Additional Director, Urology, Fortis Hospital, Shalimar Bagh, New Delhi
Part 5 of 8 in Prostate Cancer: Diagnosis and Latest Treatment Guidelines
Prostate Cancer Treatment: From Active Surveillance to Robotic Surgery
May 5, 2024
Prostate cancer treatment spans a spectrum from doing nothing yet to full curative surgery, chosen according to the patient's risk category, age and fitness.
Watchful waiting and active surveillance
For an older, asymptomatic patient with a life expectancy under 10 years, watchful waiting defers treatment until symptoms develop. Active surveillance is different: it is for a patient with low-risk, early cancer who is willing to be followed closely with repeated biopsies and examinations, moving to treatment only if the cancer shows signs of progression.
Robotic radical prostatectomy and radiotherapy
Radical prostatectomy, removing the entire prostate gland, is indicated for low- and intermediate-risk disease and select high-risk cases. Robotic-assisted surgery has significantly improved outcomes over older open surgery, particularly for urinary continence and preserving erectile function. Radiotherapy is an alternative for early disease, or used as palliation for advanced disease alongside androgen deprivation therapy.
This article is based on a Jivo Masterclass session conducted by Dr. Anurag Puri, Additional Director, Urology, Fortis Hospital, Shalimar Bagh, New Delhi. The article has been summarised with the assistance of an AI tool from the original masterclass recording. Watch the full Masterclass recording
Looking for a urology or prostate cancer consultation? Get in touch with the Jivo team
This guide is based on a live Jivo Masterclass: Dr. Anurag Puri taught doctors across Africa on May 5, 2024.
FROM THE LIVE Q&A
Moderator
Should a PSA test be sent for all patients with BPH?
Dr. Anurag Puri
It is not mandatory as routine screening, but a baseline PSA is checked before starting an anti-androgen such as dutasteride, which is commonly prescribed for BPH.
Frequently Asked Questions
What is the benefit of alfuzosin in the symptomatic management of BPH, and is there a newer drug?▼
Alfuzosin is a commonly used drug that relieves the urinary symptoms of BPH. Silodosin is a newer, more potent alternative. Alfuzosin is generally preferred in younger, sexually active men, while silodosin is preferred in older patients because of its sexual side-effect profile.
Is there really no treatment available for prostate cancer above the age of 80?▼
That is not the case. Between the ages of 80 and 90, up to 80% of men are found to harbour some focus of prostate cancer, but most die of other causes rather than the cancer itself. Because it is often a low-risk, indolent disease in this age group, treatment is sometimes deliberately avoided if the patient is asymptomatic.
Does declining male sexual performance with age relate to atherosclerotic changes in penile vessels? Is there a better urological explanation?▼
Yes - this is generally due to atherosclerosis: as blood vessels narrow with age, blood supply to the penis decreases, and this reduced blood flow is the main driver of declining sexual performance.
What are the principles of prostate cancer management, the survival rates by stage, and can advanced disease be managed locally?▼
Management is decided by the disease's staging and parameters: PSA level, Gleason score, and clinical stage on digital rectal examination. Survival rates vary sharply by stage - low-risk, early disease has close to a 100% cure rate, and even metastatic (stage four) patients now have meaningfully better life expectancy with appropriate treatment than with many other stage-four cancers.
What does a kidney transplant require if the donor's genetic makeup is different, and what can be done to restore a failing transplanted kidney?▼
Kidney transplant is the treatment of choice for renal failure, and results are best with a related, genetically matched donor. Even without a genetic match or matching blood group, plasmapheresis, an advanced technique that lowers the antigenicity of the donor organ, can still allow a transplant to proceed.
What is the difference between watchful waiting and active surveillance?▼
Watchful waiting defers all treatment for an older, asymptomatic patient with a short life expectancy; active surveillance closely monitors a low-risk early cancer with repeated biopsies, moving to treatment only if it progresses.
How has robotic surgery changed radical prostatectomy?▼
It has significantly improved outcomes for urinary continence and erectile function preservation compared with older open surgery.
In This Series: Prostate Cancer: Diagnosis and Latest Treatment Guidelines
- 1.Prostate Cancer
- 2.Prostate Cancer Risk Factors and How It Presents
- 3.Diagnosing Prostate Cancer: PSA, Biopsy and Staging
- 4.Gleason Score and Risk Stratification in Prostate Cancer
- 5.Prostate Cancer Treatment: From Active Surveillance to Robotic Surgery
- 6.Advanced and Hormone-Resistant Prostate Cancer Management
- 7.Managing BPH: Medications and When Size Doesn't Matter
- 8.When to Refer a Prostate Cancer Patient for Treatment Abroad