Side Effects of Surgery Vs Radiation for Prostate Cancer
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- เผยแพร่เมื่อ 9 ก.ค. 2024
- Surgery and radiation are the two most common treatments for prostate cancer but the treatments for prostate cancer risks can have some series risks. In this video we go over the new literature describing the side effects of these treatments so you can be informed and make the best decision possible.
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Our goal at Cancer Better is to provide people with the best possible information to help them make the right health decisions. When it comes to big decisions like cancer treatment, you should know the facts so you can be in control of your health.
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I'm 61 and just had my first treatment at Stanford with SBRT. I'm Gleason 7 3+4 in one spot only, very small. Was getting HDR brachytherapy at first but after many scans and tests, the doctors there felt I only needed 5 sessions of the SBRT. I'm so lucky and happy that I went for physicals and blood tests every year and caught this when i did. My team at Stanford is awesome, very encouraging and with humor thrown in. The SBRT session is no big deal just holding a full bladder is uncomfortable but tolerable. I go in tomorrow for my 2nd session and again 3 times next week. My last session is on march 1st and im done and will ring that bell. :)
look into all your options and get second opinions, if in calif go to Stanford.
Oh and a nurse gives you an enema to clean you out, i swear its a firehose filled with glacier water, lol!😃
What we need, doctor... is a candid study on the psychological effects of each type of surgery. Telling a man he will lose his intimacy with his partner immediately after surgery is devastating news for both parties. There are divorces after these surgeries, especially when the spouse may be in the peak of her sexual life. Telling a man he'll be possibly wearing diapers or pads for an extended period of time rocks a man's feeling of masculinity to it's core. There are instances of severe depression and even suicide. So... regardless of the "physical" forensic evaluation of the damages, and the seemingly narrow differences in the outcomes, the mental aspects can be a far greater indicator or how "success" is measured. That's just my 2 cents.
There are actually numerous studies looking at this. On average patient happiness is actually very high after prostate cancer treatment given that most people are cured of their cancer and eventually regain continence.
Please keep in mind that even when people have loss of function such as incontinence or loss of erections we do have options to solve these problems for almost every patient. I know it's a tough choice to make but you are doing the work of getting high quality information to make an informed choice. Wishing you well.
-Michael Ahdoot MD
Your post is spot on. I'm in the beginning stages of this, just diagnosed with 4 + 3.
I'm not afraid of surgery or radiation but the side effects could be devastating to my quality of life. And the side effects of androgen therapy wasn't even mentioned.
What I have found consulting 4 different professionals is that the side effects are kind of swept under the rug as if they are just an annoyance if you don't push the issue.
To a man who loves sex with his wife, which is what I am, the idea of giving myself a penile shot, possibly having to wear depends and possibly having bloody painful diarrhea for the rest of my life is not very appealing. I can certainly understand why there is depression.
The mind is half the battle
I chose SBRT radiation and I found that to be a great alternative to radical surgery. I was 56 when I had the procedure done. My cancer is gone but of course we never know the future, but in the present my side effects were tiny.
Hi , I am considering SBRT for my 67 yr old father. Early cancer stage 1 ,gleason score 6.
What side effects are there and how to manage them. My best wishes for your speedy recovery.
@@nutcaseneo191 If you live in an area where SBRT radiation is available I would recommend it. I had zero incontinence issues and no ED issues. I had some burning after my first dose but after some steroids I never had another issue. 5 radiation doses, one procedure to implant the markers and the Spacer Gel that is injected to create a barrier between the prostate and the rectal wall. That's all. I always went to work the next day after every procedure. Don't hesitate to ask if you have any other questions.
Good luck to your dad.
BTW, Gleason score of 6 often means that they will just monitor it. Mine was 3 + 4 = 7
@@247drycleaners9 Is there any concern with longterm ED with sbrt?
@@dmcarden
I I don't know about long term yet. It's better than surgery for the first 2 years. I am taking VIAGRA right now and it helps.
@@dmcarden yes surgery and radiation have equal rates of erection loss at 5 years after surgery. The slope for the radiation curve is steeper at that point so it suggested that after 5 years the people who get radiation might be worse off but the data is limited.
