Introduction: Choosing the Right Specialist Matters
After a prostate cancer diagnosis, one of the first decisions men face is which type of doctor to see. Both urologists and radiation oncologists are central to prostate cancer care, but their expertise and treatment options differ significantly.
Urologists are surgeons and interventional specialists. They diagnose prostate cancer, perform surgery, and offer advanced therapies like Pulsed Electric Field (PEF) Ablation, focal treatments, and, in some centers, brachytherapy.
Radiation oncologists specialize exclusively in radiation therapy, an effective treatment for many men, but one that represents only a single approach.
Understanding the difference can help you choose a specialist who will give you the most complete picture of your options.
The Urologist's Role in Prostate Cancer Treatment
Urologists manage the full spectrum of prostate cancer care, from diagnosis to treatment and long-term follow-up. They typically:
Perform diagnostic tests, including PSA bloodwork, digital rectal exams, and prostate biopsies.
Interpret prostate MRI scans and biopsy results to determine risk.
Guide patients through personalized treatment plans based on cancer stage and goals.
Treatment Options from Urologists
Robotic Prostatectomy (RALP): A minimally invasive surgery to remove the prostate, available only through urologists.
PEF Ablation: A non-thermal focal therapy that targets cancer cells while protecting nerves and urinary function. Ideal for men with localized, MRI-visible Gleason 6 and favorable Gleason 7 cancers.
Brachytherapy: In some practices, urologists provide seed implantation, often in collaboration with radiation oncologists.
Active Surveillance: For low-risk disease, urologists monitor cancer safely with PSA, MRI, and repeat biopsies.
Bottom line: Urologists provide the broadest range of treatment choices, from surveillance to surgery and advanced focal therapies.
The Radiation Oncologist's Role in Prostate Cancer
Radiation oncologists are experts in using energy beams to kill cancer cells. Their role is important, but focused on a single treatment pathway.
Main Treatments from Radiation Oncologists
External Beam Radiation Therapy (EBRT): Daily treatments over several weeks that target the prostate with precision beams.
Brachytherapy: In some cases, radiation oncologists co-manage radioactive seed placement with urologists.
Strengths and Limitations of Radiation Oncology
Strengths: Expertise in radiation planning, proven long-term outcomes for intermediate and high-risk disease, and a non-surgical option for men unfit for surgery.
Limitations: Radiation is their only tool, and side effects can include bowel irritation, urinary symptoms, and sexual dysfunction that may develop years later. If cancer returns after radiation, salvage surgery is technically complex and carries higher risks.
Urologists vs Radiation Oncologists: Comparing Options
Treatment |
Urologist |
Radiation Oncologist |
Active Surveillance |
✅ Yes |
❌ No |
Robotic Prostatectomy |
✅ Yes |
❌ No |
PEF Ablation (Focal Therapy) |
✅ Yes |
❌ No |
External Beam Radiation |
❌ Referral only |
✅ Yes |
Brachytherapy |
✅ Often yes |
✅ Often yes |
Urologists can offer surgery, focal therapy, surveillance, and sometimes brachytherapy. Radiation oncologists focus exclusively on radiation-based approaches.
Why Starting With a Urologist Makes Sense
Full Spectrum of Options: Urologists can present every pathway: surveillance, focal therapy, surgery, and radiation referrals.
Personalized Treatment: Urologists match risk with therapy. For Gleason 6, surveillance or focal therapy may be best; for Gleason 7, surgery or PEF Ablation; and for higher-risk cancers, surgery or radiation.
Access to Innovation: Urologists lead the way in new treatments like PEF Ablation, offering effective cancer control with fewer side effects.
Continuity of Care: Urologists also treat urinary and sexual function, providing comprehensive support after treatment.
PEF Ablation: A Breakthrough Focal Therapy
Among urologist-led treatments, Pulsed Electric Field (PEF) Ablation is generating strong interest.
Best for: Men with low-volume Gleason 6 or favorable Gleason 7 cancers that are visible on MRI.
Benefits: Outpatient procedure, preserves continence and erectile function, minimal downtime, and does not limit future treatments.
Compared with radiation: PEF Ablation targets only the cancer, while radiation treats the entire prostate and often brings long-term side effects.
When Radiation Is the Right Choice
Radiation remains an excellent treatment option in specific situations. It is often chosen for older men who are not good candidates for surgery. It is also highly effective for patients with unfavorable intermediate or high-risk prostate cancer. In addition, some men prefer radiation because they want to avoid surgery and are willing to accept the long-term side effect profile that comes with it. However, for men with early, low-risk prostate cancer, radiation can be more treatment than necessary, and focal therapies such as PEF Ablation may offer a better balance of effectiveness and quality of life.
Quality of Life Considerations
Quality of life is one of the most important considerations when choosing a prostate cancer treatment. Radiation therapy can provide strong cancer control, but it may lead to gradual erectile dysfunction, urinary irritation, or bowel changes that develop over time. Robotic prostatectomy carries risks such as urinary leakage and erectile dysfunction, although many men experience significant recovery with time and targeted therapy. PEF Ablation is specifically designed to minimize both urinary and sexual side effects, which makes it an especially appealing option for younger men who want to preserve function while treating their cancer.
How to Decide Which Specialist to See
Deciding which specialist to see begins with confirming your risk using PSA results, MRI imaging, and biopsy findings. Once you have this information, the next step is to meet with a urologist, who can explain the full range of treatment options rather than focusing on a single approach. From there, it is important to define your personal goals, whether your priority is cure, preserving function, or achieving both. Finally, the decision should be made in collaboration with your care team to ensure the chosen path aligns with your diagnosis and lifestyle.
Conclusion: See a Urologist First
Both urologists and radiation oncologists play vital roles in prostate cancer treatment. However, starting with a urologist ensures you will learn about every option available, from active surveillance to surgery, to focal therapy like PEF Ablation, to radiation if indicated.
Contact Atlanta Prostate Center today to schedule a consultation.
