Radiation and Surgery Side Effects for Prostate Cancer | Ask a Prostate Expert, Mark Scholz, MD
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- čas přidán 24. 07. 2024
- Alex asks medical oncologist Mark Scholz, MD to compare the risks of side effects between prostate surgery (radical prostatectomy) and radiation therapy for prostate cancer.
0:05 What is the side effect rate of radical prostatectomy for prostate cancer?
1:14 What percentage of radiation patients will experience negative side effects?
4:19 How permanent are the side effects of radical prostatectomy?
6:32 How often does radiation cause rectal burns? How effective is SpaceOAR for preventing them?
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The Prostate Cancer Research Institute (PCRI) is a 501(c)(3) not-for-profit organization that is dedicated to helping you research your treatment options. We understand that you have many questions, and we can help you find the answers that are specific to your case. All of our resources are designed by a multidisciplinary team of advocates and expert physicians, for patients. We believe that by educating yourself about the disease, you will have more productive interactions with your medical professionals and receive better-individualized care. Feel free to explore our website or call our free helpline at 1 (800) 641-7274 with any questions that you have. Our Federal Tax ID # is 95-4617875 and qualifies for maximum charitable gift deductions by individual donors.
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#ProstateCancer #Prostate #MarkScholzMD
After a positive biopsy with 6 Gleason score I had brachytherapy with Dr. Brian Moran through DuPage Medical near Chicago. Near identical urinary and sexual function afterwards. My urologist was eager to do RP and advised against IBRT and I had to seek out brachytherapy independently. Glad I did and I suggest that anyone needing treatment for PC consider other options.
My dad name is Robert as well and I’m here educating myself because he has PC. He received some not so good news today about his bones. My dad is a much older man whose been fighting as hard as he can and following all instructions provided to him. I’m so proud of him and I pray he will be on this earth many more years because who else imma call a old fart and they burst out laughing like he do. I’m glad your therapy worked well.
@@Socialmediaoverload , thanks for your comment. Good luck to your dad. He’s fortunate to have your support and love.
@Robery Mizek I'm in the same situation. Being "only" 57, with a 6 Gleason and level 1, I'm not eager to entertain surgery either. Brachytherapy seems a good choice to make. Although I did switch from my original urologist at DMG to one at northwestern downtown.
@@habanos2000 like me you’re up is the best possible situation if you have to be face with Pc. If you have any interest in speaking with Pc survivors who have gone through what you’re going through check out this local support group. I found it helpful. good luck to you. www.chicagoprostatefoundation.org
What exactly is brachytherapy? I learned today that I have prostate cancer from the results of my biopsy last week. I’ve already seen enough videos do you know I am not having surgery. The idea of spending the rest of my life without getting an erection is something I can’t deal with. I don’t exactly have women lined up at my bedroom door, but the ones that I do see, or I should say couldn’t see anymore is something I can’t deal with. I’m going through some severe anxiety right now of my choices.
You guys are absolutely wonderful thank you so much for what you're doing.
This is another great explanation. Thanks.
Excellent information as always. Thank you both! 😊
Thank you so much!
I went into my diagnoses, Gleason 8 without the benefit of a medical education. I was lucky when I reached out to friends who sent me to doctors who had proven results without surgery. I also fell upon a urologist (head of robotics surgery) who said “we want a medical victory not an emotional one”. After 20 sessions of Kylipso guided radiation and Lupron and Abiraterone acetate my PSA went from 30.2 to
Hi, it takes time but the hormones do return! See my blog.
Really informative vlog, thanks.
Thank you both for your useful knowledgeable discussions answering many of the questions we have .
Thank you so much for the information you provide. Your channel rocks! I just finished my radiation. Very hopeful for a long term positive outcome.
Did you go through the hormo al therapy first?
