PCRI’s Executive Director, Mark Scholz, MD, explains why there has been a surgery vs. radiation controversy, describes the pertinent risks and considerations when deciding between the two treatments, and explains why he thinks radiation is usually going to be the preferable option, all things considered.

0:43 The main reason why there is a controversy about whether surgery or radiation is better for treating prostate cancer is that as recently as 1015 years ago the technology for radiation was significantly less effective and more toxic than it is today. There were also fewer options for salvage therapy after radiation in the event of a relapse. Since then, radiation technology has advanced significantly, but the dialogue has been comparatively mired. Today, radiation can be precisely delivered, and radiation is achieving even better cure rates than surgery.

1:59 Surgeons are constrained by the fact that the bladder and the rectum are within millimeters of the prostate. They cannot cut a margin around the gland. Radiation oncologists are not limited in this way.

2:21 External beam radiation has a cure rate about as good as surgery, and radioactive seed implants have even better cure rates than surgery.

2:33 Most men will live for a very long time after being treated for prostate cancer, and so it is important to consider the side effects of each treatment, especially now that they all have comparable cure rates.

2:54 There is a risk of sexual dysfunction with both surgery and radiation, however, the rate of impotence after surgery is significantly higher than after radiation.

3:15 There is a risk of incontinence with surgery that is almost nonexistent with radiation. An operation performed by a top surgeon on an ideal candidate has about a 510% risk of causing incontinence, and that is with the best possible conditions. Stress incontinence occurs in around 50% of men, and ejaculation of urine occurs in about 20% of men.

4:00 Rectum burns used to be a concerning side effect of radiation, but that risk has been eliminated with the advent of SpaceOAR, a gel that separates the prostate from the rectum and protects it from radiation.

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