Which is Better - Surgery vs. Radiation for Prostate Cancer?
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- เผยแพร่เมื่อ 10 มิ.ย. 2024
- PCRI’s Executive Director, Mark Scholz, MD, explains why there has been a surgery vs. radiation controversy, describes the pertinent risks and considerations when deciding between the two treatments, and explains why he thinks radiation is usually going to be the preferable option, all things considered.
0:43 The main reason why there is a controversy about whether surgery or radiation is better for treating prostate cancer is that as recently as 10-15 years ago the technology for radiation was significantly less effective and more toxic than it is today. There were also fewer options for salvage therapy after radiation in the event of a relapse. Since then, radiation technology has advanced significantly, but the dialogue has been comparatively mired. Today, radiation can be precisely delivered, and radiation is achieving even better cure rates than surgery.
1:59 Surgeons are constrained by the fact that the bladder and the rectum are within millimeters of the prostate. They cannot cut a margin around the gland. Radiation oncologists are not limited in this way.
2:21 External beam radiation has a cure rate about as good as surgery, and radioactive seed implants have even better cure rates than surgery.
2:33 Most men will live for a very long time after being treated for prostate cancer, and so it is important to consider the side effects of each treatment, especially now that they all have comparable cure rates.
2:54 There is a risk of sexual dysfunction with both surgery and radiation, however, the rate of impotence after surgery is significantly higher than after radiation.
3:15 There is a risk of incontinence with surgery that is almost non-existent with radiation. An operation performed by a top surgeon on an ideal candidate has about a 5-10% risk of causing incontinence, and that is with the best possible conditions. Stress incontinence occurs in around 50% of men, and ejaculation of urine occurs in about 20% of men.
4:00 Rectum burns used to be a concerning side effect of radiation, but that risk has been eliminated with the advent of SpaceOAR, a gel that separates the prostate from the rectum and protects it from radiation.
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Here in the UK I opted for surgery (Da Vinci robotic) on the basis that removing the whole gland would remove the problem for good. After 4 yrs my PSA which without a prostate should be zero, started to appear. At PSA of 0.2 I had radiotherapy to treat the prostate bed, the area that surrounded the prostate. I’m now one year later, on 2 medications for a total of 2 years. Speaking with a senior radio therapist and as noted in this video, surgeons removing the prostate have to leave a small margin in the body and its from these cells that the cancer can remain and grow. Modern radiotherapy is a wonderful very high tech and accurate treatment and I have no side effects from it or the surgery. I’m so thankful for the treatment I’ve had, that I support The Prostate Project, a local prostate cancer charity.
That’s wonderful for you, I believe it varies patient to patient.
I have many reactions similar to what this doctor says happens with surgery.
I had a full week/45 minute sessions, of radiation soon going on 7 years.
Actually, I wish I had never had any procedure done.
IMO.
I had maybe two weeks before my next appointment.
The receptionist called to tell me the doctor was closing his cyber knife practice.
I don’t understand how anyone just decides overnight to close.
I had to pick up my records.
Ended up finding a horrible urologist.
He caused unnecessary trauma as outpatient surgery without any sedation.
Now, I have a much younger doctor.
He’s got his profession down to an art.
I advise anyone diagnosed with any form of cancer.
To thoroughly research and listen to other cases.
Which is a truly difficult task when put in a situation, in such a shame based society.
Although it is difficult to cope with, trust me it’s well worth your effort and time.
Excellent video Dr Scholz. I was just diagnosed with prostate cancer and was tossing coins between surgery and radiation. Radiation just won!!! Thank You for all you do for prostate cancer research and helping patients like me.
Thank you for being so clear and helping me understand.
I can't tell you how much this video means to me. After stressing about my options over and over and over, I had decided radiation therapy was the answer, but your confirmation of this just sealed the deal for me. My urologist is trained in the DaVinci Robotic system and recommended Radical Prostatectomy. I was scared and agreed, but now after having researched studies concerning both, especially the incontinence aspect of surgery, I am definitely going with radiation. Dr. Scholz, I personally thank you for your candid and unbiased opinion on these two treatment solutions!
Did you do the radiation and how are things going so far, facing this issue right now
@@dappa311 My radiation treatments (28) start December 5
Keep The Lord on your side...no matter what options you have. When I had the biopsy done a couple years ago, one of the 12 showed cancer. I changed my diet, and take several different herbal & other supplements. My last PSA was 5....which was MUCH LOWER than when I went to the urologist....God be with you brother....
I wish I went that route, the removal of my prostate and lymph nodes has just ruined my life. I’m still a productive member of society, but at 59 I still have a strong sex drive and it’s driving me crazy
@@petegodfrey5735 I have an entire host of prayer warriors sending them up with me.
Thank so much, now I'm exactly in the situation to make a this decision, and this explanation is very on time. 👍
Amazing information at the finger tips of the world... Thank you!
Thank for you the PCRI videos, they are incredibly helpful and it is so fantastic to have access to all this knowledge :-)
First of all, my heart goes out to those gentlemen who have been diagnosed with prostate cancer. I had my prostate surgery in 2004 at Johns Hopkins University. I was in that category in which it would be wiser to choose surgery, as discussed by Dr. Scholz above. Now, 17 years later, I wish I had had access to the new technical information we have now. Certainly, my life would have been much different over the last 17 years. May God bless you all.
blessing you for your recovery. If you were a new patient now, which options would you choose? radical prostatectomy ot radiation therapy?
fortunately, my elevated PSA is caused by BPH and prostatitis, no need of any prostate cancer therapy.
God bless you and everyone.
@@jameslee2465 Read full text description of this video. It will help you decide that radiation is the better option, in case required.
@@HB-mn8lh I think he said he didn't need any treatment , he just has prostatitis and BPH that means he doesn't have cancer
@@jameslee2465 That was my case for the longest time too, but six months ago I was diagnosed with prostate cancer. Stay on top of this as you go forward. Don't take your BPH for granted.
Thank you for this wonderful message!
Very interesting and helpful vid. Many thanks for making it.
You mention a form of shielding during radiation, which seems a real ‘game changer’.
Is this also being done when the cancer is locally advanced?
Great information .Thank you doctor.
I opted to have 20 shots of radiation on my stage 4’ 3 years later PSA around 1-2. No washroom issues here. Biggest part for me was to walk a lot and even more effort to clean up my diet which was never real bad. Have no fear and make your decisions from a place of well being and not fear.
