Prostate Cancer – Second Opinion

The initial diagnosis of prostate cancer leads to shock and disbelief, but patients and their families must quickly move forward to tackle the problem. While the best choice is often surgery, there are other effective treatments. Patients should look for a provider with extensive experience in treating prostate cancer in a manner tailored to each patient’s individual circumstances. Having treated thousands of prostate cancer cases in San Antonio and South Texas, the doctors at The Urology Place have the experience to assist patients with their individual case or provide a prostate cancer second opinion.

Options for Prostate Cancer Treatment

For early or mid-stage prostate cancer, there are three options. Broadly speaking, the options include:

  • Surgery
  • Radiation
  • Active surveillance

Late-stage prostate cancer is typically treated aggressively with surgery and radiation. Unfortunately, some patients may not be able to be cured; however, cancer can be controlled. For example, hormone therapy and chemotherapy are options.


Surgery is a common treatment for prostate cancer, and usually is either open or robotic. Cancer control, urinary control, and sexual function can all depend on the surgeon’s experience. Fortunately, Dr. Naveen Kella at The Urology Place and his team are very experienced with robotic surgery. Other types of surgery include cryosurgery (freezing prostate cancer cells) and high-intensity focused ultrasound (HIFU). With cryosurgery, cancer control is questionable and unfortunately, even properly performed cryotherapy has a high rate of erectile dysfunction. As a result, cryosurgery is seldom performed. HIFU, however, is considered a more viable treatment, especially for patients with a small prostate and a relatively low Gleason Score. HIFU patients should be advised of the real risk of urethral strictures (narrowing of the urethra which can restrict or block urine flow) following the procedure.

Radiation Therapy

Radiation therapy is another treatment that has the potential to cure prostate cancer. Two types of radiation are available. Intensity Modulated Radiation Therapy (IMRT) is the state of the art for external radiation therapy. Nine weeks of therapy is the normal course, with patients receiving treatments Monday through Friday. Each session typically lasts 15-20 minutes and it is imperative that the patient communicate with the radiation oncologist if it becomes necessary to miss a treatment day. Side effects of radiation therapy may include blood in the urine or stool, fatigue, especially towards the end of treatment, and, in some patients, erectile dysfunction. Usually, erectile dysfunction peaks about one year after treatment but fortunately, medications such as Viagra can help.

Seed or pellet therapy is another form of radiation. During this procedure, general anesthesia is given and the patient undergoes surgery, during which radioactive pellets are placed in the prostate. Patients usually go home after the procedure or the next day. In some cases, the patient must temporarily wear a catheter to drain the bladder. Robotic surgery has similar requirements, but has the advantage of removing the prostate allowing the pathologist to see if there are any other related issues that need to be addressed.

Dr Kella shares his expertise on prostate cancer during African American History Month

Active Surveillance

Some prostate cancers are slow growing and the patient is likely to die of other causes before the prostate cancer becomes severe. In these cases, patients may elect to carefully watch their disease. Patients who have small amounts of prostate cancer or a low Gleason Score may be candidates for active surveillance. Also, a patient who has many medical problems or is elderly may elect the “watch and wait” approach due to the potential complications of aggressive treatment.

Second Opinion for Prostate Cancer Diagnosis

Decisions on prostate cancer treatment options can be difficult, and physicians sometimes use genetic testing and other measures to help determine how best to move forward. It is advisable to seek a second opinion in all cases, but certainly when the best options remain unclear after consulting with your urologist. Dr. Kella at The Urology Place in San Antonio, Texas is often sought after for an expert second opinion due to his extensive knowledge and experience.


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First availableNaveen Kella MDTimothy Hlavinka MD

A San Antonio urologist, Naveen Kella M.D. is the Founder of the Urology Place. He is one of the most experienced surgeons in the country with robotic prostate cancer surgery.

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