Up to Stage 2, when the cancer is contained within the Prostate Gland, Prostate Cancer can be dealt with by removal of the Prostate Gland using Surgery. This is called a Prostatectomy. If the cancer has moved to Stage 3, or even Stage 4, Surgery can still be used to remove the Prostate Gland, but also removing some surrounding tissue and the Seminal Vesicles. This is called a Radical Prostatectomy. However, Surgery becomes more risky once the cancer has spread beyond the Prostate Gland.
There are various techniques by which a Prostatectomy is performed, some of which are performed entirely by the surgeon and others which involve robotic assistance.
In the late 20th century, and right into the early years of the 21st century, Surgery tended to be the treatment of choice for prostate cancer. At these times, Radiotherapy was emerging from its infancy and was not performing as well as Surgery in terms of long term survival, coupled with some troublesome side effects. But this has gradually changed in recent years, firstly to a point where Radiotherapy was the equal of Surgery in terms of survival, but now, in addition to showing good long term survival, Radiotherapy offers a higher quality of life, than does surgery. Radiotherapy now commands “millimetre accuracy” using modern high technology Linear Accelerators.
Thus surgery now tends to have more significant side effects than does Radiotherapy – especially the relatively high risk of incontinence, plus a worse outcome for sexual function.
So today, Radiotherapy is now the preferred mode of treatment.
It is worth noting that if Prostate Cancer recurs locally after a Prostatectomy, then Radiotherapy can be used to treat this recurrence. But if a patient elects to have Radiotherapy initially he does not have a choice of either Radiotherapy or Surgery if the cancer recurs. In the past this led to many men deciding to have surgery first. This is no longer a problem. Various Focal Ablation treatment procedures can be used to safely deal with any recurrence within the Prostate Gland. The improvements in treatment are now providing many more choices for the patient during the Prostate Cancer journey, and surgery is now just one of the treatment options.
Dr Mark Scholz, of the Prostate Cancer Research Institute in Los Angeles discusses this in the video which follows.