This is an awesome testimony right here!
So you haven’t suffered any sexual dysfunction or leakage
Bless you, Bro!
Is walking excercising good between radiations??
I’m 77 and recently just completed the six month hormone treatment period. My PSA went from 26 to 1.2 after the first three months. I’m now on my 8th of 20 radiation sessions after seed implants. I cannot fault my treatment and results so far, so count myself as extremely lucky. This vlog was very informative so thank you once again.
Good luck Fred, mate.
Cheers. After completing radiation my next PSA came down to 0.09. Now need to present my next test after the six month period to monitor all. A good result and feel lucky.
Hi My father 74 age 3+4=7,grade 2,psa 8,8,biopsy 4 of 12 positiv all left and left centar 1 and 2 (6%-10%) 3 and 4 (11%-20%)
Surgery or radiation advise
@@bojanreljic8310 How healthy is he? Is surgery an unusual risk for any reason? Remember at 77, nothing heals as well as when we were younger. I would heavily read about his options on the PCRI web site.
@@bojanreljic8310 Did you decide?
(1) Is SpaceOAR limited to short term radiation treatments like SBRT? I've heard that if you get a 5 week treatment of radiation you can't use SpaceOAR due to the gel dissolving, altering the architecture of the physiology slowly and risking mis placement of the beam. (2) What about long term effects of radiation? Impotence over time? other cancers? Thank you.
Very helpful. Would love to see an update as to whether the considerations now are different than four years ago
Thank you guys for all the information, I now need to make a decision on surgery or radiation or the seeds, though the doctor was very luke warm 🤔 about the seeds, very of a matter of fact with the radiation, especially its side effects the only thing he gave me literature on was radical surgery and it was about 20 pages. Lots to think about while I wait for my CT scan and something about the bones with contrast, they are wanting to see if it had spread, my doctor doesn't think it has, wish me luck guys.
Hi Bennie, if we can help, please feel free to reach out. help@pcri.org
Thank you so much for that information
Thank you 😊 💓
Dear Doctor:
How soon after a Robotic Assisted Radical Prostatectomy can I resume my maintenance BCG treatment for my NMIBC safely? What is your best suggestion on this?
Thanks.
Thank you very much.
Very nice and informative. 🙏
This video is amazing, thanks doc
Sir which is preferable in case of Pancreatic cancer.
Thanks for sharing
Thanks
Dr. Scholz: If ia have both bladder cancer (BCG treated) and prostate cancer (3+4), is it true that radiation therapy is not recommended for the prostate cancer because it might cause recurrence on the bladder cancer? In such case, is prostatectomy the most feasible option?
Thank you.
I`ve been told that there is a problem with SpaceOAR and some centers have stopped using it? Any news on this?
I had my PSA ramp up suddenly when I turned 63 and hit 8.4 from ~5 in two years. After a DRE, I went with a needle biopsy since the doctor didn't even mention the Opko 4kScore blood test or the SelectMDX urine test, after repeatedly asking him if there are any other tests. The Biopsy revealed a Gleason score of 6 and the Urologist started looking at his calendar for a surgery appointment. I started my own research since it seemed to me the Urologist wasn't very forthcoming and pushing me where he wanted. His arguments for radiation (48 sessions!) vs surgery etc. were the same arguments made 30 years ago! I discovered on my own that I had the option of Cyberknife, which is a highly accurate high intensity X-ray radiation that is very common in Europe, less common here in the US. I had a 3T MRI and a CT scan (one of them to locate the target) which was a rice bead size non radioactive gold pellet/target (called a fiduciary) being placed in the prostate, I had the surgery in six (6) 1 hour long sessions. My PSA dropped to below 1 and has stayed in that vicinity for almost 3 years. No other side effects such as bathroom issues or impotence etc. All my subsequent medical tests are 100% normal and I'm over 68 now. I'm not worried about DNA changes either since the beam affected such a small region. I'm so glad everything went the way it did! This was my experience, yours might vary, but I hope it helps someone.
Now there are even newer methods like PSMA PET scans that could obviate painful biopsies! These treatments could gain FDA approval anytime and be available for Medicare patients.
The real POWER in your story is the way YOU took command of YOUR situation including doing deep dives on the necessary research. Good on, ya!
@@larryk1865 Thanks! I believe everyone should study their own situation and NOT blindly go along with any advice if it is that important to your survival and quality of life.
@@anantdabholkar685 you had surgery can you clarify or just Cyberknife treatment
- Very good description of your case, Anant.
This is certainly proving to be important for many men across the world. Thanks for your clarifications.
At this moment, I'm about to decide about surgery or radiation - or none of those (just Active Observation).
I'm 74, white, good health, sexually active and live by myself.
Once more, thank you.
_Anton, Rio de Janeiro, Brazil - August 23, 2022_
@@maliwaqar only Cyberknife, nothing else. Your situation maybe different.
Thanks 🙏 doc and God bless
Hi had my radiotherapy back last year, everything has been great but getting blood now on number 2s Spaceoar was not offered can you recommend any help here? Thank you. Gleason9
He didn't mention the 2 years of hormone treatment that will be needed along with RT if you have an aggressive 8, 9 or 10 Gleason score cancer.
Fantastic info but is this still correct/Dr Scholz opinion 4 years later? Also, the Radiation Side Effects video is 10 years old so is the info now outdated?
What should my PSA be after a Full removal of the Prostate,,,,,mine was .06,,,raised to .12,,,,,
Thank you kind sir for helping me understand and make the right decision for me
Wow thank u so much sir.
I've been diagnosed with a Gleason 8 (4+4). I was offered surgery and told the alternative is hormone therapy (which would continue regularly for 2 years), brachytherapy and THEN radiation. The side effects of hormone therapy alone are enough to put me off so I'm opting for surgery.
Combination therapy with radiation has been found to have superior cure rates in Gleason 8 prostate cancer with fewer risks of permeant side effects (www.prostatecancerfree.org/compare-prostate-cancer-treatments-high-risk/). There is also the possibility of doing hormone therapy for 18 months instead of 24. However, everything is up to you and your priorities. If you have any questions, feel free to contact our helpline; our contact information is here: pcri.org/helpline
I was diagnosed Gleason 8 with presacral node spread Sept 2019 during workup for aortic valve replacement. Inoperable. After the valve surgery, proceeded to 18 months hormone therapy and targeted radiotherapy.
