Radical prostatectomy is one of the most popular treatments for prostate cancer. Surgery is broadcasted all over the media as the gold standard of prostate cancer treatment. But does surgery really live up to the hype?

This episode of PROSTATE PROS covers the “Just Cut it Out!” mentality, the surgery versus radiation debate, and the side effects of the radical prostatectomy.

Dr. Scholz: Welcome to the PROSTATE PROS podcast. We’re guiding you to treatment success and avoiding prostate cancer pitfalls. I’m your host, Dr. Mark Scholz, here with my co-host Liz Graves.

Liz: Today on PROSTATE PROS, we’re addressing the desire to just cut the cancer out.

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Dr. Scholz: Why is surgery so popular for prostate cancer? The prostate cancer landscape is unusual because prostate cancer is the only cancer where surgeons are in the driver’s seat. ALl the other cancers: lung cancer, colon cancer, brain cancers, all these other types of cancers are supervised by cancer experts called medical oncologists. Why is prostate cancer such a backwards industry? 40, 50 years ago, surgeons were running all the cancers, but as the world became more complex and technology progressed, one by one the medical oncologists started taking over the management and only referring speciality cases for surgery. The prostate cancer world is the only exception to this procedure and to this day, urologists, who are surgeons are in the driver’s seat and controlling the prostate cancer decision making process.

Liz: Yes, we’ve talked about that before, how urologists have this leadership in the prostate cancer world and so a lot of men get surgery because that’s the only advice they are hearing.

Dr. Scholz: It’s not really apparent to patients when they’re thrown into a diagnosis, the urologist is the one that did the biopsy and he’s the one sharing the bad news that prostate cancer has been diagnosed. So it seems very natural and a smooth transition to assume he will continue in the leadership position. It’s obvious why surgery is so popular. Is there any problem with that? I mean, surgery seem like a natural solution for just about any type of cancer. The problem is the location of the prostate is in such a sensitive area in the body and it’s nearly impossible for the surgeon to finesse the prostate out without causing some collateral damage to urinary or sexual function. Historically, that’s what you were stuck with. The other options like radiation were very antiquated, caused a lot of side effects, had poor cure rates. But as technology has advanced over the last 15 years, radiation therapy, in my professional opinion, has become much better than surgery. I suppose we shouldn’t be surprised that the urologists have been a little slow to adopt this new policy because it involved referring their patients to a specialist, and they, therefore lose the opportunity to practice their own craft.

Liz: Yeah, to someone who isn’t in the medical profession, it makes sense to just cut the cancer out. It seems like a one time procedure: you go in, you get it done, and it’s gone.

Dr. Scholz: Yeah, and about one third of the men that have operations have a fairly good result. They’ll be able to get erections, they won’t be leaking urine, but those sorts of odds are terrible. Imagine that, two-thirds of men either have the cancer come back or they’re having a terrible problem with urinary leakage or they’ve lost their ability to get an erection. It’s not a satisfying outcome at all. I’m glad we’re having this conversation and raising awareness about the fact that other newer, better options such as many of the radiation therapy options are really far superior. Assuming of course, you go to a center of excellence where they have state of the art equipment.

Liz: Ok, so surgery hypothetically removes the cancer. But then you have to deal with all these problems that are in