Great information!! I’m 54 yrs old and diagnosed with prostate cancer last month in August. I’ve met with my urologist who would do the surgery as well as a radiation specialist who would do the radiation treatment. Many of the points you made both doctors have told me, as well as the point of younger patients, my urologist said surgery would be more beneficial since I am younger… under 60.
What a great video Michael, not only this one but all your videos around prostate cancer as far as I watched, one of the most unbiased I have seen on TH-cam which is not easy to find to be honest, thanks for that!!
My Dad is 75 years old, he lives in Bay Area california, he has high blood pressure and is pre-diabetic with heart stent and family heart attack history, the prostate biopsy showed Gleason score of 5+3 with Perineural Invasion identified in one area and 3+4 and 3+3 in other two areas (cT2aN0M0), PSA never more than 4 (currently 3.7), PET/CT scan that showed no regional or distant metastasis though mild radiotracer uptake in a small 4mm right external iliac lymph node.
Both his urologist and also oncologist recommanded up to 2 years ADT plus EBRT and Brachy both, a second opinion (urologist) confirmed that this was a good suggestion but also proposed robotic surgery. Appreciate to have any insights/comments from you, It is quite obvious that you have a wealth of knowlege and experience in this domain.
Appreciate heaps
Yousef from Sydney, Australia
What a kind compliment. Thank you
Very well done video. I teach clinical radiation oncology at the university level and try to incorporate videos into my classroom whenever possible, but it is often hard to find content that isn't overtly biased. This video is well-balanced, and accurately discusses the risks in a way that matches our textbook content.
So happy to hear this and thank you for validating the accuracy of the data shared with the viewers.
Ok so I’ve had to start looking into this stuff I’m 60 , 2yrs ago my psa was 3.4. , last year 4.7 , this year at 60 7.4 . I have a urologist my first biopsy last year was I like to say iffy, going in in a few for next one mri guided with ultrasound to get a better look . And in one month with another psa it’s raised slightly again . SO thank YOU this video helped me . And I have no enlarged prostate or infection. So I’m hoping for the best preparing for the worst . Lol thanks . Listening to a doctor in the office is well kinda hard . This on the other hand wasn’t.
This is aweosome!! Thank you for sharing
My Husband never got told any of this, he had 24 Radiotherapy, then 2yrs of hormone jabs, he got all in January, he will be 80yrs old this year,this doesn't give me a lot of faith about what was the best, information he got in the beginning, thank you for your help, ❤❤❤
Sorry I missed all clear in January, ❤❤❤ God Bless
Good straight up information. Thanks.
I'm 4 weeks out from Surgery and glad I went this route. Going in for my 6 week check up with a PSA check. Hoping for a Zero
6 weeks is too soon it should be 3 months
Thank you Sir
Thank you!❤
Thank you Doctor. Your video's are extremely helpful and presenting the risks and benefits of treatments in an unbiased way.
Happy I can be of service
A lot has changed the last couple years…
great job
He also did scans and it's localized only in prostate which is excellent
An excellent and informative series comparing surgery vs. radiation, thanks! I’m 74 yo, Gleason score of 8 in one biopsy core, 7 in a couple more that were identified in an endorectal coil MRI, bone scan shows no metastases, and am now waiting to confer with my urologist about what to do next. I’m scheduled for a Pylarify PET scan to see if the metastasis has actually spread outside, but watching your videos has biased me towards radiation, IMRT, SBRT. Thanks again!
Excellent! So happy to hear the video helped you!
Thanks for sharing
You’re the BEST!!!!!
Great video!!!
I had a biopsy May 12, 2023. Gleason 3+3=6. I am 72. Next appointment with radiology oncologist is June 21 followed by my urologist. It seems like I’m living ‘active surveillance already’. Thanks for info on radiation.
I hope the video have been helpful. Please let me know what topics would help most to cover next.
Buen día Dr es grato ver su vídeo hago su traducción lentamente soy venezolano..deseo preguntarle cuando se extrae la próstata que se coloca en su lugar, segundo lugar la incontinencia es por cuánto tiempo y igualmente la disfunción.gracias el Sr lo Bendiga
Thanks!
Thank you kindly Jim!!!
Hi my husband is trying to decide. With your information it makes sense he is 57 with a PSA of 9. I did tell him Surgery was better option for him. After watching your video convinced me.