Impotent, but alive. Flushes. Minor problem My last hormone treatment was a year ago. Lots of people live with far greater problems. Initial bladder and rectal problems. Rectal has settled. I used a homeopathic remedy which was basically a stool hardener. Urine frequency, occasional urge incontinence.
My Psa levels not measurable. Bone density normal. MRI whole body, no signs of any spread. I am very grateful for the highly skilled medical people involved in my treatment. I would trust and go with the recommendation. Good luck.
Previous studies from John Hopkins, the most respected location for prostate cancer surgery in the world noted poor surgical outcomes with Gleason Scores 8 or greater. The study authors from JH did NOT recommend surgery for Gleason 8 or greater even at their own institution....... very instructive.
The best solution how to get guet rid of Cancer is whit CiberNife Prostate cancer at Georgetown University Hospital, Doctor Sean Collims offer 2 months of Medicación of Oral Hormone reducer, then only 5 Radiaton of 1 hours each, and then 2 months Oral Medication and then, follow up of 3, 6,months, and 1 year after. ..I completed my Treatment on April this year and I’m doing fine..
Bob, Just found out I'm a Gleason 8 (4+4) as well, I was wondering what option you decided on? Results so far? Hopefully you're doing well. Thank you.
Ok I am facing the same decision and my urologist says surgery ,,same with my regular doctor , I am 3-4 with one vial out of 14 showing 57 % aggressive ,,when I ask both doctors about proton therapy they both say it doesn't really matter they melt your prostate
im so confused
I'm facing this right now
Amen Doc Thank You I need to hear this I’m on the choice to chose 🙏💯🙏
Thank you Dr Scholz !
Hello mate whatever you do please do not go with robotic surgery operation please..try other options. I Had the surgery as well mate and my life has been changed badly.Last year I admitted to A&E twice this year so far 6 times.
Girl friend became a X,feeling no man anymore, Still 3 years after the operation I get pains all over my body,before the surgery operation I never walked into a hospital but now I go regularly!!
Because use of Catheter I got a kidney infection, liver problems etc.you name it.
Before the surgery I was not waking up of the bed night time
Before the surgery I was not suffering with any pains.
Before the surgery no kidney no liver problems at all.
Sex life was top of the range great.
I can't even lift up a toddler for 5 minutes.
Just imagine that.I lost my job as well.
Before I set off my house I always make plans to visit toilets.
Still there are leaks what an embarrassing situation!!!
I can make a massive list really .
It's a horrible feeling that I put my self into this situation I let them destroy my life.
But I'm the one guilty at first place to let them destroy my life.
I don't include shortening of my penis.
Before the surgery I was leaving my house and was able to not to visit toilets for 5-6 hours now I do every 30 minutes maximum..
As I said at the beginning please try hormon therapy Radiotherapy whatever but do not go ahead with Surgery operation option.
i was fortunate that i choose to go with radiation in 2009 and had what you said was Pin Point Radiation once a day for 5 days over 8 weeks. I have been free of cancer for 13 years with a PSA of basically zero. I never regretted doing the radiation and i feel blessed so far.
You are indeed blessed!
Hi. My father 74 age 3+4=7,grade 2,psa 8,8,biopsy 4 of 12 positiv all left and left centar 1 and 2 (6%-10%) 3 and 4 (11%-20%)
Help radiation or surgery
Hi My father 74 age 3+4=7,grade 2,psa 8,8,biopsy 4 of 12 positiv all left and left centar 1 and 2 (6%-10%) 3 and 4 (11%-20%)
Surgery or radiation advise
@@SinnerSince1962 thank you and yes i was blessed to have discovered it early
Hi, what was your gleason score, age and psa?
My father 74 age 3+4=7,psa 8.8
Excellent, thanks.
I'm 70 years with a Gleason 6 but had an MRI score of P-Rads 5 . Lesion on right side of prostate but a low Gleason .
Dr recommended RT , is AS a good way to go at this time or get treatment now ?. Dr said surgery was overkill but the MRI reading is worrisome will get a biopsy again in 6 months.
The PI-RADs system only refers to the radiologist's confidence that what they are seeing is aggressive prostate cancer; it does not refer to the aggression of the cancer. A PI-RADS 5 means that they believe it is aggressive prostate cancer, but a biopsy is the only way to confirm or refute that , and it is fairly common for PI-RADS 5 lesions to be ruled benign upon biopsy. The biopsy, if it is well-performed (meaning it actually hit the target) provides the best information for guiding treatment (or not) decisions. If you have any questions about your case, feel free to contact our free helpline at pcri.org/helpline.
Dr Please will you discuss what PSA rate is and what Gleason rate is and how the two are compared and how surgeons come to the decision to operate.
I just think that money is the criteria for opting for surgery and not the interest of the patient.
Gary,
Here is a video on Gleason score:
th-cam.com/video/1Q7ERNtLcvk/w-d-xo.html
And here is one on screening using the PSA:
th-cam.com/video/tHrqESnfx_U/w-d-xo.html
PSA velocity, or the rate of PSA change over time, is mostly used after treatment to determine how quickly relapsed prostate cancer is growing. It is less reliable for screening since PSA can rise for many reasons if the prostate has not been treated.
My father have done rediation for prostate cancer but it's very weakness muscles not have energy can't get up and sit so we give degapride injection evry two months
God bless you Doctor thanks for your help
The real difference is the expertise of hands if the surgeons and the machines, the human mind behind each of the two modalities. So there should-be no doubt on the precision and standardization of machines vs the subjectivity of hands of the surgeons.
How can we get in touch with you Dr schools pls
Respected sir
I would like to inform you
My father fight to prostate cancer
Plz suggest me
Hello, our prostate cancer helpline may be able to help with your questions. Please feel free to contact us here: pcri.org/helpline
Which radiation therapy are you discussing? I'm recently diagnosed 10% in 1 of 16 cores with a Gleason of 3+3. Age 62, PSA of 14, which jumped from last year's 7. I've had high PSA for years. This was my third biopsy. The 2nd urologist I saw said it was natural for me to have a high PSA due to the size of the prostate. When it shot from 7 to 14 it was decided to have another biopsy, which led to the finding. Not sure which treatment is right for me. The VA will not pay for proton therapy.
