How Prostate Cancer Treatment Decisions Are Made: Surgery, Radiation and More

Genitourinary cancers, prostate cancer chief among them, often present patients with more than one reasonable path forward. Dr. Yu-Wei Chen, a medical oncologist at UC San Diego Health, spoke with CURE about how those decisions get made and what has changed in treatment.

How is it decided whether surgery should come first?

"Generally speaking, the treatment for prostate cancer [is] basically two routes. One is surgery; the other is either radiation with or without hormone therapy," Chen said.

He pointed to the multidisciplinary clinic at UC San Diego, where patients meet a urologic surgeon, a radiation oncologist and a medical oncologist in a single visit.

"Patients [get] a chance to decide and to learn more about the pros and cons with either approach, and to learn more about the side effects and toxicities associated with either treatment option."

Physicians then discuss a final recommendation, he noted, though the patient's own preference carries through the clinic visit and the follow-ups after it.

How do patients weigh effectiveness against quality of life?

Chen starts by asking what the patient wants treatment to accomplish, particularly when a cancer is no longer curable. "I would ask my patients, what's their goal?" he said.

Some tell him they would rather stop treatment than live with the side effects. Those conversations are not easy, but tend to come up first.

What is changing in prostate cancer treatment?

"We are entering an era of precision oncology," Chen said, describing treatment tailored to an individual's cancer biology.

That begins with molecular testing, which he framed as the first question to raise after a diagnosis: whether testing has been ordered, and what more personalized options it might open up.

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