Journal · prostate cancer
Prostate Cancer Treatment: Robotic Surgery vs Radiation vs Focal Therapy
3 ways to treat prostate cancer. Here's what each one trades.
What will I learn about prostate cancer in this article?
3 ways to treat prostate cancer. Here's what each one trades. We will apply this to your own history when you come to our Johns Creek or Cumming office.
A prostate cancer diagnosis usually comes with three options: robotic surgery, radiation and focal therapy. Each one trades something different. I'm Dr.
Neal Patel with Advanced Urology. I did my robotic surgery fellowship at the USC Institute of Urology, and I treat men with all three. Here's how they really compare.
Not every cancer needs treatment right away
First, not every prostate cancer needs treatment right away. Many men with low-risk Gleason 6 cancer are watched closely with PSA tests, MRI and biopsies. That's active surveillance.
Separate from treatment decisions, prostate cancer screening with PSA usually starts at 45, or at 40 or earlier if you're at higher risk. If you need or want treatment, here are your three paths.
Robotic prostatectomy
Robotic prostatectomy removes the entire prostate. Our urologists do it at the hospital or in our outpatient surgery centers. The operation runs roughly 90 minutes to two hours through a handful of small incisions; most men are discharged that day or the following one.
The upside: the cancer comes out, we see the whole prostate under the microscope, and your PSA should drop to almost zero. Radiation is still available later if it's ever needed.
Now the honest part. You'll have a catheter for about a week. Leakage is expected at first, and for most men it resolves in about three months.
Erections take the biggest hit. Even with nerve-sparing surgery, they're weaker afterward, recovering them may take a year or longer, and for many men they never fully return. There's also no ejaculation after surgery.
Treatments help, and we'll plan for them before surgery, not after.
Radiation and brachytherapy
Radiation is another option with a long track record. It's given from outside the body over several weeks, or as brachytherapy, where tiny radioactive seeds are placed in the prostate. Our urologists place brachytherapy seeds in our surgery centers, and most men leave the same day.
Long-term leakage is uncommon. But expect burning and frequent urination lasting weeks, sometimes months. Erections usually hold up at first, then fade for many men over the following years. And surgery after radiation is harder if the cancer ever comes back.
Focal therapy
Focal therapy is the newest path, and in our view, it's where prostate cancer care is heading. Instead of treating the whole prostate, we treat the cancer.
At Advanced Urology, we use Vanquish. If you're considering Vanquish without insurance, call 678-344-8900 and we'll walk you through the next steps. There are no incisions.
Using your MRI and biopsy map, our urologists target the tumor and a margin around it. The remaining prostate, and the nerves for erections and bladder control, are left untouched.
It's an option for many men with Gleason 6 or Gleason 3+4 cancer that shows on MRI. In early studies, urinary and sexual side effects have been uncommon. It can be repeated if needed, and surgery and radiation stay on the table.
The trade-off: the data is early, so long-term results aren't in yet. You'll need follow-up PSA tests, MRI and biopsies, because cancer can appear somewhere else in the prostate. If you've been on surveillance, waiting for a treatment with fewer side effects, this is worth a conversation.
How to choose
So how do you choose? Want the prostate out, and willing to accept the hit to erections? Robotic surgery.
Want to avoid surgery and long-term leakage? Radiation. Gleason 6 or 3+4 on MRI, and want to protect erections and bladder control while keeping every option open?
Ask about Vanquish.
The decision rests on three things: your Gleason grade, your MRI, and your own priorities. Each of these treatments, and any anesthesia it needs, has risks; we'll walk through yours one by one. Our urologists offer all three, so the recommendation fits you. Wait times to see our urologists, and to get a procedure on the calendar, are usually short.
Book through Advanced Urology at 678-344-8900.
