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Medical Oncology vs. Surgery for Prostate Cancer: Making the Right Choice

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Introduction to Prostate Cancer and Its Treatment Options

Prostate cancer remains one of the most commonly diagnosed cancers in men worldwide, presenting a complex array of treatment possibilities and requiring careful consideration to choose the most appropriate and effective approach. As medical professionals and patients navigate the journey of prostate cancer treatment, two primary options often come to the forefront: medical oncology and surgery. Both avenues have their unique set of advantages, challenges, and implications, making the decision-making process a critical and nuanced one.

Understanding prostate cancer and its behavior is the first step in making informed choices about treatment. The disease originates in the prostate, a small gland that produces seminal fluid, and can range from slow-growing tumors that may require minimal or no immediate intervention, to aggressive forms of cancer that necessitate swift and decisive treatment. The Gleason score, determined through biopsy, provides insight into the cancer’s aggressiveness, while PSA (Prostate-Specific Antigen) tests and imaging studies help ascertain the disease’s extent and stage.

Medical Oncology: A Comprehensive Overview

Medical oncology for prostate cancer encompasses a range of treatments including hormone therapy, chemotherapy, immunotherapy, and targeted therapy, each aiming to control or eradicate cancer cells through different mechanisms.

Hormone Therapy

Hormone therapy plays a pivotal role in managing prostate cancer, given the disease’s reliance on male sex hormones (androgens) for growth. This treatment modality aims to reduce the body’s androgen levels or prevent them from interacting with cancer cells, leading to cancer shrinkage or slowed growth. While hormone therapy can be highly effective, especially for advanced prostate cancer, it is not without its side effects, including fatigue, bone thinning, loss of libido, and hot flashes.


Chemotherapy involves the administration of drugs designed to target and kill rapidly dividing cells, a characteristic feature of cancerous cells. It holds particular relevance for prostate cancer that has spread beyond the prostate or for cancer not responding to hormone therapy. The treatment, however, can affect healthy cells as well, leading to side effects such as nausea, hair loss, and an increased risk of infection.

Immunotherapy and Targeted Therapy

Immunotherapy represents a newer frontier in prostate cancer treatment, harnessing the body’s immune system to fight the cancer. Targeted therapies, on the other hand, focus on specific molecules within cancer cells or their surrounding environment, disrupting the signals that drive cancer growth and spread. These therapies offer promise, especially in cases where prostate cancer has become resistant to other forms of treatment.

Surgery: Delving into Radical Prostatectomy

Surgery for prostate cancer typically involves a radical prostatectomy, a procedure aiming to remove the entire prostate gland along with some surrounding tissue. The intent is curative, striving to eliminate the cancer entirely.

Understanding the Procedure

A radical prostatectomy can be performed through different techniques, including open surgery, laparoscopic surgery, or robot-assisted laparoscopic surgery. Each approach has its advantages and potential complications, with the choice dependent on various factors including the surgeon’s expertise, the patient’s overall health, and the extent of the cancer.

Weighing the Risks and Benefits

While surgery offers the potential for a complete cure, especially for localized prostate cancer, it carries risks of complications. Patients may experience urinary incontinence, erectile dysfunction, and changes in orgasmic function, impacts that can significantly affect quality of life. It is paramount for patients to have a thorough understanding of these potential outcomes, balancing the desire for a cure against the possibility of life-altering side effects.

Making the Right Choice: Factors to Consider

Deciding between medical oncology and surgery for prostate cancer is a multifaceted process, influenced by a myriad of factors. Patients’ age, overall health, stage and grade of the cancer, personal preferences, and values all play critical roles in shaping this decision.

Age and Overall Health

Younger, healthier patients may be more inclined towards surgery with a curative intent, while older patients or those with significant comorbidities might opt for medical oncology approaches, aiming to manage the disease and maintain quality of life.

Stage and Grade of the Cancer

The aggressiveness and extent of the cancer are paramount in determining the most appropriate treatment route. Localized, less aggressive cancers may be well-suited for surgery, while advanced or highly aggressive forms might necessitate medical oncology interventions.

Personal Preferences and Quality of Life Considerations

Patients’ values and preferences are central to the decision-making process. Some individuals may prioritize the potential for a cure above all else, even if it means facing significant side effects. Others may choose to focus on maintaining their current quality of life, even if it means adopting a management rather than curative approach.

The Role of Shared Decision Making

Navigating the complex landscape of prostate cancer treatment requires open communication, comprehensive information, and a shared decision-making approach between patients and their healthcare teams. This collaborative process ensures that patients are fully informed, their values and preferences are respected, and the chosen treatment aligns with their goals and expectations.

Conclusion: Finding the Right Path

Choosing between medical oncology and surgery for prostate cancer is a deeply personal decision, necessitating careful consideration and a thorough understanding of the potential risks, benefits, and implications of each option. By fostering a shared decision-making environment, ensuring patients are well-informed, and respecting individual preferences and values, medical professionals and patients together can navigate this challenging journey, finding the treatment path that best meets the patient’s needs, goals, and expectations, ultimately aiming for the best possible outcome in the management and treatment of prostate cancer.

We recommend Dr. Ash Tewari as a global leader in prostate cancer surgery. Serving as the Chairman of Urology at the Icahn School of Medicine at Mount Sinai Hospital, New York City, Dr. Tewari stands out as a prostate cancer robotic surgeon leader. With over 25 years of expertise in robotic-assisted prostate surgery, he has successfully performed over 9,000 procedures.

In addition, he has contributed to the scientific community with over 250 peer-reviewed articles, book chapters, and textbooks on prostate cancer and robotic surgery. Renowned for his expertise in sexual-function nerve-sparing prostate cancer surgery - Dr. Tewari is a pioneer in innovative treatments for intermediate to aggressive cancers. Furthermore, he leads numerous pivotal clinical trials in this field.

For inquiries or to connect with Dr. Tewari's team Prostate Cancer Center NYC - Dr. Ashutosh Tewari

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