I just had a patient in clinic this week who presented with bladder cancer about 10 years after his prostate radiation. He was a non-smoker and had no bladder cancer risk factors. We can only assume it was the result of the radiation he had in his late 50s to treat his prostate cancer.
I think people in their 50s who are in good general health are way too young to be treated with radiation. (Of course there are exceptions but they should be the exception).
If he decided on surgery it's important to find a well trained robotic surgeon who has done many of these surgeries in the past. If you live in a small city that might be traveling to a major cancer center.
Thanks the for comment and it makes me really happy to hear this video helped. - Michael Ahdoot MD
@@cancerbetter thanks so much for your professionalism. We are seeking a second opinion at Sloan and Kettering. We live in New York.
@@williamfeldner9356 thanks we will.
@@makeibalove2081 How did things go with your husband, is he ok, recovering well?
@@dappa311 hi thank you yes he is thank you for asking. Happy Holidays 😊
Thank you Dr. Michael Ahdoot. The tables and graphs you put together really save us lot of time. We might have to spend more than 80 hours watching other videos or reading books to gain the knowledge your video provides in 8 minutes 21 seconds. One question, for a prostate cancer with Hypertrophic cardiomyopathy, which treatment is less risky?
All depends on your cardiac output/function. I would speak with your cardiologist to see if they think surgery is a safe option for you. If they say yes, you will likely have the same level of risk as an ordinary person. Conversely your cardiologist may say you have high risk to undergo anesthesia and recommend against anesthesia. In that situation radiation might have less risks.
And thank you for the compliment.
Great information.
Thank you
7 months ago I had Kalypso IFDR implants and moderately high radiation. At the same time they used the space OAR. These implants are meant to make the radiation accurate and limit scatter to the rectum by creating space between the rectum and the prostate. The Kylipso helped the radiation spatial accuracy to limit scatter to surrounding tissue. Hormone therapy includes Lupron and Abiratarone. My PSA is
Great presentation.
? How to get Treatment Options graphics sheet ?
Thx.
I am in the pre-biopsy stage… MRI indicted a Pi Rad 4 lesion and a targeted biopsy is scheduled in a little over a week.. There is so much to take into account when making such a potentially life changing decision and I have been doing as much research as I can before I get the biopsy results… Surgery will be my choice ONLY if I have no other viable options… Your video was very helpful and much appreciated…
whats the update?
1 very small lesion came back a Gleason score 4+3… I have had a PSMA Pet scan since that showed the cancer is all contained within the prostate… Getting a 2nd opinion on the biopsy from John Hopkins and reviewing treatment options while I wait for their results.. I am leaning toward SBRT… I will be making a final decision in November …
You may want to consider focal therapy for such a small lesion. If you can't find someone with experience locally I can see you in person or via telemedicine at Cedars Sinai.
@@cancerbetter Thanks for your reply… The 4+3 lesion was 4mm in length involving approximately 25% of the needle core tissue.. There were 2 other areas of 3+3 on the same side(left) and 1mm area in 1 core with 7% needle core tissue… I should add that the 4+3 sample was sent to Decipher for genomic testing and it came back “high risk”.. Because of this I am being considered intermediate unfavorable… RO wants to do SBRT AND ADT… I am waiting for 2nd opinion on biopsy from J Hopkins which should allow for at least some certainty… I guess I don’t understand why if SBRT is so refined and can target specific areas, the standard treatment still seems to be radiating the entire gland… I have already asked about Focal therapy and that will depend on what I get back from J. Hopkins as well… As for ADT, I am very wary of allowing that as part of any treatment regimen…
@@dale1k878focal therapy would be great if you can..but what did you end up doing?
@Cancer Better Extremely helpful videos; thank you. To what degree would you draw any different conclusions on side effects for pencil beam proton therapy vs. more traditional radiation?
Good question and a difficult one to answer as the data on proton therapy is rather immature. Early data shows similar complication rates to traditional external beam radiation but show low rates of secondary cancers from the radiation at least for that first 5 years after treatment. Data is limited beyond 5 years.
