Prostate cancer- How does one decide on therapy?

A colleague of mine asked on a blog comment:
“Do patients need to make there own decisions or should the urologist guide them to the best decision?”
That’s a great question and every urologist, medical oncologist, and radiation doc would have his/her own opinion.


Personally, i try not to decide for patients. Being a high volume robotic surgeon, I tell my patients that I am biased towards robotic surgery. I feel that for most people with a good 10 year life expectancy it is the best treatment available.

I also recommend that my patients obtain second opinions from another doctor. I usually recommend a radiation oncologist who will likely be biased towards radiation. It has been shown that physicians are more likely to recommend therapies that they perform. I think most urologists that do not perform robotics will not recommend robotic surgery and most urologists that perform robotics regularly, will not recommend open surgery.
I think its up to a patient to due research, ask tough questions from their physicians, ask their physicians for patient references, get opinions from their primary care physicians or possibly medical oncologists.

If a patient asks me to decide for them, then I would tell them what I would do if I was them or if they were my father. I also explain to them that there are several issues that may lead one to certain therapies.

If they do not want to have any anesthesia, then external beam would be a good choice.
If they want to avoid any incontinence, then surgery should be avoided. I explain that surgical patients usually have some incontinence at least. I also explain that the long term effects of radiation can also lead to incontinence and in my opinion they are more likely to have incontinence several years from now with radiation than surgery.

Patients that want the best idea of their recurrence rate may choose surgery since you obtain more detailed information from the pathology report as to extent of disease.