Can you get on Medicaid and Medicare with your disability? If so you can get a better healthcare like a HMO or PPO and possibly get proton beam!
@@cafireman PPO will cover more. My HMO never had Proton Beam Machine.
Very clear. Thanks!
What about radiation and urinary voiding issues that persisi? My voiding is optimal after surgery. No bothersome side effects for me. Grateful.
Hello Steve, we answer questions like these through our free prostate cancer Helpline. Please feel free to contact us here: pcri.org/helpline
How long ago did you have surgery?
Any problems with having sex now or holding your pee
Steve , this answer is accurate - urinary results vary . I had CyberKnife radiation with zero effects of what you describe , and others who've had surgery have problems -
But it's visa versa also for some!
The answer is that there is no answer , just use the best practitioners in the specialty for the best results .
Steve - how are you doing now. Can you provide your surgeons full name and was it done robotically/da Vinci, and was it nerve sparing ?
I have treated thousands of patients in Houston with modern image guided radiation over the past 2 decades, and my patients are virtually all very satisfied and disease free. Your discussion pretty much mirrors what I preach and practice every day.
My husband had Space Oar and radiation last summer and he is doing very well
Thank you . Good luck
Hey Nancy thanks for the input. What was his Gleason score when he did the radiation ? And what treatment did he do ? Every day for 5 weeks ?
Studies are good for SpaceOar reducing the rectal complications after radiation. Space Oar is a good idea prior to radiation.
Very good video. It was because of this video that I went the way of radiation exactly 1 year ago. my Gleason was 7(4+3). It was done in 5 sessions over 2 weeks. So far no side effects. ( I was on 6 months hormonal too) Thank you so muchmuch
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Thanks Dr Scholz for helping the prostate cancer community - greatly appreciated; I have been referred to a urologist specialized in laparoscopy; how can I suggest radiation therapy without offending the Doctor?
Hello, our prostate cancer helpline may be able to help with your question. Please feel free to contact us here: pcri.org/helpline
Tell your Urologist you want to evaluate all options including radiation. Ask him to recommend Radiation Oncologists with whom to consult. Ask for both EBRT and Brachytherapy recommendations. After speaking to them all, you can make a decision. This is your life. Do not be afraid to ask questions and do the proper research
Screw offending him , that's how .
It's your life and your choice . And your doctor should understand and respect that .
You're not opting for voodoo or something .
Offending a doctor? Who cares, man? It's your life!
I have my Robotic surgery done in 2018 (Dr Vipul Patel). Gleason 3+4, post surgical biopsy revealed 10% of prostate was involved. Part of what drove this decision of family history. My father had it and his brother had it (My Uncle). My dad did not die as a direct result (but did later on from a another form). My Uncle did pass away as a direct result of the prostate cancer, and it was rough. I think, based on this video and other PCRI videos, I was in a transition or grey area of these two types of technologies. If this diagnoses have been made on me today, I would further explore the radiation option as it seems the technology has vastly improved. Still not sure which way I would go, but radiations seem more viable toady compared to back then.
Bob Lynch how did your surgery go? Any side effects (short or long term)? Were all nerves spared?
@@ovhome6841 most nerves spared. Typical post surgical side effects
@@boblynch2802 is this dr v. patel in FL? can you be more specific please. Do you suffer from incontinence? Or nocturia?
`Don't second guess it...Patients in favour of radiation leave out one important detail: Lupron. Now, I was an 8, so I was slotted into 2 years of what they politely call HRT, which, truth be told is chemotherapy, Lupron and medical castration. Since you were a 3+4, you would have probably had to have undergone a year of Lupron, which is unpleasant but doable. The side effects of having your testosterone driven down to zero are intense and severe...All this information about Lupron is out there...This doctor sidesteps the 3 ton elephant in the bedroom: Lupron....The problem is that radiation wout Lupron will make your long term prognosis worse...There's just no getting around Lupron, and all people facing this dilemma (surgery v radiation) would do well to research the side effects of Lupron before making that call.,
Im in favor of CiberNife Radiation, because CiberNife Radiaton destroy the Cancer Tumor..
Recently diagnosed. Radiation not an option as I already had that in 2016 for bowel cancer. Not keen on yet more surgery. Nor chemo. Guess I'm screwed.
Either way you go there will be complications that seem to play on every male not only physically but emotionally also but the big question is how badly do you want to live? I had the surgery 11 years ago. I had a friend diagnosed 1 year after me and had hormone replacement therapy and lived for 4 years. Every case will be different so ultimately it will be your decision. I fill like I made the best choice for me.
Your friend obviously had more advanced and extensive disease than you did. You made the right decision, but in his case there was no option for surgery.
This is great and it validates my decision to go with radiation.
Same here..
Hello everyone. I was just diagnosed with a high grade Gleason 9 pc. My urologist recommended surgery. What are my best treatment options. Please advise based on your experience. Thank you and God bless each and everyone.
Hello, we are not able to answer case questions on our comment section but we can help you through our Helpline who can speak with you either by phone or email. Here is the link to contact them: pcri.org/helpline
Thank you Dr Scholz for sharing your knowledge and experience. God Bless You.
Fistula, excessive bleeding are side effects of prostate ca right?
They can be side effects of prostate cancer treatments. Feel free to contact our helpline if you have anymore questions: pcri.org/helpline
Just diagnosed with Gleason 9 (4+5). I am leaning toward prostate removal at this point, but I go in for a couple of scans tomorrow to try to judge if, or how much, it has spread.
I'm 68 years old and diagnosed with PC (Gleason 4+3). My urologist said surgery or radiation were about equal at the 10 years point. (my research showed the same with surgery a tad bit better). I decided on surgery to get the cancer in someone else's petri dish. I have seen several of your videos and it seems now, that radiation has a lot of advantages over what it was 10 years ago. In a month I have a PSMA scan scheduled and depending on the location of the cancer, surgery may not be the best option. I guess if surgery is not the best option, from the surgeon's view, why not just do radiation anyway?? When speaking with a RO, his plan was hormone theory and 5 weeks of radiation, nothing was mentioned about using seed implants. Am I not asking the right questions or is there just the "standard" method of treatment, surgery or radiation?