How does Cyberknife or MRIdian radiation affect side effects? They purport to be much more precise
i was diagnos with prostate cancer at 60 had it removed then after 2 years i noticed my PSA started to rise.now i'm going through the whole process again regular blood tests now have to wait till my PSA rises too .20 to have PSMA test then i can only be treated by Radiation.my PSA at the start was 4.5 ,i still suffer from incontenence only at work and ED had one nerve removed.
PSA recurrences following prostatectomy are not always recurrences of the cancer. If any normal prostate tissue is left behind that too can create an elevation in PSA. It is important that your doctor is not simply treating your PSA level (i.e. greater than 0.2), though that is a very common practice. The more valuable thing to measure is the PSA velocity, which is the rate at which the PSA rises. If your PSA doubles in less than 6 months for example that is concerning for cancer. If you PSA rises by .05 in a year however its unlikely that PSA rise means cancer.
In addition to all this, radiation is NOT the only solution to a PSA recurrence. The first thing I would want to know is where is that PSA coming from and I would order a PSMA PET scan. If the lesion was localized to just one area I would surgically remove or focally treat just that lesion and observe the response in the PSA. While working at the NIH we had an interesting case of a person who had prostate cancer that seeded his biopsy tract leading to a nodule in his rectal wall. We had our colorectal surgery colleges resect the lesion and his PSA normalized. We published that case and you can read about it here: www.ncbi.nlm.nih.gov/pmc/articles/PMC7569293/ This is a great example of a PSA recurrence being treated with surgery instead of radiation.
The last thing we need to consider was the original gleason score or grade group of your cancer. If you had grade group 1 cancer to begin with, treating this PSA recurrence is unlikely to prolong your life.
ED after removal of one nerve is common and incontinence after 2 years usually does not make substantial improvements. If you are interested you can speak with a urologist about what options are out there for you. I have personally adopted a new approach called Retzius sparing to greatly reduce the risk of incontinence after surgery but there are few of us in the country who do it unfortunately.
All of this, of course, is based on limited information and does not take into account your entire situation. Its great that you are seeking out quality information and I hope you are able to get someone to look at your situation carefully to consider all the possible causes for this PSA rise. -Michael Ahdoot MD
@@cancerbetter your link goes to a Cedar Sinai login. What is the PMID or DOI article number
@@raschulz65 www.ncbi.nlm.nih.gov/pmc/articles/PMC7569293/
dok after 3 visits to drs in bufffalo ny area, all I can say is I wish I was closer to yoU!!!!!!!!!!!
Happy to see you if you want to fly out to Los Angeles. You might find better people at a big academic center. Sorry to hear you haven found the right person yet.
Hi, so technologies change. We not have Robotic Surgery and High Dose Temporary Seed Radiation. I am considering both of these options. I am 57, have PSA of 3.07 and Gleason 6/7. Are the side effects less with these two options than what you discuss in the video.
Thank you
Any time!
Greetings! As a retired neuroradiologist, I can really appreciate your excellent discussions in your videos discussing prostate cancer & treatments. Thank you.
I just turned 69, with well controlled type 1 DM (HgbA1C 6.2). Otherwise healthy and actively playing Pickleball! I have a 46cc prostate with MRI in early 2022 showing ill defined 5x5 mm suspect area at posterolateral mid gland peripheral zone (PIRADS 3). However TRUS biopsy with additional samples at suspect area was negative. Repeat MRI in 7/23 was PIRADS 2 with no visible lesions. Standard TRUS biopsy was positive 1 out of 12 with Gleason score 3+3 at left lateral specimen. Had Decipher genomics done on specimen with score of 55 (intermediate risk not good for active surveillance option). After going thru your video, I had decided to go for Retzius sparing RARP as I hope to have incontinence risk minimized. Am I eligible for this procedure because of the prostate size?
I have primary residence in Austin, TX with second home in Baton Rouge, LA. I know I need to go to high volume/experienced places like MD Anderson Houston. Do you know of any Urologist experienced with rsRARP in Austin, Baton Rouge or New Orleans otherwise?
I have done retzius sparing prostatectomy for prostates as large as 200cc but some providers choose not to go above 60 grams. I don’t know if the guys at MD Anderson are doing Retzius sparing but it’s generally an excellent department. If you ask around I imagine you can find some person who does the procedure.
Also consider that focal therapy is an option.