@@simondumoulin2254 I did not do hormonal therapy beforehand. I thought long and hard about weather or not to do it but in the end decided not to do it. My reasoning was:
1) My gleason score was (3+4)=7 and my PSA at its highest was 8.6. This put me at a fairly low risk that the cancer had spread outside the prostate. - (In retrospect I wish I would have asked for
2) My doctors told me that the statistical increase in success using hormonal therapy with radiation for my level of cancer would only amount to about 1%. (Meaning if you treated 100 men with hormonal therapy, only 1 of them would see a benefit. The other 99 would suffer all of the negative side effects with no cancer benefit.)
3) I did not want the negative side effects of chemical castration. (Muscle loss, loss of drive and motivation, breast growth, increased risk of diabetes and cardiovascular disease, etc. )
@@simondumoulin2254 ** (In retrospect I wish I would have asked for a PSMA pet scan to confirm that there was no evidence the cancer had spread outside the prostate.)
@@scottj0007
I thank you deeply for your informative reply.
In my case, the cancer is agressive and it has already spread to the pelvic bone.
This certainly means that I will chemo/radiation regardless.
I am thinking that I might as well get rid of the prostate all together.
From everything I have heard and read so far, it seems that radiation on the prostate has better outcomes than surgical removal.
The treatment I dread the the most is hormonal therapy.
The side effects and the reduction of quality of life appear to be far more terrible than the bennefits.
Thanks again Scott
How many fractions did you have?
I read all the comments below I wonder why my case is so different? I came to know last week that I have an agressive pc gleason score of 9 but why my psa is so low only 3.8? I am so worried that will spread anytime soon. The expert in the Hospital still discussing what the best treatment they will give me.
I am SO grateful for these videos from PCRI and Dr. Scholz! This video in particular has given me further solace that ADT and high dose brachytherapy, followed by low dose external radiation is definitely the correct direction for me. Especially with perinueral and periprostatic invasion, Gleason 3+4 and T-3 upper end intermediate ratings. With that status, the real question is whether surgery would "get it all". Without this type of education, where would I be? In the camp of the unaware. THANK YOU for helping me on this journey.
I honestly think it is the ADT (3, 6, 12 or more months...with the effects double the dosing period ) that turns some folks away from radiation and towards surgery. That being said, if there is periprostatic invasion I would think ADT, Brachy and external radiation (with its wider margins) would be the better initial curative option over surgery. Someone choosing surgery in that circumstance might very well wind up with subsequent radiation (w/wo ADT).
@@robertmonroe3678 Spot on. Someone I know, dealing with Gleason 4 + 3 and perineural invasion opted for prostatectomy and subsequently is dealing with radiation. I totally agree with you.
@@rolfeliason5950Just adding a detail, but perineural invasion is simply so common in Gleason 3+3 and above I've seen it essentially written off (rightly or wrongly) in terms of a factor in prostate cancer initial treatment plans. (Apparently PNI is a topic of debate amongst the experts with studies that are at odds with each other.)
This explains why it is so important for people to get multiple opinions from a variety of physician many of whom do not specialize in gu oncology.
When you speak of surgery, I am assuming you mean having the prostate removed. Is this correct? I was diagnosed with prostate cancer in August of 2020 and went through "high Dose" 5-day radiation treatment in November. The team at SCRIPPS in San Diego were exemplary in the orderliness of their processes. Now over a year later I am still on Flomax but do have a small amount of ejaculate with my orgasms. My PSA test before the radiation was 11.2 and then within three months of the treatment my PSA went down to 5.29. Four months later it went down to 1.5. I am scheduled for my next PSA within February this year, and will have one every six months until it is apparent that the cancer is not coming back. The worst part was when they put the four Gold Seeds in my prostate so the MRI and other machines could track then lock onto exactly where to aim the treatment. The actual biopsy was not all that uncomfortable if not a Little embarrassing.
Are you happy with your treatment choice?
@@WendellLive YES !
U rock sir
1:29 You’ve got that right I NEVER had ANY of the side effects of radiation ☢️ explained.
Let alone discussed with me.
It’s a horrible procedure, I was given a stricture when I was catheterized.
The biopsy has no sedation.
