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Differentiating Among Surgery, RT, and Active Surveillance in Localized Prostate Cancer

Gina Columbus @ginacolumbusonc
Published: Tuesday, Nov 01, 2016

Bertram Yuh, MD

Bertram Yuh, MD

Surgery and radiation therapy are standard treatment options for localized prostate cancer, but are not comparative to one another, explains Bertram Yuh, MD.

“The reason for that is there is not a lot of good literature looking at these 2 treatments together—looking at these side-by-side,” said Yuh, an assistant clinical professor of Urologic Oncology and a urologic oncology surgeon at City of Hope.

Yuh shed light on outcomes with surgery and radiation treatment in localized prostate cancer during the 2016 OncLive State of the Science Summit on GU Cancer.

In an interview with OncLive, Yuh discussed the selection of surgery or radiation therapy in patients with localized disease, as well as the potential for using active surveillance with these patients.

OncLive: What are the standard treatments for localized prostate cancer?

Yuh: The most standard treatments for local prostate cancer include surgical treatment to remove the prostate, as well as radiation treatments to essentially burn areas in the prostate. There are also additional therapies that have been looked at, but a lot of the data are not as robust, such as focal therapies like cryotherapy or high-intensity focused ultrasound. Generally though, in the present day and age, the mainstays of treatment tend to be surgery and radiation.

Do the outcomes differ between surgery and radiation therapy?

I discussed a lot about the outcomes of prostate cancer management and surgery and in radiation, but I mostly discussed the treatment outcomes separately. [Comparing the 2 treatments] is a type of study that is very difficult to run, in that it’s hard to tell a patient, “We are going to do an operation for you, but you might get radiation instead, and vice versa, all right?”

Because of that, what we tend to see is that patients who undergo surgery are a little different population than patients who undergo radiation treatments. Because they’re going into the operation or radiation treatment a little bit differently, it’s really hard to compare them side-by-side. We know that both treatments can be very effective. They both can play a major role in the management of patients.

There may be certain patients who would be better served by one treatment or another, depending on their individual biases. Some patients may be very against having an operation, for instance. Or, some patients may be very scared of radiation therapy. Therefore, we want to be sensitive to that.

As an oncologist, how do you decide which treatment a patient is better suited for? What are some of the things that you look for?

One of the very important things is to try our best to set aside biases. This is a very big challenge. A lot of clinicians are going to have certain treatments that they feel may be better for one reason or another. When talking to patients, you really need to try to present the options to them as objectively as possible.

[You need to discuss] the effects of an operation, the effects of radiation therapy, and what to expect when they go through 1 of these different treatments.




View Conference Coverage
Online CME Activities
TitleExpiration DateCME Credits
Community Practice Connections™: Personalized Sequencing in Castration-Resistant Prostate Cancer: Bridging the Latest Evidence to the Bedside in Clinical ManagementAug 25, 20181.5
Community Practice Connections™: Precision Medicine for Community Oncologists: Assessing the Role of Tumor-Testing Technologies in Cancer CareNov 30, 20181.0
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