Prostate Cancer: Radiation vs. Surgery | Sanjay Mehta, M.D.

This episode explores the evolution of prostate cancer radiation treatment and patient selection criteria. Against the backdrop of older data limitations due to patient selection, the discussion highlights the modern era's broadened eligibility for radiation therapy, mirroring surgical candidacy. More significantly, the conversation delves into the complexities of Gleason scoring and risk stratification, introducing the Decipher and Arterra tests as tools for more precise risk assessment. For instance, the Arterra AI test, now included in NCCN guidelines, helps differentiate favorable from unfavorable intermediate-risk patients, potentially reducing the need for androgen deprivation therapy in some cases. The main advantages of radiation therapy, particularly concerning quality of life, are emphasized, focusing on reduced incontinence and impotence compared to surgery. Finally, the episode addresses inoperable patients, emphasizing the collaborative approach between urologists and radiation oncologists to balance cure rates with quality of life considerations.