I was scolded by a RN the entire time while having 13 pieces torn off of my prostate.
Not to mention radium seed implantation, which is totally emasculating.
I got rectal proctitis from radium seed leakage.
Which resembled a heavy flow period.
I had meatal dilation, which is having a shaving blade that’s inserted into the urethra and opens filleting away tissue on it’s way out.
All these procedures are done without sedation for reasons I will never understand.
Other than being told by a female RN it’s much more painful when coming out of sedation from these procedures.
Seriously I would rather be given a choice of my pain induction.
I have been a heavy sweater since childhood, I feel like I am in womanspause all the time.
I never wear a coat, nor as much as a jacket in the dead of winter.
I scrape ice without gloves or a jacket, ‘yes I get that hot.’
Only now it’s like I am microwaved from within outward.
Everyone should begin a familial cancer list.
Trust me you will be amazed at how much there is, as I was.
I now found a competent urologist that actually deals with me in person.
I appreciate that, I’m a patient that enjoys conversation, as well as being communicated with.
I now have night sweats, no ejaculation, I have to use Flomax.
After the painful dilation left me unable to urinate in a steady stream.
I have to sit like a woman to have control of my flow.
With the use of Flomax I am capable of making it to the restroom.
It’s embarrassing to be mid~50s when I continuously pleaded with my PCP.
I was constantly told it wasn’t necessary, after several years.
He finally ordered a PSA drawn, which came back positive.
That I should be checked because my Dad had prostate cancer.
(In all seriousness I hope my post isn’t deleted.)
I would have never had this surgery done, possibly the reason it’s never discussed.
Thank you for this information. And I will be following your Instagram for your beautiful dog
Ive heard that with radiotherapy men can get secondary cancers a few years later, is that common? Thank you
I fear that too; it’s worse for men who get a bad radiologist, perhaps poorly calibrated machines with poor aim, older men, smokers, people with other health issues like diabetes.
But also, the longer one lives, the more chance for the genetic damage caused to spiral into tumors in the vulnerable bladder and rectum. Nowadays I think the bottom of the bladder is the vulnerable area.
I like brachytherapy because there’s far less of an “aim” issue...there’s not a beam shooting through snd into your body.
Yes, but concerned that brachytherapy can worsen bph and urination! Thanks for message.
@@roger1uk676 it can scar the urethra but not so common. Should relieve bph.
If you want to shrink your prostate, go vegan and lower your cholesterol with statins which will reduce testosterone. Your bph should go away. DHT is what causes an enlarged prostate. There are supplements to reduce DHT.
Casein is the worst thing for prostate cancer cells. Saturated fats and animal proteins are also bad.
Thanks, ive already gone vegan, lost a stone in weight, cut out sugar ie chocolate,sweets,biscuits!
Not sure about starting to take statins!
Does the patient feel any side effects after radiation, or is it just like getting an x-ray, where you feel nothing afterwards?
There are side effects towards the end of the sessions. Lot of peeing, urgency, frequency, hesitancy...but these clear up within weeks. Some get temporary bowel problems like diarrhea but I had none. Modern linacs are very precise and problems seem minimal.
I had 20 radiation treatments in May 2022. So far I don’t have any side effects whatsoever. At my first blood test my PSA went down from 5.7 to 1.3. My Radiation Oncologist was very happy with that result.
Will side effects possibly develop down the track or I will I stay the same?
Cheers
Ben
It is hard to say and a lot of it depends on your pre-existing health, age, and function. We have a few more videos about it that you can find by searching "PCRI Radiation side effects."
