Understanding The Differences Between Surgery and Radiation to Treat Prostate Cancer

5 min read

Understanding The Differences Between Surgery and Radiation to Treat Prostate Cancer

Thanks to an increase in screening, the majority of men receive a prostate cancer diagnosis when the cancer is still at an early stage and hasn’t spread beyond the prostate. Detecting a tumor while it is still small and localized makes it highly treatable, and you can choose from several different treatment options. In these cases, chemotherapy is likely not necessary. 

Many men start with a monitoring-only approach called active surveillance. However, at some point, most men will see a growth in the cancer and need to choose a treatment path. Two common options are surgery and radiation therapy. Both can be very effective treatment methods. However, there are some important differences that may impact your decision. 

What is Active Surveillance? 

Active surveillance is the process of carefully monitoring prostate cancer for any signs of emerging symptoms. Your doctor may suggest active surveillance if you have early-stage prostate cancer or if you are older and have other health conditions that would make it difficult to tolerate the treatments. 

During active surveillance, you will see the doctor every six months for an exam and blood test to see if your PSA levels are increasing. A repeat of the prostate biopsy may be requested to see if the prostate cells have changed significantly compared to the previous biopsy. The results will tell the oncologist if it’s time to start treatment. 

Starting with active surveillance allows you to delay or entirely avoid the side effects of surgery and radiation. It also gives you additional time to consider various treatment approaches. 

Surgery for Prostate Cancer 

A radical prostatectomy is the surgical removal of the prostate gland, along with some of the surrounding tissue. A urologist will typically perform this procedure. The surgery is usually performed laparoscopically, which only requires a few small incisions in the abdomen. In some cases, the surgeon is assisted with a robotic arm. 

Surgery can damage the nerves around the prostate, which could lead to side effects such as urinary incontinence and erectile dysfunction. Men with intact nerves post-surgery may see an improvement in these conditions over time. Talk to your doctor and your partner about possible side effects and what to expect after surgery. There can be other concerns as well, such as shortening of the penis, infection, and blood clots. 

Some patients will require additional treatments after surgery, depending on whether the lymph nodes removed during the procedure show signs of cancer. The most common treatment after surgery is radiation therapy.

Radiation Therapy for Prostate Cancer 

Radiation therapy, or radiotherapy, uses radiation to destroy cancer cells. Prostate cancer can be treated at any stage using this therapy. It can be used as the primary treatment for prostate cancer or in combination with other treatments, such as hormone therapy after surgery, to eliminate any remaining cancer cells in the area. Radiation therapy may also help manage pain in men with advanced prostate cancer by shrinking a tumor that is causing discomfort.

There are two primary types of radiation therapy used for prostate cancer: external beam radiation therapy and internal radiation therapy. 

External Beam Radiation Therapy

External beam radiation therapy (EBRT) directs beams of radiation at the prostate gland from a large machine outside the body. Treatments are typically administered five days a week in an outpatient setting, often at a cancer center. Some men may receive hypofractionated radiation therapy, which delivers radiation in fewer, larger doses, reducing the total treatment time from 6-8 weeks to 3-5 weeks. Intensity-modulated radiation therapy (IMRT) and 3-dimensional conformal radiation therapy (3D-CRT) are two common types of external beam radiation therapy used to target the prostate tumor while minimizing damage to surrounding healthy tissue. 

Side effects of external beam radiation therapy for prostate cancer

There are some side effects of radiation therapy, especially while going through the treatments. Most of the time, these are not long-term or permanent side effects.

  • Due to the proximity of the bowels to the prostate, radiation may cause rectal irritation and diarrhea. 
  • You may experience frequent urination, blood in the urine, or urinary incontinence. This is due to the prostate being located close to the bladder. Your oncologist may take additional steps to further protect your bladder using technologies such as SpaceOAR.
  • Erectile dysfunction can occur and is typically temporary. Talk to your oncologist if you notice that it does not improve on its own after treatment.
  • Fatigue, or feeling very tired even if you haven’t exerted yourself, is common for all patients who receive radiation therapy and improves after treatments are complete.

Prostate Cancer Brachytherapy

Internal radiation therapy, also called brachytherapy, involves placing radioactive material (called seeds) directly into the prostate or near the prostate to kill the cancer cells. This treatment is more common for men with early-stage prostate cancer. In addition, men whose prostate cancer is likely to spread outside past the prostate may receive a combination of brachytherapy and external beam radiation therapy.

  • Low Dose Rate (LDR) Brachytherapy involves permanently placing radioactive seeds in the prostate gland, slowly releasing radiation over the course of several months.

  • High Dose Rate (HDR) Brachytherapy delivers high doses of radiation to the tumor. Unlike low dose rate brachytherapy, HDR brachytherapy is delivered in a few doses, each lasting several minutes. This outpatient procedure leaves no radioactive material in the body. A tube is put in place for a short period of time the radiation is delivered to the prostate and then removed. 

Side Effects of Prostate Brachytherapy

Many of the side effects of brachytherapy are similar to those of external beam radiation therapy, such as bowel issues, urinary problems, and erectile dysfunction.

If your doctor treats you with LDR brachytherapy, you may need to stay away from spending long periods of time with pregnant women and children. This is because the radioactive seeds remain in your body for weeks or months, slowly breaking down on their own. 

Radiopharmaceuticals for Advanced Prostate Cancer

Men diagnosed with advanced or metastatic prostate cancer may be able to take advantage of an emerging treatment called Pluvicto. This drug contains radioactive elements that target prostate-specific membrane antigen (PSMA), a protein that is found in nearly all prostate cancer cells. 

Pluvicto is administered as an intravenous (IV) infusion, which allows it to spread and reach cancer cells throughout the body. The radiation in Pluvicto targets cancerous cells in your body, providing precise doses of radiation directly to the tumor without damaging healthy tissue. As the cancer cells absorb the radiation, they are destroyed. This drug may be used in combination with other prostate cancer treatments, such as hormone therapy or chemotherapy. 

Deciding Which Treatment is Right for Your Prostate Cancer

Because every patient with prostate cancer is unique, the plan can be different for each person. Your doctor will consider the stage and the grade of cancer (Gleason score) in addition to your age, overall health status, and personal preferences.

It’s always a good idea to meet with both the urologist and an oncologist to review your options and likely side effects from each treatment. Research shows that both surgery and radiation therapy are reliable treatment options, although they are not the only ones. Your oncologist may provide additional information about what they recommend to help make your decision. With access to the treatment information, you and your partner can discuss which decision is best for you. 

Prostate Cancer Treatment Available in the Albany Area

The New York Oncology Hematology cancer centers are ready to help patients with a prostate cancer diagnosis. Our oncologists will discuss your options and create a personalized treatment plan to meet your needs. We will also work with your urologist to develop the plan. 

Request an appointment with one of our prostate cancer specialists throughout the Capital District, including Albany, Troy, Amsterdam, Clifton Park, and Hudson, New York.