From the Guidelines
Radiotherapy is preferred over surgical removal of the prostate for patients with prostate cancer due to its ability to deliver high doses of radiation safely, reducing the risk of acute and chronic toxicities, and improving biochemical outcomes, as seen in the study by Kuban et al. 1. When considering treatment options for prostate cancer, it's essential to weigh the benefits and risks of each approach. Radiotherapy has evolved significantly, with techniques like 3-dimensional conformal radiation therapy (3D-CRT) and intensity-modulated radiation therapy (IMRT) allowing for higher doses to be administered with lower risk of late effects. Some key advantages of radiotherapy include:
- Avoiding complications associated with surgery, such as bleeding and transfusion-related effects, and risks associated with anesthesia, such as myocardial infarction and pulmonary embolus 1
- Low risk for urinary incontinence and stricture, and a good chance of short-term preservation of erectile function 1
- Ability to deliver high doses of radiation safely, reducing the risk of acute and chronic toxicities, and improving biochemical outcomes, as seen in the study by Kuban et al. 1 However, radiotherapy also has some disadvantages, including:
- A treatment course of 8 to 9 weeks, with up to 50% of patients experiencing temporary bladder or bowel symptoms during treatment 1
- A low but definite risk for protracted rectal symptoms from radiation proctitis, and an increased risk for erectile dysfunction over time 1 Ultimately, the choice between radiotherapy and surgery should be individualized based on cancer characteristics, patient age, health status, and personal preferences regarding side effects and quality of life. Radiotherapy is a viable option for patients with prostate cancer, particularly those with locally advanced disease or those who are not good surgical candidates, as it offers a non-invasive treatment option with a lower risk of immediate complications compared to surgery 1.
From the Research
Treatment Options for Prostate Cancer
- Radiotherapy and surgery are the main local therapeutic strategies for localized and locally advanced prostate cancer 2.
- The choice of treatment depends on the risk of disease recurrence, which can be stratified into low-, intermediate-, and high-risk groups 2, 3, 4.
- For low-risk patients, active surveillance is an option, while brachytherapy can be used for low- and intermediate-risk patients 2, 4.
- For intermediate- and high-risk patients, radical prostatectomy and radiotherapy should be considered, with concomitant androgen deprivation therapy possibly needed 2.
Comparison of Treatment Outcomes
- Radical prostatectomy and external beam radiation therapy have similar effectiveness for high-risk prostate cancer, but different adverse effect profiles 4.
- Patients who undergo radical prostatectomy are more likely to experience urinary incontinence and erectile dysfunction compared to those who opt for radiation therapy 4.
- A cohort study found that prostate cancer-specific mortality was lower after local therapy for those with higher-risk disease, particularly after radical prostatectomy 5.
Patient Preferences and Decision-Making
- A decision aid can help patients choose between active surveillance, radical prostatectomy, and radiotherapy, with most patients choosing treatment in accordance with their post-decision aid preference 6.
- Patient preferences, such as postponing unnecessary treatment or valuing tumor removal, play a significant role in treatment decision-making 6.
- Urologists' treatment preferences also influence patients' final treatment decisions, although to a lesser extent than patient preferences 6.