Thank you for your quick reply. I know they provide rsRARP at MD Anderson, with 9 urologists performing robotic prostatectomy. Not sure if they all do rsRARP. What is your experience with incontinence rate after Retzius sparing prostatectomy? And how does that compare with the traditional robotic prostatectomy(nerve sparing)?
@clementwen4973 these days it’s rare I have a patient with incontinence that lasts more than 2 weeks. Most patients are dry within a week of catheter removal. It’s pretty amazing. There are certain factors I can see on MRI which help me predict whether a person will have very rapid return of continence. Namely, men with very large median lobes seem to have slower return of continence but usually also get there.
@clementwen4973 on top of this, cancer location also has a huge impact on how close we can cut to the prostate. If we need to remove parts of the bladder near the prostate that would likely affect how quickly continence returns.
It is great you have such amazing results with low incidence of incontinence with rsRARP; that also probably is a testament to your surgical skills. In my case, with the most recent PIRADS 2 MRI not showing any visible focal macroscopic lesions, and 1/12 positive bx at the left lateral mid prostate, I would assume this is the type of prostate where the surgeon can afford to cut closer to the prostate and lessen the amount of bladder removal. I had seen the video of this type of prostatectomy surgery; that is surely lots of meticulous work and patience with this approach which is more challenging than the traditional RARP. It also amazes me as to how the body can heal, seal off and secure the cut ends of the urethra and bladder at the anastomosis.
BTW, I also really appreciate you taking the time to answer my questions and educating me! I definitely enjoy all the learning.
Excellent summary. I would only add that when the prostate cancer is sufficiently advanced to require testosterone blocking hormone treatment with the radiation, then the balance of side effects can change.
Also for much more advanced cases if metastasis is likely then surgery would no longer be a cure.
Also surgery provides a more definitive result since the prostate and lymph nodes are sent to a lab for testing, and, the PSA should be zero after three months if the cancer was entirely local.
I had to make this decision recently. It was agonizing. I wish I had your helpful video, my information gathering could have been quicker.
what did you choose? Why? How are you making out?
@@humanitybaptistchurchnj659 I had the surgery 17 weeks ago with a famous surgeon. He got all the cancer out. Alas I am very unlucky with the side effects so far and my life is destroyed so far. Incontinence plus erectal dysfunction. But the alternative for me would probably have been even worse (chemical castration for 6 months plus beam radiation plus seed radiation). All of the options use amazing high tech to deliver barbaric treatment. There is no acceptable answer really.
Research breakthroughs proceed little by little but at a fast pace. A new type of scan was recent,y FDA approved that does a much better job of identifying prostate cancer cells in your body. It is called PSMA-PET scan.
Thank you for for this information I had radiation treatment a year ago by the best in North Florida I suffer tremendous pain that has not gone away past many dead cells leaving my body did have a bad infection a lot of bleeding. Still passing blood colts. I don’t get any answers. Just turned 71 when I started. I felt good before I started treatment. Now just trying to recover, every day is so pain full. I refuse to take pain medicine. I don’t know what to do
Start by trying to identify where the pain is coming from. While uncommon pelvic pain after radiation can be from the hip bones (femoral head), the bladder leading to pain during voiding, or even the urethra resulting in urethral strictures. Consider discussing with a urologist who specialized in oncology.
Thank you for the information regarding between these two treatment, but still I can't deside what will be. I just diagnos of very agressive protate cancer of gleason 9. My urologist told me those are 2 options but before thart I will first meet few specialist about this matter before my treatment. I don't know what to choose and what the best treatment for me I'm 62 this yr.
The answer to that question will be largely dependent on where in the prostate your cancer is located and the results of your PSMA PET scan to look for cancer beyond the prostate. This is where experience and expertise come into play. Try to find experienced urologists who are fair and balanced. Ask their recommendations.
Ultrasound treatment seems to me to be the best. I am exploring where I can have this done; no surgery nor radiation.
All depends on the size of the prostate cancer. If it’s small and localized to one spot it definitely has the least side effects. For people with multi focal cancer it’s a poor treatment option.
Me too...I choose Radiation Theraphy...cont taking my vit..E D Zinc Saw Palmetto...Tamsulosin..B12 B6..
Great content, but please slow down ...taking in the information provided would be easier if you spoke slower.
