For Prostate Cancer, Radiation Complications May Outweigh Risks (Op-Ed)

Dr. David Samadi, Lenox Hill Hospital in New York City
February 1, 2014

Dr. David Samadi is the chairman of urology and chief of robotic surgery at Lenox Hill Hospital in New York City and is a board-certified urologist and oncologist specializing in the diagnosis and treatment of urologic diseases, kidney cancer, bladder cancer and prostate cancer. Samadi also specializes in many advanced, minimally invasive treatments for prostate cancer; is one of the few urologic surgeons in the United States trained in oncology, open-, laparoscopic- and robotic-surgery; and was the first surgeon in the nation to successfully perform a robotic surgery redo. He contributed this article to LiveScience's Expert Voices: Op-Ed & Insights.

Radiation for prostate cancer has shown once again that it leads to more complications than surgery. For men with prostate cancer, deciding whether to opt for radiation or surgical removal of the gland can be overwhelming. How does one decide with the risks, such as the unpleasant side-effects of erectile dysfunction and incontinence?

Prostate cancer is the second most common malignancy, second only to skin cancer. Unfortunately, doctors diagnose more than 240,000 men in the United States with the disease every year, which translates into 1 in every 6 men being affected by prostate cancer. A new study published last Thursday in the Lancet Oncology Journal found that "men treated with radiotherapy had fewer minimally invasive urological procedures compared to those who chose surgery." However, over time, "the radiation group had a higher proportion of hospital admissions, rectal or anal procedures, related surgeries and secondary cancers."

Men need to take the time to do their research on how "radiation" really works and what side effects they will have to live with. There are two kinds of radiation, external beam and brachytherapy, which involves radioactive material inside the prostate. We as men have all the control in the world to decide what form of treatment is best for us. Do you just want a quick fix that will sometimes show you upfront results from radiation, but will cause you to suffer from side effects in the long run or would you rather choose robotic prostatectomy with minimal bleeding, 95 percent to 97 percent continence rate, and an overall better quality of life? Put aside the temporary leakage and erectile dysfunction that you may receive from robotic prostatectomy, because a year from your surgery those minimal side effects will dissipate.

The questions I suggest my patients ask themselves are:

  • Do you want to be admitted to the hospital more frequently?
  • Do you want to likely bleed from your bladder or rectum?
  • Do you want to risk a second cancer?

This can be the reality for patients who undergo radiation treatments and how it can decrease your confidence and overall quality of life. In the recent study, radiotherapy complication rates were 2- to 10-times higher than complication rates in men who were treated with robotic prostatectomy. Choosing surgery after radiation makes the surgery more complicated. Radiation destroys the surrounding healthy tissue causing the prostate to be embedded in scar tissue. This makes the surgery more complex than operating on tissue that has not been affected by radiation.

Once the prostate is removed, surgeons like myself monitor the prostate-specific antigen (PSA) levels to ensure that the cancer doesn't come back. If radiotherapy is performed prior to the surgery, the PSA will fluctuate due to radiotherapy and pieces of the prostate that are left behind, confusing that monitoring process.

Following a prostate cancer diagnosis, men are flooded with tons of informationand must try to make sense of the different treatment options — it can make even the most educated patient uncertain. [Prostate Cancer Screening Test May Prevent 17,000 Advanced Cases Yearly]

Do your homework and really look at the outcomes one month to one year to a lifetime from now and ask yourself: "Will I be happy with these results?" As the numbers point to robotic prostatectomy, the decision lies in your hands.

The views expressed are those of the author and do not necessarily reflect the views of the publisher. This version of the article was originally published on LiveScience.

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