Prostate cancer surgery and radiotherapy affect urinary function and sexual function differently. How to choose the right prostate cancer therapy method? Dr. Anton Titov, MD. This might be a complicated question. How do you choose between surgery and several radiotherapy methods? It's a challenge similar to therapy of acoustic neuroma in neurosurgery. It's very challenging to compare benefits of surgery with radiotherapy. Dr. Mark Emberton, MD. Yes. I think to date, there is no comparative prostate cancer clinical trial comparing surgery with radiotherapy with surveillance. Very soon we will have a clinical study in the public domain. It's a study from the UK, I am not directly involved in it. It's called PROTECT. That will give us the results in terms of prostate cancer-specific survival and overall survival. The study will provide the side effects of each of the interventions over a long period of time. And so we will have data to help men choose between prostate cancer treatments. At the moment I think the assumption is that all prostate cancer therapies work relatively equally well. But we don't have the data to prove that, that's the assumption. But prostate cancer treatment methods have very distinct side effects. So for radiation therapy you have to attend the hospital maybe for 35 days - that's 6 or 7 weeks. If you live 150 miles from your hospital, it's quite an ordeal. Surgery is a big operation. I mean, prostate cancer surgery is a very controlled operation. Surgery t’s a big life event. Some people have very strong emotional predisposition towards or against either prostate cancer radiotherapy or prostate cancer surgery. So I did a clinic yesterday. I see patients who don't want surgery or radiotherapy. They come to see me. I'm always very interested to try and understand why they don't want a particular treatment. Dr. Anton Titov, MD. And it's a non-rational sense. Some people just fear prostate cancer radiation. Maybe they had a friend that was harmed by radiotherapy. Some people fear going under anesthetic and having prostate cancer surgery. Dr. Mark Emberton, MD. I think a lot of it is for reasons that we don't understand. Some of reasons is a prioritization of the side effects. Incontinence is the big thing with prostate cancer surgery. Incontinence doesn't occur with prostate cancer radiotherapy. Both surgery and prostate cancer radiotherapy affect sexual function. Radiotherapy has a greater propensity for affecting the way the rectum works. Because of the damage to the rectal mucosa from the radiation dose. So patients can see that. There are many decision aids available in the public domain. They ask patients to value how they might feel afterwards to try and help them rate different prostate cancer therapy methods. But ultimately, the biggest driver of prostate cancer treatment method is who the patient sees first. Dr. Anton Titov, MD. Do they see a surgeon first or radiotherapist first? That's what the data would suggest. And then, choice of prostate cancer therapy is driven principally by practical issues. Proximity to the hospital service. Also the prostate cancer therapy side effect profile affects which method patients prefer.
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