My father 74 age 3+4=7,grade 2,psa 8,8,biopsy 4 of 12 positiv all left and left centar 1 and 2 (6%-10%) 3 and 4 (11%-20%)
Surgery or radiation advise
@@bojanreljic8310 I had first thought surgery just to get it out, but then opted for radiation since both had the same results at 10 years. Just completed 28 sessions. Issues were the time it takes (office 4 miles from home) and having to get the bladder full each time. Only issues now is an over active bladder which is clearing up. I hit the gym everyday after treatment and now after treatment. I am on 18 months of ADT as well. No bad reactions to the ADT or radiation (weight gain, fatigue, loss of muscle). So overall I feel very good.
Good luck on your decision.
@@MrRrace Thanks, his psa 1.11.2022 is 8.8 and 31.1.23 is 7.9 its good or no.
@@bojanreljic8310 my PSA was 4.5 when they sent me to a urologist. We had an MRI confirming the leason and then biopsy. We followed that with a PSMA scan. No mastitis. The urologist said surgery or radiation were the same at 10 years. Given that and my age, radiation sounded good. So far I am very pleased. Radiation was a cake walk
@@MrRrace Thank u for sharing your story. Like you I went through the same procedures after being confirmed I have prostate cancer this past August. I’ve heard from three men that radiation was fine it was the Hormone Therapy was the worst. Then I heard from three men who had the surgery and was glad they did. With this information I am still on the fence on what I should do. I’m leaning towards surgery but not happy having to deal with a catheter for 11 days. I’m scheduling to have.the PSMA PET CT SCAN then talking with a Radiologist regarding radiation. I’ll soon make a decision and just go with it and keeping God first in my prayers.
My psa increased so my family doctor sent me to an urologist, rectal exam showed nothing also ultrasound, mri showed something and my urologist did a biopsy February 2023, the result was 3+3 so I went A.S. my PSA increased to 9.5 and MRI and biopsy again in February 2024, the result showed 3+4 less than 5% and two samples showed 20 and 25 percent 4. The last PSA in May was 9. I really don't know what to do?
I'm 62 years old and healthy and fit.
I live in Canada
Some of his claims favoring radiation over surgery for sexual function don't hold up with the reading I'm doing (which puts them on par - not initially, surgery short term is much worse for sexual and urinary function, but gets better. Radiation is the opposite, the damage it does takes months to years so that 2-3 years later, the two approaches are pretty close. Surgery has also come far with robotics and has a slightly better cure rate, but both are way up there. Caveat is that this depends on location of tumor, stage of the cancer and aggressiveness, and age of the patient. I'm 53 and recently diagnosed, and the data mostly exists for men 15 years older than me, where many things are different (including life expectancy at each age). So, one has to weigh many things.
Is it true that if you choose radiation as your initial treatment that you later cannot have a prostatectomy?
Hello,
Here is a video we have on that topic:
th-cam.com/video/XeCfJ885PvE/w-d-xo.html
Although he does not mention it in that video, Dr. Scholz has said in a more recent video that currently, in 2021, the chance of a local recurrence (that is, a recurrence that appears in the treated prostate itself rather than in nearby lymph nodes or any other metastatic site) after radiation is exceedingly low if the radiation therapy is well-performed and that in the rare event of it happening, there are other options for salvage treatment that he considers preferable to salvage radical prostatectomy, for example, cryotherapy, high-intensity focused ultrasound (HIFU), laser ablation, salvage brachytherapy, etc. I will try to find that video and will update you when I do.
@@ThePCRI Thank you.
How about the long term side affects of radiation. I hear that after 4 years plus, incontinences kicks in. Is this still a fact?
Respected sir
My father fight prostate cancer
PSA is 867
Radiotherapy done in this month July (Monday to Friday )
But some problem observe details in given below
1. Weekness is more
2. Donot feel in poty
3. Alway sleep mode
Plz suggest me all reason during radiotherapy
Waiting Ur reply
Hello, our prostate cancer helpline may be able to help with your question. Please feel free to contact us here: pcri.org/helpline
Hi , how is your father doing now ?
Same my father done rediation in October 2022 but weakness is there can't walk now taking injection degapride 80 for reducing psa level what to do sujest for body movement
I went through the Nanoknife IRE almost 4years, the result is perfect good
Glad to hear you are doing well Victor!
blessing you. where did you get Nanoknife therapy? how its effect in therapy?
I am 63 years old. Will seeds and beam cause issues years from now? Am I to young for radiation therapy?
Hi, our prostate cancer helpline may be able to answer your questions and help you find helpful information. Please feel free to contact us here: pcri.org/helpline
Hi, My father 74 age 3+4=7,grade 2,psa 8,8,biopsy 4 of 12 positiv all left and left centar 1 and 2 (6%-10%) 3 and 4 (11%-20%)
Surgery or radiation
I am sorry Dr. but the gel spacer can and does causes bad infections. Its better to go with using a full bladder approach.
thank you !
Why is surgery not difficult after radiation anymore, Dr Scholz claims that, but he does not explain why, Could somebody clarify.
Dr. Scholz, is the pencil thin radiation beam coming from a Cyberknife or something like it, or regular EBRT?
My EBRT and I assume all now, have shutters at the beam's window that shape the beam as the head rotates around the body . The first step in the EBRT treatment session, is a 360 degree xray to find the gland, then the beam knows how to shape that beam as it's head rotates around you.
@@SeanONeill13 Thank you for sharing. I have been on active surveillance since July of last year but now have a very tiny escape from the capsule. I will have biopsy specimens taken tomorrow, so depending on the outcome I may be opting for a procedure. I was leaning against removal so Dr. Scholz put the nail on that coffin for me.
Indeed a tough choice- I lost sleep over the 2-3 weeks it took me to decide on RP vs HDR. My nail was a local Doctor (Dr. Andrew Loblaw, at Sunnybrook Medical Center here in Toronto), after talking to him, looking at his research. The big thing was the Plan B (the WHAT IF Plan A did not work 100%). With RP, Plan B is EBRT. If Plan A is HDR/EBRT, removal as a Plan B is very hard. Dr Loblaw's research shows that extra EBRT as a Plan B is as successful as removal + EBRT. When I discussed with the surgeon who suggested RP, he actually agreed.
Biopsy- I had a recatal one, 12 samples, 3 yrs earlier- nothing came back. In early 2018, I had a second via the perineum- 1 sample, #8 of 10 came back positive. I feel that was a very lucky sample!!!
