Prostate Cancer Treatment – Top Three Questions Answered
Robotic prostatectomy surgery has significant sex and recovery benefits over radiation, according to Dr. David Samadi New York, NY – Prostate cancer diagnoses may bring out the fight in men but patients need to know which punch to throw first. When diagnosed early, prostate cancer is highly treatable and patients most often choose between robotic prostate removal surgery or radiation for prostate cancer, including external beam radiation therapy (ERBT) and brachytherapy seed radiation.
Three concerns drive the prostate cancer treatment decision for most men: sex after prostate cancer, cure rates, and the likelihood of prostate cancer recurrence, according to Dr. David Samadi, a prostate cancer expert who is Vice Chairman, Department of Urology, and Chief of Robotics and Minimally Invasive Surgery at The Mount Sinai Medical Center; Vice Chairman, Department of Urology; and Chief of Robotics and Minimally Invasive Surgery at The Mount Sinai Medical Center.
“Surgery has significant benefits over radiation for sex and recovery,” says Dr. Samadi, one of the few New York prostate surgeons qualified to robotically remove cancerous prostates with the da Vinci Surgical System. He is one of even fewer robotic surgeons to have performed successful salvage prostatectomy surgery in the case of recurrence after radiation. However, he says, “a salvage procedure is far from ideal. Leading with radiation severely limits secondary treatment success.”
The prostate cancer treatment questions most frequently posed to Dr. Samadi:
1) Will I have sex after prostate cancer?
Erectile dysfunction (ED) after prostate cancer is a top concern. Dr. Samadi's unique bilateral nerve sparing robotic prostatectomy—the Samadi Modified Advanced Robotic Technique (SMART)—yields highly successful sexual and urinary results. “For the majority of my patients, the answer is yes: there is enjoyable sex after robotic prostatectomy,” Dr. Samadi assures his patients. “Preserving quality of life was the impetus for SMART surgery.” Eighty-five percent of men in Dr. Samadi’s care resume sexual function in 12 months or more with continual improvement.
In contrast, ED after radiation can be less favorable and may worsen over time, according to Dr. Samadi. A brachytherapy study published in The Journal of Urology in 2001 found 79 percent of men were sexually potent three years after treatment, but only 59 percent remained so six years after treatment (see http://www.jurology.com/article/S0022-5347(05)66717-1/abstract).
Patients who had brachytherapy or prostatectomy had lower long-term toxicities and treatment-related costs than EBRT, according to an analysis released by the Cleveland Clinic in 2012 (see http://my.clevelandclinic.org/media_relations/library/2012/2011-01-31-cleveland-clinic-analysis-provides-first-comparative-long-term-look-at-least-toxic-prostate-cancer-treatments.aspx).
2) Which prostate cancer treatment yields the best recovery: robotic prostatectomy or radiation?
Both options can yield positive recovery results, depending on the patient's unique condition. Robotic prostatectomy surgery is the only treatment that completely removes the cancerous prostate and ultimately provides the lifelong assurance of a zero PSA (prostate-specific antigen), according to Dr. Samadi.
A Memorial Sloan Kettering study published in The Journal of Clinical Oncology in 2010 (see http://jco.ascopubs.org/content/28/9/1508.abstract?sid=b6d8c0cd-b1fc-4dfb-a3e0-1bd70cac6a3d ) found the risk of metastasis after radical robotic prostatectomy surgery to be 65 percent lower than after EBRT at a five-year median follow-up. “Men may judge successful prostate cancer treatment by their ability to have sex, but certainly survival trumps. Robotic surgery improves those odds significantly, according to this study,” adds Dr. Samadi.
3) What happens if my prostate cancer comes back?
Dr. Samadi suggests patients consider what Plan B would look like if they were to experience prostate cancer recurrence. “I recommend men reserve radiation as a secondary treatment,” he says. “Prostate removal is next to impossible after radiation. Extensive scar tissue caused by radiation can prohibit access to the prostate. In the rare case when removal is possible, multiple surgeries are needed.”
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