There are also varied definitions of success and failure,” he explains.

Barrett’s team recently published clinical data supporting radiation seed therapy as an effective way of obtaining biochemical control of localized prostate cancer, as compared with surgery. His team analyzed the three-year follow-up PSA data of 163 patients who underwent radiation seed therapy between 1996 and 2003 at the UC Health Barrett Cancer Institute. Their results were published in the April 2010 issue of UroToday International Journal.

According to the American Cancer Society, more than 219,000 men are diagnosed with prostate cancer each year—75 percent of which are diagnosed with disease that has not spread beyond the prostate gland. It is the second most commonly diagnosed cancer in the United States.

Provided by University of Cincinnati