Radiation Therapy as Effective as Surgery for Prostate Cancer

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The disease can be cause for serious concern, but for most men, it will not prove fatal. In fact, not all prostate cancers even need treatment. Deciding how to move forward requires a thorough understanding of the options best suited to each patient’s particular situation.

For patients with less aggressive prostate cancer, active surveillance—keeping a watchful eye on a tumor’s growth and spread—may be the right approach. Those with more aggressive forms of the disease may opt for more immediate intervention.

“Men who are considering treatment should definitely meet with a urologist and a radiation oncologist. Many people don’t realize that, when evaluating surgery versus radiation for prostate cancer, both are equally effective at curing the disease,” said Benjamin King, MD, a radiation oncologist at Cedars-Sinai.

Precision Treatment, Preferred Timing

Advances in radiation therapy have made it an attractive alternative to surgery. Whereas the standard course of radiation treatment for prostate cancer used to be seven to nine weeks, today it is only five and a half. In some cases, the course can be shortened even further, to just five treatments over a two-week period.

The short course, known as stereotactic body radiation therapy (SBRT), can be especially convenient for younger patients focused on limiting time away from work and mitigating other logistical concerns.

“Outcomes from SBRT are equivalent to those from the standard course, so it’s a good option for the right candidate,” King said. “However, patients with significant baseline urinary symptoms may experience more side effects with SBRT. In those cases, or if the prostate gland is too large, they would typically be better treated by the longer course.”

Kingnoted that many patients have preconceived notions about radiation andassociate it with what they’ve read in the news about nuclear power disastersor the atomic bomb. The reality is far different. 

 “Radiotherapy for prostate cancer is precisely targeted, and we continue to refine its accuracy,” he said. “For instance, we are now able to use MRIs in our radiation planning, giving us a clearer look inside the prostate and allowing us to direct radiation more precisely to the tumor while better protecting surrounding healthy tissue.”

Doctors can also inject a hydrogel spacer between the prostate and the rectum prior to treatment, separating the two to minimize the rectum’s radiation exposure and decrease rectal side effects. The short, in-office procedure takes about 30minutes, and the spacer dissolves on its own within six months.

“Sparing a dose to the rectum is particularly important for the short-course treatment, where higher doses of radiation per treatment are used,” King said.

A Targeted Surgical Technique

Patients electing prostate cancer surgery are also benefitting from significant leaps forward in technology and techniques. Focal therapy, an application of high-frequency ultrasound ablation (HIFU), enables surgeons to pinpoint treatment so it only reaches the area of the prostate with the most aggressive tumor while leaving the rest of it untouched.

“Imagine that childhood experiment where you’re using a magnifying glass to compress the sun’s rays and burn a leaf—focal therapy works on a similar principle. By focusing ultrasound waves on the prostate, we heat up the tumor and ‘burn,’ orkill, it, without affecting the surrounding structures,” said Timothy Daskivich, MD, director of Academic Urologic Oncology and associate professor of Urology.

The Question of Sexual Function

Any treatment for prostate cancer—whether it involves surgery or radiation therapy—will have some downtime and side effects to consider. One common concern shared by many men is impact on sexual health.

“The rate of erectile dysfunction related to surgery and radiation is about the same,” King said. “The nerves and blood vessels involved in erectile function pass behind the prostate, and either treatment may injure them. However, formany patients, erectile function returns or can be successfully treated.”

Universal Prescriptions for Prostate Patient Health

Patients contemplating whether to pursue prostate cancer surgery, radiation or to stick with active surveillance have another new weapon in their arsenal, as well.

“For some patients, we can use specialized genetic tests on the biopsy tissue to learn more about how aggressive their cancer might be,” King said. “These tests, combined with standard biopsy results, can sometimes help us make bettertreatment decisions, particularly when it’s not clear whether activesurveillance or treatment is the best choice.”

No matter which direction someone chooses to go, doctors point to meaningful steps every prostate cancer patient can take to maximize their success in treating the disease.

“While surgery and radiation are both good options for patients who need the whole prostate treated, regardless of treatment, we encourage all of our patients to eat a healthy diet, exercise regularly and avoid smoking,” said Stephen Freedland, MD, director of the Center for Integrated Research in Cancer Lifestyle and the Warschaw, Robertson, Law Families Chair in Prostate Cancer. “Indeed, Cedars-Sinai Cancer has a strong interest in lifestyle and prostate cancer, with multiple trials ongoing across various stages of prostate cancer.”

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