|“I’m talking about comparing the results from the best surgeons with the results from the best radiation therapists. And when you make that comparison, these results from surgery are far inferior to what modern radiation therapists can accomplish.”- Mark Scholz, MD|
For the past 100 years, prostate cancer treatment has been dominated by the urologist. In most cases, the urologist is the one who performs the biopsy and diagnosis the patient with prostate cancer. For a lot of men, the urologist’s opinion is the only one they will hear throughout their prostate cancer journey.
Because urologists are trained as surgeons, they tend to recommend surgery as a one-size-fits-all treatment option for prostate cancer. The urologist’s recommendation lines up with what the media has propagated for decades– that surgery saves lives, that it’s the gold standard of treatment. While this may have been true 20 years ago, it is not the case today. With improvements in technology, cure rates with modern radiation have surpassed those of surgery. Radiation also comes with the added benefit of lower side effect rates.
So if this is true, why are men still getting radical prostatectomies? One reason has to do with the excitement over the new robotic surgery. Robotic surgery boasts of a more precise procedure, smaller incisions, and a shorter hospital stay. Patients and urologists alike get swept away by the allure of a ‘cutting-edge’ new technology. Unfortunately, studies have shown that there is no difference in cure rates or rates of side effects between radical prostatectomy with the da Vinci robot and radical prostatectomy performed without the da Vinci robot.
The idea that the radical prostatectomy is a one-and-done procedure is simply not true. A successful surgery is defined by what surgeons call the “treatment trifecta.” The trifecta consists of cure, no urinary leakage, no damage to sexual function. For a 60-65 year old the chances of having a successful surgery as defined by the treatment trifecta is only 30%-35%. To ensure that surgery was successful, men will need to follow up with monitoring for years after the surgery.
Also, the prostate is located in very close proximity to the bladder and rectum, which prevents surgeons from being able to cut a wide margin around the prostate. This means the surgeon may be at risk of leaving behind cancer. While to the visual eye, it may appear all the cancer has been removed, micrometastases may still be present. Micrometastases are microscopic cancer cells that can be present outside of the prostate capsule. Micromets are very dangerous because just like visible mets, micromets are able to grow and spread. The chance that cancer is left behind after surgery is called a “positive margin.” Prior to the surgical operation there is always a level of uncertainty about the extent of the spread. If the argument for surgery is that you are going to have all the cancer removed, consider that this may not be not the reality. There is a large change a secondary treatment will be necessary to target the cancer that the surgery missed. Why put yourself on the operating table if a radical prostatectomy may not remove all the cancer and may leave you with lifelong, irreversible side effects?
Surgery is no longer the gold standard of care. By seeking opinions from medical professionals with different backgrounds and empowering themselves with stage specific knowledge men are on track to successfully navigate the biased prostate cancer industry and find a treatment personalized to them.
The Robots Have Landed by Ralph Blum: http://prostatesnatchers.blogspot.com/2011/08/robots-have-landed.html
Prostate Cancer Staging Quiz: keytopc.com
Register for the PCRI Patient Conference: https://pcri.org/2019-conference
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