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 (HDR 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 entales.

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 hormone therapy.

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. Is HDR (high dose rate) brachytherapy better than radiation seed implants?

A: Both HDR (high dose rate) brachytherapy and low dose rate brachytherapy (radiation seed implants), with or without external beam radiation, are good options for effective treatment of prostate cancer. While both forms of treatment offer comparable results for stopping prostate cancer growth, HDR Brachytherapy does offer some advantages in the way that it delivers radiation to the prostate. Unlike seed implantation, HDR does not leave radioactive material in the prostate so there is no risk of radiation exposure to other people. HDR enables your doctor to control precisely where in the prostate (and for how long) the radiation is delivered so the tumor can receive a higher dose while the urethra and rectum receive a lower dose. This is important for improving treatment outcomes and reducing unwanted side effects such as impotence and incontinence.

8.  How can I be sure that the surgeons at Saint Joseph’s are experts in robotic surgery?

A: Anytime you are considering surgery, do your homework and ask plenty of questions. It is important that you feel completely comfortable that the surgeon you 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.

All of the surgeons performing the robotic prostatectomy procedure at Saint Joseph’s are board certified in Urology by the American Board of Urology and each have completed an additional three years of fellowship training specifically in robotic surgery. Drs. Nikhil Shah and Rajesh Laungani, make up the robotic urology team at Saint Joseph’s and combined have performed over 1,600 robotic prostatectomy cases. Biographical information for Dr. Nikhil Shah and Dr. Rajesh Laungani is available on our website. You can also visit Urology Specialists of Atlanta (USA) for more information about Dr. Shah and Dr. Laungani.

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

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 rsevy@sjha.org.

9. I’d like to speak with someone who has had a robotic prostatectomy 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 Dr. Shah or Dr. Laungani for their robotic prostatectomy. 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 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.

10. I’d like to speak with someone who has had a High Dose Rate 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 Dr. Wiggers or Dr. Possert for their 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.

11. 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." 

Both of the surgeons performing the robotic prostatectomy procedure at Saint Joseph’s are board certified in Urology by the American Board of Urology and each have completed an additional three years of fellowship training at the highly-regarded Vattikuti Urology Institute (VUI) at Henry Ford Hospital in Detroit, Michigan. Under Dr. Mani Menon, the VUI is a noted as being the first institute to establish robotic surgery as a treatment for prostate cancer. Drs. Nikhil Shah and Rajesh Laungani, make up the robotic urology team at Saint Joseph’s and combined have performed over 1,600 robotic prostatectomy cases. Biographical information for Dr. Nikhil Shah and Dr. Rajesh Laungani is available on our website. You can also visit Urology Specialists of Atlanta (USA) for more information about Dr. Shah and Dr. Laungani.

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

12. 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 rcommend 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 rsevy@sjha.org. To begin the process online, click here for more information and to access the New Patient Request for Appointment Submission Form. You are not required to consult with both a surgeon and radiation oncologist, it is simply our recommendation. Learn More>> Making the Treatment Decision Informational Seminars are offered monthly to provide clear, unbiased information on the treatment options available for prostate cancer. Free to attend. Spouses and adult family members are welcome to attend. Bring your questions, a physician will answer your questions during the final 30 minutes of the session.

*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 and has been medically reviewed by Rajesh G. Laungani, MD, 2010. The PCC follows American Urological Association and  National Comprehensive Cancer Network (NCCN) Clinical Practice Guidelines for the treatment of prostate cancer.

Last Updated: March 28, 2011 (RSH)