Radiation Treatment or Surgery for Patients with Prostate Cancer?

Choice between radiation treatment or surgery is discussed.

Radiation Treatment or SurgeryProstate cancer patients must choose between radiation treatment or surgery. In addition to radiation treatment or surgery, active surveillance may also be considered. When speaking with a specialist, the desired outcome of radiation treatment or surgery must be outlined very clearly. Three markers are used in determining a successful route of radiation treatment or surgery: curing patients, continence ,and the ability to maintain use of the bladder and sexual functions.

Each patient has a different set of circumstances to consider in radiation treatment or surgery. A decision should only be made after a discussion with the appropriate physician, the patient, and his family. There are many factors involved in considering radiation treatment or surgery. The spread of the cancer is one of them and while there are many tools, no one method can detect spread with complete accuracy.


David Albala, M.D.:  Clearly, when one sits down after making the diagnosis of prostate cancer, the goal of the discussion with the physician is to outline the different treatment modalities that are available.  Clearly, active surveillance is one modality that can be used for treating patients with prostate cancer.  Radiation therapy is another modality and then surgical intervention is a third modality.

When one sits down typically with a physician, whether it’s a radiation oncologist to talk about radiation or a surgeon to talk about surgical intervention, the goals and objectives of the treatment need to be outlined very clearly.  When one looks at outcomes, we look at curing patients with their prostate cancer; we look at continence as an outcome measure and are they able to hold their urine and potency.

Those are the three markers that we look at typically in patients that undergo prostate cancer surgery and indeed all of these three markers play or outcomes play an extremely sensitive role in making a final decision.  When you look at the outcomes with surgical intervention versus radiation, in most cases, surgical intervention will have better outcomes, but only in some cases slightly better outcomes.  You know couple percentage points difference and the average patient would not see much of a difference.

Clearly, if you are younger patient and you have got moderately aggressive disease, you want to be more aggressive in your treatment modality and one might choose surgery rather than radiation.  On a flip side, if you have an older patient that has much more advanced disease, one might choose radiation because the chance of curing the patient may be significantly less.  I like to tell patients to think of the prostate as an orange.  When one develops cancer and the juice you bite into the orange, the treatment has to be directed at not only the juice you bite into the orange, but also the orange peel and surgical intervention does address that.  The question is does the disease extend outside that orange peel.  Now, we do not have any blood test, we do not have terrific x-ray tests that can tell us whether microscopic disease is outside.  We now are using MRI testing, magnetic resonance imaging to try to give us an understanding of the diseases outside the prostate itself, the capsule of the prostate, but this is the decision whether one chooses radiation or surgical intervention, it is made after a discussion with the appropriate physician and the patient and his family.

Dr. David Albala
Dr. David M. Albala is Chief of Urology at Crouse Hospital in Syracuse, New York and Medical Director for Associated Medical Professionals. He is considered a national and international authority in laparoscopic and robotic urological surgery and has been an active teacher in this area for over 20 years.


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