The decision about which treatments to use for prostate cancer at high risk for relapse depends on many factors, including technical issues, such as whether it is safe for the man to undergo an operation and whether the prostate is the appropriate size and in the appropriate position for radiation therapy. Other considerations include whether the man has many urinary tract symptoms, which may get worse with some types of radiation treatment.
No randomized studies have compared surgery to radiation in men with intermediate- or high-risk prostate cancer, so there is no clear answer about which approach is more likely to cure the disease. The best way to estimate the likelihood of side effects and design an optimal treatment approach is to get input from an experienced team of leading prostate cancer specialists who know the outcomes and quality of life issues associated with each treatment.
Surgery for High-Risk Prostate Cancer
Prostatectomy (surgery to remove the prostate) provides the potential for cure by attempting to remove all obvious evidence of cancer in the prostate and surrounding tissue and lymph nodes. An important but evolving area of study is whether extended lymph-node dissection (more extensive removal of lymph nodes outside of the standard dissection area) will improve the staging and curing of prostate cancer. Urologists at Seattle Cancer Care Alliance routinely perform this dissection for patients with high-risk prostate cancer.
Radiation Therapy for High-Risk Prostate Cancer
Radiation therapy provides the potential for cure by exposing prostate cancer to high doses of radiation. Radiation may be used to treat the prostate, surrounding tissue, and lymph nodes within the pelvis. It has been the most commonly used approach in men with high-risk prostate cancer, in part because of a concern that surgery may not be able to remove all the cancer in the prostate in some men. In many cases, hormone therapy is used with radiation therapy because this combination has been shown to be helpful in treating men who are at high risk for relapse.
Combination Surgery and Radiation Therapy for High-Risk Prostate Cancer
Another approach to high-risk prostate cancer is to treat men with surgery first and to add radiation therapy after surgery. In this case, the radiation is intended to kill any cells in the area that might have been left behind after the prostate was removed. Studies conflict on whether radiation should be given immediately after surgery (adjuvant radiation therapy) or when PSA starts to rise.