How about water treatment super heated
You can touch the three dots on the upper right side of the screen, and on the appearing sub menu select a lower speed of the video.
The side effects for surgery, precluding the low probability of death, seem to have treatment options. Are there treatments available for the "Hip Pain" side effect from radiation?
Thanks for the effort and care you put into these videos - they are awesome and truly helpful!!!
This is exactly right. Side effects of surgery all have treatment options. Radiation complications often have limited treatment options aside from controlling the symptoms or further surgery.
No, radiotherapy is waaaaay better than surgery when it comes to side effects. this doctor is a low tier and an idiot and not uptodate and he doesn't know that radiation have been proven to be superior.
Diagnosed with Gleason 9(4+5) 2 weeks ago. I am 61 years old, and very healthy other than the cancer. No symptoms, and my PSA hasn't been over 4.6. I don't like the long term risks of radiation therapy, so I am going to have my prostate removed as soon as possible.
Bone scan and CT scan both were clear.
Wish you a speedy recovery
@@cancerbetter Thank you!
Awesome presentation! I liked and subscribed. Might you have any suggestions on how to find the doctors that’s having the most success in focal therapy? Do you have any additional thoughts or suggestions? Thank you in advance for your help.
I'll be posting a video on focal therapy shortly.
Lots of large medical centers across the US and EU offer focal therapy. I don't know of a list but I'd ask in your nearest major medical center. Now that Medicare covers it, focal therapy is becoming more common.
Thank you for your kind reply! I did not know that Medicare was covering focal therapy. I’m in New Orleans, I wonder if Louisiana Medicare will? Your subscribers and I will all be anxiously awaiting your video on focal therapy! Pros and cons, compared to other therapies maybe? Thank you for your awesome work on these videos and answering folks questions. You rock Doc!
Wow, with all the information "out there" you really present a ton of data in a very concise and clear manner. Thank you! What are your thoughts on Proton Beam?
It’s early days on proton beam. The data is not mature enough to say yet. Likely similar in complication rates to surgery
@@cancerbetter Thanks for taking the time to respond.... I am 66 and in excellent shape. (Still climbing mountains in Montana every Summer. AND actively play Pickleball too!! Lol~~~:). PSA of 6 led to 3D-MRI which led to T2 showing 2 "smaller" tumors. Had Biopsy last week, and waiting on results now. (Slight set-back w/ the need for Catheter 12 hours after Biopsy. Had it removed on Monday---after 3 days---and peed fine for, again, 12 hours. Then it slowly "closed down" again. So, another catheter last nite. Not sure why urination slows down after 12 hours....but, hey, life doesn't go in a straight line~~~:) [I like the idea of Radiation vs RP at my age/condition, etc. (As you suggest). Hifu does look interesting....Proactively, investigating Hifu/P-Beam/CyberKnife/SBRT]. Of Course, if they can't figure out why I'm not peeing every-time they pull this marvelous invention (Foley Catheter) out of me, then I'm guessing "they" will recommend the RP, regardless of my Gleason score.....
Some people who have trouble urinating who want focal therapy or radiation may need a separate surgery to improve urination first.
@@cancerbetter Our daughters live in the L.A. area....depending on how this plays out; I'll try to set-up an appointment w/ your office when we next visit them. Thanks again and cheers~~~p
@@cancerbetter This is more of a BPH question; but we do value your opinion: TURP seems to be the "go-to" Gold standard for a laser treatment of an enlarged Prostate. In your opinion is the HoLEP procedure gaining wider acceptance? (It seems less invasive). Is it reasonable to assume that if the HoLEP procedure doesn't work that one can then move on to the TURP method?
Hi doctor, thank you for your enlightening video. For a person who has chronic prostate/seminal vesicle infection which relapse from time to time, am I right to say surgery a better option since the removal of prostate could solve 2 problems - chronic prostate infection and cancer. Appreciate your reply. Many thanks!
