D’Amico On Surgery Versus Radiation

Dr. Anthony D’Amico is Professor of Radiation Oncology at Harvard Medical School and Chief of the Division of Genitourinary Radiation Oncology at Brigham and Women’s Hospital and Dana-Farber Cancer Institute in Boston, Massachusetts.

Photo by Sam Ogden.
Anthony D'Amico, M.D., Ph.D.

Dr. Anthony D’Amico is Professor of Radiation Oncology at Harvard Medical School and Chief of the Division of Genitourinary Radiation Oncology at Brigham and Women’s Hospital and Dana-Farber Cancer Institute in Boston, Massachusetts.

Prostatepedia spoke with him about advances in radiation oncology for prostate cancer.

Are there any further thoughts on how radiation compares to surgery?

Dr. D’Amico: The ProtecT trial was published in the New England Journal of Medicine a couple of months ago. ProtecT is the first and only randomized study comparing surgery with radiation plus short-course hormones.

What I found very exciting about their results is that for 10 years we don’t see a difference in metastatic prostate cancer between the two major modalities of either radiation or surgery. It’s the first evidence that men with Gleason 6 or 7 prostate cancer truly have a choice between radiation therapy with short-course hormones or surgery. ProtecT is a randomized, 1,500-patient study. This is level-one evidence. ProtecT also shows that the quality of life men experience following these two treatments is very different. Two recent papers also show that even with advances in robotic prostatectomy and in radiation, the side effect profiles of those treatments have not really changed relative to one another. The absolute rates of toxicity have decreased, but you still have more urinary incontinence and erectile dysfunction with surgery and more bowel issues with radiation.

How do we rank surgery versus radiation, knowing as we do that cancer control is truly equivalent? Patients can choose their treatment based on the side effect profile alone and not worry that they may die of prostate cancer if they make the wrong choice.

So the choice of surgery versus radiation comes down to personal preference?

Dr. D’Amico: Correct. Just like in breast cancer: lumpectomy and radiation versus mastectomy? Women have a choice. Men with a Gleason 6 or 7 prostate cancer have a choice.

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1 Comment

Peter Williams

And if proton beam radiation is used there are NO bowel issues because the beam does NOT penetrate to the bowel or rectum. WHY do X-ray radiation oncologists withhold this information from the public (and their patients)? Is this ethical?

Posted: Jul 07, 2017

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