Wishing you all the success in the world!!!!!!!!!! One thing that sat with me, was the pre-op nurse telling me, if you are going to get cancer, THIS is the one to get as it is very treatable.
Cheers.
@@SeanONeill13 Interesting information in this report on the most recent research published about LDR vs RP. I am assuming HDR would achieve similar results as the LDR. There is a good chance I would opt for Cyberknife but it isn't covered by my insurance, and long term LDR or HDR plus EBRT may be just as effective. That is the $30K question.
www.renalandurologynews.com/home/news/urology/prostate-cancer/brachytherapy-beneficial-in-low-risk-prostate-cancer-study-finds/
We have public health care (pros and cons, yes). LDR is not funded, HDR is. (RP is, not all hospitals have robotic however) I think, HDR + EBRT is easier than LDR + EBRT, as the half life of the seeds with LDR is 60-90 days, so one stays radiated for quite a long time LDR, and before EBRT can be done. HDR, mine was Sept 18th, 2 weeks later, I started 15 daily sessions of EBRT (250 cGy units each), no delay. I think most of the locals are prescribed HDR + EBRT now (unless RP is chosen).
Question: I have been told of some side effects of radiation take a year or two to develop. The argument for surgery is that you see the worst side effects immediately and they just get better (though not always), whereas the side effects of radiation can be very substantial and develop insidiously over several years, even 5 years or more. Would you please address this either here or in an upcoming video?
Also radiation is often accompanied by hormone therapy which has gruesome side effects, some temporary, and some that can be permanent if one is not careful.
I'm not trying to argue against radiation, just trying to understand the full picture. I'm overdue to choose a treatment actually, perhaps dangerously overdue, but it's an agonizing decision. Your HELP line has been FANTASTICALLY helpful in every respect other than addressing this one question above. Thank you.
We will add that to the list for a future video!
Hey Art. I hope you are doing well. What decision did you make your prostate treatment? Prostate cancer seems to be rearing it’s ugly head at my dad after being on remission for 5-6yrs & we r back to the drawing board. The decision with his urologist back then was a hormonal treatment as the cancer was at it’s early stages. Hoping to get your input. Thank you in advance.
@@lululets6338 If I was grade 2 (Gleason 3+4) I would probably have just gotten one round of SBRT radiation. But my GP was not doing annual PSA testing so my prostate cancer was discovered at grade 3 (Gleason 4+3).
My options were
1. Surgery OR
2. Six months of ADT plus beam radiation like SBRT plus seed radiation.
I felt that the combination in #2 was more gruesome than surgery. And only surgery tells you within months if you are clear or not.
I had the surgery in Feb 2021 and it went smoothly plus all tests show that the cancer is gone, so far.
BUT the side effects of incontinence and erectal dysfunction left me extremely depressed. Some guys heal quickly but I did not, despite following all recommended rehab.
My incontinence is healing very slowly but steadily. Around 75% cured at this point. But man that steady drip drip drip all day long can drive you crazy. ED is improving too.
The depression really surprised me.
@@artmaltman Hi Art ,6 month on from surgery and i have been very lucky with not wetting myself, only get the odd drip if i over stretch. ED is very (excuse the pun ) hard to deal with, i have been using a pump to keep things healthy, but not a lot happening at the moment, so hoping its a slow return to normality . i have a very personal question though, they told me i would have dry ejaculations but i wee a little bit instead which is not great ,does that go??
@@davidking3139 That kind of thing should heal along with the incontinence. Mine has. Can’t be sure though.
is he a Dr. one can visit at PCI ?
i 'M 70, PSA is 8.0 average over 10 years. (my 94 yr old dad is same), had 13 biopysies 5 years ago, no cancer detected, 185cc size, Have been told that a PAE is not effective on prostate size (only 25% reduction in best case) The same with Greenlight, Resume, Urolift. Suggested that Simple Robotic Prostatectomy is only effective solution. Would like opinion? Thanks
Hello,
I will add this to our list of questions for upcoming videos. In the meantime, we have a free helpline that might be able to provide some information on that. You can find our contact information at pcri.org/helpline.
Hi Larry, I disagree about PAE. I had one done on a 250cc prostate last oct 2021. My shrinkage was near 70% went down to 100cc when I had a MRI four months later in feb 2022. The radiologist said there was even more shrinkage to come. It was what I was looking for to save the day.
PAE works best on really big sizes. Andrew
My question is will I be treated. I failed at an MRI because of severe claustrophobia and sleep apnea-they put me out with profolol but had to wake me up (in the MRI tube egad's) when my O2 went down. I have 8 positive cores G6 in 7 of them but one had a second opinion and found the one core was a G7 So I want brachy or SBRT I do not want surgery. So, how can they treat me if I cannot have an MRI? (I can do CT scan) thank you.
8 core's of 12 with one core being G7 the rest were G6 my PSA is always high with a huge prostate but am steady between 4.5 to 5.1
Hello, our prostate cancer helpline may be able to help with your question. Please feel free to contact us here: pcri.org/helpline
@@glenbearh9109 Hello sis, use Dr omo herbal medicine very active with no side effects it will help you get rid of them fast
Glen Bear - I am sorry to hear of your claustrophobia...Perhaps I have no idea what it is like to have a truly severe problem with it, but the last time I went and was anxious about it, they suggested I close my eyes BEFORE being put in the tube and keep them closed throughout the test. It really did help. I did not get the feelings of panic and suffocation I had on previous occasions. Best of luck to you - I hope you will receive a way around this problem to get the care you need, and I pray it will be the very best, expert care.
@@NYBarbieP Thats funny because I did just that last month for a CT scan and it was okay. I also had 15mg of valium which helped.
First time RP 5 years later Rad & Chemo Lupron. I would go with surgery you can always do Rad & Lupron later if needed. 8 years and definitely radiation and Lupron had the worst side effects. at
Dr. Scholtz is the best doctor. He is my doctor and that's why I'm undetectable today since 2010. See him. You won't regret it.
10 years, that's awesome!
what was your stage- psa age gleason? and what did you do? radio or protastectomy?
Did you have radiation or surgery. Please respond.
@@melissaonline7560 I was stage 4 and did not do surgery only radiation and chemo.
