I Want My Prostate Out!

BY MARK SCHOLZ, MD & LIZ GRAVES

For many men, surgery seems like the best option: “A quick operation and the problem will be gone.” While this thinking may apply to other aspects of life, such as removing the brown parts of a banana before you eat it, or trimming the dead leaves off the plants in your garden, it doesn’t work with prostate cancer.    

Prostate cancer, like all cancers, is dangerous when it spreads.  You may have been told that your cancer is confined to the prostate.  So you are probably thinking “I should stop wasting my time and get on with surgery!”   But there’s one big problem…a cancer’s confinement can only be assumed. 

Have you heard of microscopic metastases?  Microscopic metastases, or micromets, are invisible on imaging scans and undetectable by biopsy.  They are just as dangerous as visible metastases because they can grow and spread.  This is why staging is so crucial.  Prostate cancer staging provides the most accurate way to predict if micromets are present.  The presence or absence of micromets dictates how aggressively the cancer is treated.  To find your stage and stage-specific information take the quiz on keytopc.com

Patients forget that surgeons can’t target or remove anything they cannot visibly see.  Not only does surgery fail to cure micromets; it also fails to eradicate all the cancer in the gland.  The rate of positive margins (cancer that is left behind after surgery) ranges from 10%-50% depending on the cancer’s stage.  The problem with surgery is that prostate is located close to many fragile body systems.  Urologists are unable to cut a large margin around the gland (like they do with other types of cancer).  This is why radiation is frequently needed after surgery. 

Micromets commonly spread to the pelvic nodes, which surgeons talk about removing during surgery.  Yet, even the most aggressive surgeons typically only remove about twenty of the one-hundred plus nodes in the pelvis.  Unlike surgery, the combination of radiation and hormonal therapy doesn’t discriminate between visible and micro metastases.  Meaning the cancer in the prostate gland as well as all of the lymph nodes has a better chance at being eradicated.

If a radical prostatectomy was a simple operation, like an appendectomy for example, initial surgery followed by subsequent radiation to ‘mop up’ might be reasonable.   The problem is that an operation on the prostate is more like brain surgery—too few men emerge totally unscathed.  They end up with irreversible incontinence and impotence while requiring salvage radiation to mop up what the surgery left behind.

 Five Facts to Consider Before Choosing Surgery:

1. When micromets are present, doing surgery is like closing the barn door after the horse has left.
2. When surgery fails, men have to endure two treatments instead of one (surgery plus radiation)
3. Hormonal therapy plus radiation clearly offers higher cure rates with fewer side effects.
4. The likelihood of micromets can be predicted with accurate staging. Take the staging quiz at keytopc.com to learn your substage and treatment options.
5. Side effects from surgery are irreversible. Keep your prostate until you have explored all options.