Episode 086: Prostate Cancer Series: Pt. 3- Surgical Approaches to Prostate Cancer
Dec 21, 2023
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Dr. Sanjay Patel, a urologic oncologist, joins the hosts to discuss prostate cancer management. They cover topics such as determining biopsy candidacy, the role of MRI in diagnosis, steps involved in a biopsy, and when additional imaging is needed. They also explore surgical approaches, when pelvic lymph node dissection is recommended, and active surveillance. The podcast provides valuable insights into the management of localized prostate cancer.
Active surveillance is recommended for low risk or favorable intermediate risk prostate cancer patients, involving close monitoring and regular biopsies.
For high risk or very high risk localized prostate cancer, radiation therapy with hormonal therapy may be recommended, and additional treatments like abiraterone, prednisone, and radiation therapy might be considered.
The choice between surgical intervention (prostatectomy) and radiation therapy depends on factors such as age, comorbidities, quality of life preferences, and the presence of high-risk disease features, with patient preference and shared decision-making being essential.
Deep dives
Active Surveillance for Low-Intermediate Risk Prostate Cancer
Active surveillance is recommended for patients with low risk or favorable intermediate risk prostate cancer. It involves close monitoring every 3-6 months with PSA tests and digital rectal exams. Confirmatory biopsies are done within 6-12 months. MRI scans may be done every 3 years to assess prostate health. The frequency of biopsies and follow-up varies depending on each patient's individual situation and preferences.
Treatment Options for High Risk and Very High Risk Prostate Cancer
Patients with high risk prostate cancer are often recommended to receive radiation therapy with 18 months to 3 years of hormonal therapy. In cases of very high risk disease, additional abiraterone, prednisone, and radiation therapy may be considered. Surgical removal of the prostate may be an option for certain younger patients with high risk features, but patient selection is crucial to avoid leaving tumor behind or causing complications. Imaging studies, such as PSA PET scans, can help guide treatment decisions.
Considerations for Surgical Intervention
Surgical intervention, such as a prostatectomy, may be preferred for patients who are good surgical candidates and are likely to tolerate the procedure well. Factors such as bladder and urinary symptoms, risk of incontinence, and erectile dysfunction should be carefully considered. The presence of positive lymph nodes may influence the decision, but individualized approaches are necessary.
Risks and Benefits of Treatment Options
The choice between surgery and radiation therapy depends on various factors, including the patient's age, comorbidities, quality of life preferences, and presence of high-risk disease features. Surgery has the advantage of providing undetectable PSA levels and potential for complete removal of the prostate. However, complications such as urinary incontinence and erectile dysfunction may occur. Radiation therapy offers a less invasive option, but can cause urinary symptoms and long-term erectile dysfunction. Patient preference and shared decision-making are essential.
Emphasizing Quality of Life
Quality of life is a crucial consideration when choosing between treatments for prostate cancer. Factors such as urinary incontinence and erectile dysfunction can significantly impact a patient's well-being. These potential side effects must be thoroughly discussed with patients to ensure they are well-informed and comfortable with their treatment choice.
In our next episode, we are joined by Dr. Sanjay Patel, a urologic oncologist from the Stephenson Cancer Center at the University of Oklahoma, who also happens to be Vivek’s older brother! We discuss the management of prostate cancer from the perspective of our urology colleagues. As medical oncologists, these are conversations and decisions that we are almost never a part of, as they are being had often before patients ever see us. It was so helpful to get to hear how Dr. Patel thinks about his patients!
Content:
- What considerations go into determining if a patient is a good candidate for a prostate biopsy?
-What is the role of an MRI in the workup?
-What are the steps involved in a biopsy?
-When is additional imaging (such as PSMA PET) needed?
-How does he decide surgery vs. radiation referral in unfavorable intermediate risk patients?
-When is pelvic lymph node dissection recommended?
-What does active surveillance entail?
-What about management of high risk and very high risk localized prostate cancer?
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