@@markbrown5117 I did High dose Radiation seeds implantation for so many hours instead of surgery at UCSF. good luck . I did chemo at Dr. scholtz's office.
You say that radiation is now better in every category, but what about long-term ED? Has that improved as well?
Hello, our prostate cancer helpline may be able to help with your question. Please feel free to contact us here: pcri.org/helpline
It's a little complicated but I can explain. The damage to erections from radiation is a gradual process leading to a gradual and progressive worsen of erectile function. With surgery the loss of erectile function is immediate but followed by a gradual recovery that takes 1-3 years! The result is that for the short term erectile function is better with radiation but by about 3 years post treatment the erectile function rate of people who had surgery starts to equal or surpass that of the men who had radiation.
So in summary.
Years 1-3 ED rates lower with surgery
Years 3 onwards ED rates the same or lower with radiation
@@cancerbetter your conclusions are reversed
@@peacefulruler1
How can his conclusions be reversed? It is undeniable that in the vast majority of prostatectomies, erectile ability is immediately disabled. It does not return for some time, and what is recovered doesn't diminish due to the aftermath of the surgery.
What do you mean more than likely survive. I know someone who said it was aggressive and metastasized. And how long has your idea been around?
Yeah he shouldn't have said that , stating "more than likely survive" about the second most cause of cancer deaths .
Hello mate whatever you do please do not go with robotic surgery operation please..try other options. I Had the surgery as well mate and my life has been changed badly.Last year I admitted to A&E twice this year so far 6 times.
Girl friend became a X,feeling no man anymore, Still 3 years after the operation I get pains all over my body,before the surgery operation I never walked into a hospital but now I go regularly!!
Because use of Catheter I got a kidney infection, liver problems etc.you name it.
Before the surgery I was not waking up of the bed night time
Before the surgery I was not suffering with any pains.
Before the surgery no kidney no liver problems at all.
Sex life was top of the range great.
I can't even lift up a toddler for 5 minutes.
Just imagine that.I lost my job as well.
Before I set off my house I always make plans to visit toilets.
Still there are leaks what an embarrassing situation!!!
I can make a massive list really .
It's a horrible feeling that I put my self into this situation I let them destroy my life.
But I'm the one guilty at first place to let them destroy my life.
I don't include shortening of my penis.
Before the surgery I was leaving my house and was able to not to visit toilets for 5-6 hours now I do every 30 minutes maximum..
As I said at the beginning please try hormon therapy Radiotherapy whatever but do not go ahead with Surgery operation option.
Ps.if you go ahead with Robotic surgery operation than you will become a robot rest of your life you will have to do kegel exercises!
Public floor!
@@Rikki-lh2mw So sorry Rikki , but as Schotz says , it's all about the expertize of the doctor .
Many are very satisfied with robotic results .
@@waldipup9010 is OK mate...I understand.
Seems most the Patients got better results than I do.
But please remember that..if you have a Robotic surgery than you wont be a man again.
Before you leave you house you would make sure that toilets available wherever you go to😪
Hello, my father is 67 years old he was diagnosed with Stage 3B (invasion in right seminal vesicle) Gleason 3+5 but its N0M0 no metastases found. He had open heart surgery 5 years ago and diabetes type 1. Can u tell which one is better for him surgery or radiaton?
Dr Scholz seems sold on stereotactic radiotherapy (aka Cyberknife). I'm a fully retired physician. 5 years ago I got the diagnosis of high-grade prostate cancer and also thought that surgery had a better survival outcome. So I scheduled surgery with my robotic surgeon/urologist. But I also continued research, looking up studies at the time and talking to the radiation oncologists who offered high-dose rate brachytherapy combined with external beam IMRT. There had been a recent report from a randomized trial of surgery versus radiation and the results were basically as Dr Scholz described. Equivalent survival but lower sexual and urinary side-effects with radiation (and this was with technology that is now 20 years old.) I also used the Decipher genomic study to make a decision about how long to continue hormonal suppression At 5 years out, My PSA is stable at 0.2, but that just one data point. Do your research.
my father has diagnosed prostrate cancer few days ago. According the biopsy report gleason score is (3+4) and its present in perinural invasion not in lymph nodes. Our doc recommended us for harmone therapy.then my father gets the lupride injection and osteomet injection with bicalutamide tablets.doctor suggested us for radical surgery after 6 months of harmone therapy because cancer has been speard in some adjecent areas.but i wanted to know that which treatment is much better in our case? Radical surgery or targated radio therapy? And i also wanted to know that can we do radical surgery after the radiotherapy?
Hi, My father 74 age 3+4=7,grade 2,psa 8,8,biopsy 4 of 12 positiv all left and left centar 1 and 2 (6%-10%) 3 and 4 (11%-20%)
Surgery or radiation
@Keith Wilson I had the surgery. I'm a month out tomorrow. I see Dr. Benson next week and have a ton of questions for him. I was supposed at the thought of it cos I've had too many that passed from other cancers. I'd rather have it out of me than play the let's see what happens game.
my psa was only 3.7 yet all 26 biopsies 13 each side were cancerous , 3-4 stage 2 without full results yet unknown. i was given a choice of radiotherapy but speaking to the surgeon told me that radiotherapy can cause so much damage if i still needed prostectomy after that radiotherapy was really out of the question ,( the radiotherapy consists of tiny radiation seeds placed in the prostate to kill the cancer, but it can aslo continue destroying everything else like nerves) but choice was mine . sooooo i have just had full prostectomy ,no messing about . felt better after two days, im in third week now , the next battle is incontinence now the catheter is out, that is not fun !!! hoping that cancer is all gone just waiting for more appointments and tests.
must just say that if i had not so much cancer in my prostate i may have considered radiotherapy , but felt mine had gone too far
Same, had surgery 2 weeks ago and am starting to feel better. Best wishes to all
@@randytatum8853 good well done, it takes a while to get there, it's about 5 months for me now, I dont use any pads but have to be careful if I over laugh or get up a bit too quick. I have not a lot going on downstairs yet but been told it can take upto two years. I'm 55. For us its difficult enough as my wife is disabled so it's not great for us at the moment but the bonus is I don't have cancer anymore yay
@@bert1450 hi Bert I had another psa test it has come back as zero, so I'm very pleased I opted for surgery. I hope all goes well with you in the end, it is a long recovery, it is very difficult to realise your sex life is going to be completely different it's very frustrating at the moment as not a lot is happening even with tadafil. But it can take upto two years. Having to use a pump to keep my penis healthy, hate it but have to do it. Bit like pumping up a tyre with a hole in it lol. all the best hope it's a better new year later for you
@@bert1450 hi Bert i was wondering if you had your results back yet? and if it's good news or crap news! sorry to hear you have been struggling all these years. I hope you get the right outcome and it gets sorted for you, all the best , Dave
Thank you...my decision has been made now!
