Fewer complications with prostate surgery than before

SALT LAKE CITY — "Cancer" and "let's not do anything right now" don't usually go together. But when a patient has been diagnosed with prostate cancer, that may actually be the best option.

It's traditionally quite slow growing and unaggressive, though there are exceptions that can be spotted through a cellular-level examination. So when you take into account whether the man with the cancer is older or not, how fast-moving it is and other factors, "watchful waiting" may trump surgery or radiation.

That's according to Dr. Richard Matern, a urologist and surgeon at LDS Hospital, and Dr. Michael Mangelson, LDS Hospital's urology division chief. The two will take phoned-in questions on the Deseret News/Intermountain Healthcare Hotline Saturday. The topic is prostate issues including cancer and the number is 1-800-925-8177. You can also post questions on the Deseret News Facebook page, facebook.comdesnews.

For patients who are younger and generally healthy, Matern said, treatment leans toward surgery, because long-term data says they do well. Someone who has had heart attacks or diabetes is probably not a great surgery candidate. For that individual, the choice will more apt to be radiation or surveillance.

Surgery itself may be open or laparoscopic, the latter often done with a robot.

Some people don't want surgery under any circumstances, worried about side effects or complications. For those individuals, brachytherapy or other radiation may be used, he said.

Doctors are doing much better managing and avoiding the twin side effects that have scared so many away: incontinence and impotence, they said. That doesn't mean they don't exist.

"The complications are quality of life issues and no matter what treatment options you choose, they are part of it," Matern said. "Anyone who tells you things will be exactly the same after treatment isn't being up front with you."

"It has a lot to do with age, muscle tone, how hard the patient works at it and surgeon skill, Matern said, That's true for any of the complications.

There are techniques to minimize them. And great strides have come because of improvements in understanding of the prostate's anatomy in relationship to other important structures nearby, said Mangelson. The technology, the anatomical knowledge and screening have all improved.