An imperfect summary of our videos is that some men get progressively worse erectile dysfunction about 1-3 years after radiation, but many others do not; my understanding is that it is about half and half, but strongly related to a person's pre-existing situation. If a person does not get ED from radiation after 1-3 years, he is unlikely to ever experience it from the radiation, although this is the age group where it is common for men to begin experiencing ED naturally. This is more of an oddity, but in the realm of sexual function, most men see a significant reduction in ejaculate volume, possibly with none being produced at all (which is also the case with surgery), but a small minority of men do recover from that and have gone on to conceive healthy children. About 5-10 years after radiation, there used to be concern about secondary cancers developing from the radiation, and so doctors were usually doing rigorous bladder and rectal cancer screening; however, since radiation aiming technology has improved, the risk of secondary cancers has become negligible, but enhanced screening would still be reasonable and possibly indicated by your physician just to be safe.
You can also contact our free helpline which has patient advocates who can tell you more. You can find our contact form here: pcri.org/helpline.
@@ThePCRI Thank you for your detailed reply. I’m in my late 60s. I have a had reduction in ejaculate. I forgot about that. I’m in good hands with the specialist I’m seeing. Hopefully the side effects are minimal. Keep up the great content. Your information helped me decide to go with radiation rather than surgery.
Would Brachy be the same as Radiation - in terms of the late start on erectile dysfunction, 1-3 years after? @@ThePCRI
I had no symptoms from my cancer. After 26 rounds of radiation, I have ED and rectal bleeding for the last 3 years.
Do you use space gel with Brachy?
Dr. Scholz is not a radiation oncologist, but SpaceOAR can be used with brachytherapy. It depends on the practitioner and the individual patient whether or not they use it. If you have any more questions, feel free to contact our helpline at pcri.org/helpline.
@@ThePCRI thanks
You should really mention the possibility of patients suffering lymphedema after surgery, as I learned after mine. When so many lymph nodes are removed in the central thoracic area, there is the small chance that the lymphatic system becomes compromised in the lower extremities. I’m upset that this risk wasn’t explained to me prior to the path I chose, not that it would have changed my decision, but it would have possibly steered me in the direction of radiation. I now have mild periods of swelling in one leg, such that I can’t put on certain boots or shoes comfortably, and sandals are discouraged altogether with this condition, which is permanent and supposedly gets worse over time.
I was told that after radiation you could not have surgery. I had surgery because i just wanted it out
Thanks Again. Great information!
Melbourne Australia
I had radiation therapy - wish I had opted for surgery. My penis and testicles atrophied horribly, and I ended up with incontinence (overactive bladder and fecal). I’m alive.
How successful is nanoknife I have had it twice but disease has returned
In appropriately selected individuals, Nanoknife, like all forms of focal therapy, have cure rates that appear to be similar to the cure rates from radical therapy (i.e. radical prostatectomy and whole-gland radiotherapy). This study, for example, is a prospective database study (so not as rigorous as a phase III randomized double-blind trial or anything) and it found similar cure rates between focal and radical therapy: www.nature.com/articles/s41391-020-00315-y#:~:text=As%20per%20definition%201%2C%20failure,(73%E2%80%9386%25)%20vs. Other data have found slightly lower cure rates with focal therapy, but rigorous studies require the randomization of patients which makes it difficult to compare focal therapy with radical therapy since patients are usually specifically selected for focal therapy based on their specific circumstances, which is not good for randomization.
Results may vary from doctor to doctor since focal therapy requires specialized knowledge and experience with treating a good margin around the disease within the gland so that the disease does not recur from the same location while also trying not to treat more of the gland than they need to since that would increase the risk of side effects. This requires special skills in imaging and in treatment. But even with a good, experienced doctor, there is the possibility of a new cancer developing in the remaining portion of the gland, and so that is why patients are following so closely after focal therapy. If a new cancer is discovered in a timely manner, it can be treated without compromising the patients longevity, although it is typically disappointing for patients who usually have paid a lot of focal therapy to then need more treatment which negates the benefit of focal therapy which is that it has a lowe risk of die effects (although, in that case, they will have hopefully enjoyed the period between the two treatments without many side effects, but it is debatable and personal whether it would be worth the money when upfront treatment is typically totally covered by insurance).
First time I have heard you speak of penile injections, and atrophy, or as I like to say "shrinkage'! 1. this is important for men to know, and 2. the needle is small and easy to do/painless I mean why add insult to injury by letting men lose size on top of all the other things that happen with this damn disease.
