Frequently Asked Questions: Treatment Options

1. Is Watchful Waiting a legitimate option to consider if I have prostate cancer?

A: Watchful waiting, also called expectant therapy or active surveillance, is a good option for some patients with prostate cancer. In general, those patients with a small amount of low grade cancer and a low PSA may benefit from watchful waiting. Learn More>> Click here for current clinical practice guidelines by the National Comprehensive Cancer Network (NCCN) for active surveillance in patients with low risk or very low risk early stage prostate cancer.

2. Is it possible to do surgery after radiation therapy if my cancer comes back?

A: Surgery after radiation therapy is possible, but it is not recommended and is associated with many complications. The most significant problem is fibrosis (scarring) in the pelvic region. It is very difficult for the surgeon because the tissue planes that allow you to separate one organ from another are obliterated. To successfully remove the prostate, the surgeon risks damage to the bladder or the rectum.

3. Who is a good candidate for surgery to treat prostate cancer?

A: Patients who are considered good candidates for surgical treatment of prostate cancer are those who are in relatively good overall health and have a life expectancy of at least 10-15 yrs. You should discuss with your doctor if you are a better candidate for surgery, radiation therapy or watchful waiting (active surveillance).

4. Who is a good candidate for radiation therapy (brachytherapy and/or external beam radiation) to treat prostate cancer?

A: Patients who are considered good candidates for radiation therapy treatment of prostate cancer are those who are in relatively good health and have a life expectancy of at least 10-15 yrs. You should discuss with your doctor if you are a better candidate for surgery, radiation therapy or watchful waiting (active surveillance).

5. I've heard of hormone therapy for prostate cancer but I'm not sure what that entails.

A: Many men refer to androgen-deprivation therapy (ADT) as "hormone therapy" because the goal of this form of therapy is to significantly reduce or eliminate testosterone (a male sex hormone) from the body. Prostate cancer grows with the help of testosterone. If testosterone is blocked, prostate cancer cannot grow. ADT involves blocking the effect of testosterone on prostate cancer cells. ADT is usually used when surgery and radiation therapy have failed or if there is evidence that prostate cancer has metastasized or spread to other organs (bones, lymph nodes). Learn More>> Click here for more information on androgen-deprivation therapy (ADT).

6. I am not sure how a surgical robot is used in the operating room. Can you explain?

A: Robotic surgery is a form of minimally invasive surgery. The entire prostate (plus some surrounding tissue, called margins) is removed through tiny keyhole sized incisions with the help of precise robotic instruments controlled by a surgeon at a surgical console. The procedure lasts approx 1-2 hrs and 99% of patients are discharged home the day after surgery. There are many advantages to robotic surgery for prostate cancer over open radical prostatectomy. Learn More>> Click here for more information about robotic prostatectomy surgery. For more information on the da Vinci Surgical Robotic System, visit to Intuitive Surgical.

7. How can I be sure that the physician I choose is an expert in treating prostate cancer?

A: For any treatment you are considering, do your homework and ask plenty of questions. It is important that you feel completely comfortable that the physician and medical team that you have select has both the expertise and skill for the procedure you're contemplating, and a communication style that suits you. The fact is, you are going to have this person in your life for some time, so building a solid and trusting relationship is important.

The PCC Patient Navigator is here to help you secure a consultation appointment. To reach Renee Sevy-Hasterok, our Patient Navigator, please call (678) 843-5665 or renee.sevy@emoryhealthcare.org

8. I'd like to speak with someone who has had brachytherapy and/or external beam radiation therapy at Saint Joseph's. Do you have any patients I can call?

A: Yes! We have a list of patients who have offered to speak to anyone considering radiation therapy. Our Patient Navigator is happy to make that connection for you. One caveat to this type of "information gathering" is that everyone's experience is different and whether people recognize it or not, we all have biases as to the best treatment option based on the treatment decision that we ourselves made. We just want you to realize that someone else's experience may not represent your experience. We recognize, though, that it's reassuring to speak to someone else who has been through the same treatment with a physician that you are considering so we offer the names with this small but important caveat.

9. What training is required for surgeons who do the robotic prostatectomy?

A: It is very important that your surgeon has undergone formal fellowship training in robotic surgery and has a case experience of at least 250-300 robotic prostatectomy cases. Many surgeons performing the robotic prostatectomy today have not had this level of training or robotic surgical experience. In a recently published report on robotic prostatectomy in Reviews in Urology* , the outcome evidence was clear that "while a surgeon is learning a new technique, numerous patients may achieve outcomes inferior to what they might otherwise have obtained with an experienced surgeon."

Learn More>> Click here for more information about robotic prostatectomy at Saint Joseph's.

10. I would like to make a consultation appointment to discuss my treatment options. Who should I consult with and how do I secure that appointment?

A: To establish which treatment would be the best option for you based on your specific situation, we recommend that you consult with both a surgeon and radiation oncologist. These consultations will provide you with the information that you need to make a well informed and educated decision about your treatment plan. Our Patient Navigator is here to help you secure these consultation appointment(s). To reach Renee Sevy-Hasterok, LMSW, our patient navigator, please call (678) 843-5665 or renee.sevy@emoryhealthcare.org. You are not required to consult with both a surgeon and radiation oncologist, it is simply our recommendation. Check with your insurance carrier to verify coverage.

*Source: Finkelstein, J. et al. Reviews In Urology, Vol. 12, No. 1, Winter 2010.

Information on this page is provided collaboratively by the team at the Prostate Cancer Center at Saint Joseph's. The PCC follows National Comprehensive Cancer Network (NCCN) Clinical Practice Guidelines for the treatment of prostate cancer.