PROSTATE CANCER: RADICAL PROSTATECTOMY IS NOT A GOOD OPTION FOR . . .
Radical prostatectomy is not helpful for men with disease that has spread widely beyond the prostate. Nor is it ideal for older patients (men who are not likely to live longer than 10 years).
Once prostate cancer escapes the wall of the prostate to the point where it widely invades the seminal vesicles, pelvic lymph nodes or bone, it can no longer be cured. Surgery in these men, with its side effects, including the risk of incontinence and impotence, not only fails to cure, it is an unnecessary ordeal. The principal goal here is to control the tumor locally; this can be done with radiation, hormone therapy, or a combination of both. Ultimately, these men need palliative care—treatment that will lengthen their lives and ease their pain. With late-stage cancer, the goal is simply to do everything possible to fight the cancer and buy more time. The focus changes to ensuring good quality of life, rather than a cancer-free life. The main line of treatment for late-stage prostate cancer is hormone therapy and, later, chemotherapy and spot radiation to treat painful metastases.
Why is age a factor? Several reasons. One is that men in their seventies often have more advanced cancer than the clinical findings might lead a doctor to suspect. As men age, the prostate enlarges from BPH—so by the time a doctor can feel a cancerous lump in these men with their larger prostates, it’s probably bigger than the cancer that can be felt in a younger man with a smaller prostate. Studies have shown that for men with Tab (B1) disease, the likelihood that the cancer is confined to the prostate is less for men in their seventies than for men in their fifties.
Also, older men are more likely to suffer side effects from surgery; they don’t do as well as younger men in recovering continence and sexual function. And finally, because men over age 70 aren’t likely to live as long as men twenty years younger, it’s difficult to show that radical prostatectomy actually does more than radiation therapy to lengthen life in these men.
Radiation Is a Better Option For . . .
The ideal candidates for radiation treatment are patients who are older, or who are less likely to be cured by surgery.
Men who undergo radiation treatment are said to be “negatively selected” —that is, they get radiation therapy because radical prostatectomy has been ruled out as the best option for them. They are generally older men; men in poor health who aren’t considered strong enough for surgery; or men who have disease that has extended beyond the prostate to the point where it can’t be removed surgically (stage T3 or T4, or C).
However, others who opt for radiation treatment are men with organ-confined disease who just don’t want to have surgery.
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