Atrophy in this case means impotence because of non use. The penis is shorter after surgery anyway because the urethra goes through the center of the prostate, so the urethra is chopped snd then reconnected after the prostate is removed.
@@peacefulruler1 I don't think so, the bladder is lowered to compensate for the gap.
@@michaelyarmas4423 prostate surgeons don’t rearrange other organs :)
@@michaelyarmas4423the bladder is pulled down to join the urethra and in turn pulls the urethra back in,guaranteed you will lose half an inch at least
I wish I knew more than I did but my psa jumped up to 14 and did surgery over radiation and six months hormone treatment now I’m having problems and every day I wish maybe I did the radiation to late now and I was sexually active before and stress that to the doctor
I had 33 doses of high level radiation after surgery, smoking hot but no erection yet.
There was no mention of the extent of disease when discussing surgery vs radiation. Additionally, not a radiation oncologist and not a surgeon. What are his credentials?
George, he is a medical oncologist. We have a number of other videos discussing radiation vs. surgery for different levels of cancer aggression and extent of disease for different types of radiation (brachytherapy and external beam). We have a helpline if you are interested. You can find our contact information here: pcri.org/helpline
Why no talk about the possibility that you get cancer in urine bladder after some years behind radiation treatment?
My RP recovery was fast. I'm the 5 percent the good Dr. Doctor refers to.
I did radiotherapy with ADT. The radiotherapy was a breeze, the ADT sucked.
What is radiotherapy? I was just informed I have prostate cancer by my doctor today and I am definitely not thinking of surgery. Every video I have seen so far concerning removing the prostate was surgery scares the hell out of me. I am not planning on going through life without getting an erection. So now my options come down to radiation. Are there different types of radiation therapy?
I never had a potency issue after my RP.
@@justdoesntaddup8620 March 20, 2019.
@@justdoesntaddup8620 yes.
I've just underground SRT.
@@justdoesntaddup8620 Every urologic surgeon in the modern era uses robotics. Its simply superior in terms of visualization, blood loss and duration of hospital stay. Hate to say it so bluntly but you really should not be getting an open prostatectomy in 2021.
There is no discussion of the chance of radiation-caused lymphoma. I was quoted by a very high quality radiation oncologist that the risk is 1% per year. With prostate cancer at age 48 that would be a remarkable high chance over the balance of my lifetime. I was hoping for getting prostate cancer in my late 60s, do radiation, and even if not fully effective die with the prostate cancer, not from it. Of course, the surgeons minimize the probability of side effects and even great surgeons have mediocre outcomes on a regular basis.
This guy has such a bias towards radiation ☢️ I’m sure it’s a substantial financial interest on his part.
Very important to get more opinions than this one.
Carlos,
We agree it is good to get multiple opinions!
Dr. Scholz does not receive any financial support from radiation oncologists or radiation companies. His opinions are based on recent advances in radiation, the outcomes of his patients, and the literature, which when accounting for the average age of surgery patients usually being much lower than radiation patients, shows similar or superior cure rates with radiation versus surgery (depending on the stage of disease) with a lower incidence of side effects.
that exactly what I though
It’s my understanding that radiation can have side effects such as ED and incontinence too. There’s no perfect treatment. I have a loved one just diagnosed with prostate CA so I’ve been researching it. I’m also an OR nurse and have seen prostatectomies first hand. There’s no easy way out here. Each man has to do the research and decide what he can live with..
There is nothing wrong with bias if it's consistent with the science.
Urologists are biased toward surgery because surgery is what they do. Radiation oncologists are biased toward radiation becuase radiation is what they do. Dr. Scholz is neither. He's a medical oncologist, so in theory he should have an obective viewpoint.
Long term side effects after radiation are same or more than after surgery. So it is a choice of patient not a doctor to decide. If i am healthy young , surgery is not abad option. Elderly in 80 ‘might want to consider radiation.