Is surgery for prostate cancer considered an elective procedure?

The Defense Department has described Defense Secretary Lloyd Austin’s surgeryto treat his prostate cancer on Dec. 22 as an “elective medical procedure.” Austin, who went home the day after the procedure, later developed complications from the operation and was hospitalized on Jan. 1, Walter Reed National Military Center officials said in a statement Tuesday.

Austin underwent a procedure called a prostatectomy, Walter Reed officials said, in which surgeons remove some or all of the prostate gland.

Aside from skin cancer, prostate cancer is the most common cancer in men in the U.S., according to the American Cancer Society. The cancer is more likely to develop in older men, and the risk is higher in Black men, the ACS says.

While “elective” can make it sound like the operation wasn’t necessary, the word instead refers to the timing of the surgery.

Simply put, any surgery that’s not needed very quickly to treat a medical emergency is considered an elective procedure. 

Operations to treat appendicitis or ruptured gallbladders, for example, are emergency procedures, said Dr. Edward Schaeffer, the director of the Polsky Urologic Cancer Institute and chair of urology at Northwestern Medicine in Chicago.

An elective procedure doesn’t mean the surgery is optional, but rather that it can be scheduled in advance, according to Johns Hopkins Medicine.

With elective surgery, “it doesn’t matter if we do it today or six weeks from now,” said Dr. Michael Stifelman, the chair of urology at Hackensack University Medical Center in New Jersey. “The outcome will be the same.”

That’s especially the case for surgery for prostate cancer, which Stifelman said is “truly an elective procedure.”

“Prostate cancer is such a slow-growing cancer in many, many cases,” Stifelman said. “You can easily wait four to six weeks before treating that patient for the cancer without any concern of changing the outcome.”

What is active surveillance and watchful waiting?

Health officials from Walter Reed Medical Center said that Austin’s prostate cancer was detected early and that “his prognosis is excellent.”

Dr. Charles Ryan, the CEO of the Prostate Cancer Foundation, said patients diagnosed early have several options.

“Should I do active surveillance, which means having repeat MRI scans followed with blood tests? Or should I have my prostate removed surgically? Or should I undergo a treatment with radiation and hormonal therapy or radiation alone?” Ryan said.

Because prostate cancer can grow very slowly, some doctors and patients may decide to withhold treatment and instead opt for either active surveillance or watchful waiting. Both involve monitoring the cancer with tests, with active surveillance being the more intensive version.

Monitoring prostate cancer rather than treating it might be recommended if the cancer isn’t causing symptoms, it is small and it hasn’t spread beyond the prostate, or it is expected to grow slowly, according to the American Cancer Society.

“The ideal candidate for that is somebody who’s younger, in their 50s, 60s or early 70s, with a cancer that is very small,” said Dr. Quoc-Dien Trinh, co-director of the Dana-Farber/Brigham and Women’s Prostate Cancer Center in Boston. Such a patient might need periodic blood tests to check PSA levels, or additional biopsies and MRIs, Trinh said.

Most men who are diagnosed with prostate cancer don’t die from it, the American Cancer Society says.

What are the risks of prostate cancer surgery?

While Austin experienced complications from his surgery, experts said that, in general, the procedure is very safe. 

“For the vast, vast majority of men who go through it, it’s an uncomplicated procedure,” Ryan said. “But, as with all surgical procedures, as with all cancer treatments, there are risks from time to time for complications that require further care.”

Ryan said complications that would lead to a patient’s being hospitalized, such as bleeding or an infection, are rare. “By rare, [I mean] less than 5% of cases,” he said. 


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