Hello mate whatever you do please do not go with robotic surgery operation please..try other options. I Had the surgery as well mate and my life has been changed badly.Last year I admitted to A&E twice this year so far 6 times.
Girl friend became a X,feeling no man anymore, Still 3 years after the operation I get pains all over my body,before the surgery operation I never walked into a hospital but now I go regularly!!
Because use of Catheter I got a kidney infection, liver problems etc.you name it.
Before the surgery I was not waking up of the bed night time
Before the surgery I was not suffering with any pains.
Before the surgery no kidney no liver problems at all.
Sex life was top of the range great.
I can't even lift up a toddler for 5 minutes.
Just imagine that.I lost my job as well.
Before I set off my house I always make plans to visit toilets.
Still there are leaks what an embarrassing situation!!!
I can make a massive list really .
It's a horrible feeling that I put my self into this situation I let them destroy my life.
But I'm the one guilty at first place to let them destroy my life.
I don't include shortening of my penis.
Before the surgery I was leaving my house and was able to not to visit toilets for 5-6 hours now I do every 30 minutes maximum..
As I said at the beginning please try hormon therapy Radiotherapy whatever but do not go ahead with Surgery operation option.
@@Rikki-lh2mw So sorry for your bad experience...I have started hormone therapy and radiation...thank you for your wonderful reply...all the best to you....Marty
@@martycorr7930 Hi Marty
I'm pleased for you that you are not getting surgery operation. I'm very pleased for you.
Yes it's a long tiring journey but at least they are not going to butchering you!!
Please do let me know in the future how do you get on with the treat8.
Kind regards.
Ps.my blood test result showed that (today) I have got kidney disease that is a results of catheter use after the surgery operation that picked infections through it .
@@Rikki-lh2mw ugh...so sorry to hear about that surgical complication...thanks again for your informative communication...it made my decision for me! Good health.
@@Rikki-lh2mw So very sorry they messed you up my friend, how are you these days?
If radiation is better, I will choose it. I have a Gleason 9 biopsy finding last Dec. 9 and no bone metastasis yet last Jan3 . But will have to decide this Feb. 3. Thank you Doctor.
What did you decide and how are you doing currently?
What about the effects of Lupron and Bicalutamide? While the radiation treatment sounds great, many men have a 1-2 year course of these ADT meds, with some serious side effects.
Almost 6 years on and still experiencing the sweats every 2-3 hours thanks to Lupron.
It depends on the doctor , but I think that 1 to 2 years is too long , a few months - if needed at all - should do .
I had seed implant done last month, 131 placed
In early morning out by noon
No side effects so far
Had it done at Cleveland Clinic my radiologist had done over 4000 procedures
My Gleason was 3+4
Bourbon, the person I advocate for also had proton beam radiation at the CCMC. The radiologist on his team of doctors is so empathetic, and tolerates a lot of questions and anxiety we have. He's great. We're dealing with a Gleason 9 with one proximate lymph node involvement, interductal carcinoma. One day at a time.....
Best wishes.
@@maureenobrien9815
Good luck
My wife had ovarian cancer 5 years ago and the clinic healed her with no recurrence
I feel confident that they will do the best job of any available hospitals in our area
Good luck
@@bourbontraveler I agree. So far so good, but as you know PC is very adaptable so I have concern, the person is my best friend for decades. I'm assuming you're in Cleveland area as am I. We are really fortunate to live close and their MyChart is a godsend. The best to you and your wife, Bourbon!
@@maureenobrien9815
Have a wonderful holiday
@@bourbontraveler You too.
I opted for radiation (Brachytherapy then 15 EBRT sessions). No incontinence, but a slight rectal issue (burning sensation with BMs).
Did you receive high dose or low dose Brachytherapy? And how long ago did this happen?
@@gustavmonger HDR, July 2018. EBRT started/Ended Oct 2018. PSA went from 11.4 (Gleason 4+3) to 0.84 just yesterday, the 1 year 'anniversary' of the end of treatments actually.
Sean, after brachytherapy, there is limited life expentancy?
@@MsMaho25 HOPE NOT!!!!!
But what if doctors have been told to the patient that he could live upto 5 to 10 years.. N patient is of 31 years old.. Can u help me to understand this?
We have a winner!
Which prostate treatment centers in the United States are most experienced with the new radiation therapies for prostate cancer?
There is a new FDA-approved option available, the TULSA procedure. Non-invasive. It's expected by most that this will displace surgery and radiation. And with far fewer side effects.
Costs so much $$$ though
@@shaunmontoya72 Starting January 2025 new insurance codes become effective. I can't see anyone opting for surgery given the safety, effectiveness, and soon, cost, for TULSA. You might want to contact Profound Medical and ask some questions. I think some doctors (surgeons!) are monitoring, hoping to keep the patients safe until insurance kicks in. It beats wearing a diaper or suffering from ED, or both, from surgery.
I find this quite scary as I have been told that there are long term issues with radiotherapy causing other tumours in the body and therefore it isn't recommended for other younger otherwise healthy men?
Would this approach be used in younger patients? If a 45 year old patient decides to do radiation over surgery and isn't cured, would surgery still be an option? Thanks in advance.
Discuss salvage surgery with the surgeon before you make your choice.
Generally not recommended to use radiation in this age group due to the increased risk of secondary malignancies associated with getting the radiation treatment. Yes, radiation does increase your risk of a second cancer in an adjacent organ and the longer you live after the treatment the higher the risk(i.e. 2x risk at 15 years after treatment). Typically we recommend surgery for men under 60.
Radiation therapy is evolving and advancing everyday. Men must educate themselves and make the best choice for themselves. Surgeons need to offer the pros and cons of surgery. Radiation therapy has really evolved compared to 10 years ago.
From everything I’ve read and disussions I’ve had it sounds like younger age is a consideration as well.. but isn’t discussed here