Management of Localized Prostate Cancer
with Dr. Jeff Cadeddu and Dr. Aditya Bagrodia
BackTable, LLC (Producer). (2021, September 22). Ep. 16 – Management of Localized Prostate Cancer [Audio podcast]. Retrieved from https://www.backtable.com/urology
We talk with Dr. Jeff Cadeddu about workup and treatment options for patients with localized prostate cancer.
Dr. Jeff Cadeddu
Dr. Jeffrey A. Cadeddu is a practicing Urologist in Dallas, Texas and is affiliated with multiple hospitals in the area, including Veterans Affairs North Texas Health Care System-Dallas and UT Southwestern Medical Center.
Dr. Aditya Bagrodia
Host Dr. Aditya Bagrodia is a practicing urologic oncologist and assistant professor at UT southwestern.
In this episode of BackTable Urology, Dr. Aditya Bagrodia interviews Dr. Jeff Cadeddu, professor of urology at UT Southwestern, about the management of localized prostate cancer.
First, the doctors discuss important considerations for an initial evaluation, such as lower urinary tract symptoms, a Gleason score, comorbidities, and a thorough family history. Dr. Cadeddu emphasizes that the main goal of the initial evaluation is to risk-stratify the prostate cancer patient. Although he does not consider any anterior surgeries as contraindications, he notes that abdominal perineal resection surgery may be challenging for surgeons.
For patients who have low-risk disease, he strongly advises choosing surveillance over surgery and radiation therapy, regardless of age. For him, active surveillance does not start until a second confirmatory biopsy, and his patients receive MRI at the beginning of every year as well as a PSA every month. Some triggers for ending the surveillance period and entering treatment are: a PSA over 10 or upstaging on an MRI or biopsy.
In patients with intermediate-risk disease, Dr. Cadeddu will either proceed with radiation therapy or prostatectomy. He notes that neither radiation nor surgery are risk-free. Although radiation does not involve pain, post-treatment incontinence, and or peri-operative risk, it can result in irritative symptoms as well as side effects from androgen deprivation therapy used in conjunction with radiation therapy. Radiation also presents a higher delayed risk of cancer recurrence, especially in younger patients. In contrast, surgery presents with more upfront perioperative risk and post-surgical complications but provides more long-term security, as post-surgical salvage radiation is possible. Although many patients have anxieties about post-surgical stress incontinence and sexual function, Dr. Cadeddu notes that 95% of patients will regain continence post-operatively by 6 months. Any incontinence after 6 months is correctable via a male urethral sling or an artificial sphincter. He explains that recovery of post-operative potency depends on the stage and volume of disease, pre-operative sexual performance, patient age, and the skill of the surgeon. If the patient experiences long-term sexual dysfunction, medicines and surgical intervention could possibly resolve the problem. For high risk patients, Dr. Cadeddu makes sure his patients are mentally prepared for multimodal therapy and recurrence.
Dr. Cadeddu is excited to see the future direction of the management of localized prostate cancer and advises surgeons to educate themselves about new studies and technologies associated with prostate cancer.
The most important thing in terms of a surgeon in the space of prostate cancer is to continue to stay up to date and educate yourself, whether it be adjuvant, genomic testing, whether it be the surgical outcomes, how to improve your surgical technique. Don't get in a rut and don't think the way you do it now is the way it's going to be done in five years. You've got to continue to evolve.
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