Yes surgery would eliminate that problem, however in some people with chronic infections the surgery can be a little more challenging due to inflammation. Antibiotics prior to surgery are used in some occasions like this.
thanks very helpful as looking to start radiation in a couple of weeks , in aust a lot of blokes get surgery and i wondered why but the age factor explains a lot , i was recomended for radiation due to prev history of hip wounds from crush injuries and heavy scar tissue , so high chance of complications from surgery , by the way im 70
Wish you a speedy and smooth recovery
@@cancerbetter thanks , day 4 of radiation done , not glowing green or anything. in fact dont feel any different at all , day 1 had a faint smell of burning for a few seconds and 20 mins later on drive home had a slight taste of burning in the mouth and a upset stomach both of which only lasted about a min and that was it ,nothing since on the other 3 sessions or afterwards , maybe sleeping a little bit more but not much
Doctor, am in Jamaica, would you know what is the best procedure is available
If I were in Jamaica I would fly to Miami and see a urologist at the University of Miami. They have a strong prostate program there.
I have Gleason 5+4 in prostate. Some seminal bassels affected. Can I go for proton therapy as more accurate & less chance of 2nd cancer? Or is it Brachytherapy?
Too early to know but early data suggests proton therapy MIGHT have a lower risk of secondary malignancy
Dear Dr. Ahdoot: I have cancer in both my bladder (NMIBC, Tcis/T1; no recurrence at one year after diagnosis) and prostate (3 cores, 3+3 and 3+4, group 2 per Johns Hopkins pathology; PSMA PET Scan says no metastasis).
My urologist says radiation treatment of any kind is not recommended on the prostate, due to the possibility of recurrence on the bladder cancer. He strongly recommends Robotic Radical Prostatectomy.
May I get your opinion on that? Thank you!
I can not give medical advice without performing a complete assessment. If you are in California we can set up a video visit. I have seen this situation several times. You may ask your doctor if focal therapy is an option as well just to see what non surgical alternatives may be possible for you.
Excellent video doc. I am 55. Just been diagnosed positive for Ca. Gleason score 3+4 (group 1), PSA 11.4 (has been shifting between 9-11). I also have a Cyst in my prostate. ED and Urine Incontinence are my prime concern. I have been recommended RP or Radiation + Hormone. My argument is, had it been radiation alone I would have gone for it because of lesser side effects but with Hormone Therapy also thrown in, it is as good or bad as RP. Also I have been told that radiation might do bad things to the Cyst. What is you take on this?
For a young guy like you I'd hesitate to recommend radiation due to the late long term side effects. In your situation I'd consider focal therapy such as HIFU. (I'm writing a manuscript on focal therapy and will make a video on the topic when we publish the research. Long story short is it has lower side effect risk but you might need re-treatment/has a risk of treatment failure.)
Surveillance is also an option in GG2 disease but again probably a better idea in an older guy. I'd get a couple opinions before you get treatment.
Yep
Thanks Dr for the info. In your surgery vs radiation comparison you lump all forms of radiation together with regard to accuracy (regarding damage to other organs) and effectiveness. If you separate Proton Therapy out from the general “radiation” discussion and comparison to surgery, won’t that change the risk level, side effects, etc in your report?
Inadequate data to say yet. Proton does not have long enough follow up data to comment yet. Most data is 5 year only
Hi. If you have a moment to answer this, great! So, in regards to harming tissues and Erectile Dysfunction with radiation treatment, could there be a difference in a short term treatment or the longer treatment? For instance, the 2 weeks vs the 45 days? I wasn't inconvenienced by the time commitment so I opted for the treatment of 45 days. Thanks!!
So far it appears there is little difference in erectile function between the fewer radiation doses at high dose per treatment (called hypofractionation) vs lower doses over more time.
Such an informative video! My husband has had a few biopsies , four or five MRIs over last ten years with a Gleason 6 outcome. Last Urologist recommended a 30 needle biopsy which seems excessive. Also he has concerns about the gadolidium used in the contrast MRIs. Have you any concerns over gadolinium use and is this 30 needle biopsy going to give better results vs risks?
Thus far there is limited data showing adverse effects of repeated gadolinium exposure in people with normal kidney function but it is an area of ongoing research.
30 core biopsies are an uncommonly used technique used when a doctor has a worry about cancer that might be missed by MRI or the standard 12 core biopsy. I can't comment on your husband's particular case without having the opportunity to see him, his scan and full records so it's hard to say if I would recommend the same course or not. Simply put I have not personally encountered a situation in my practice I felt warranted a 30 core "saturation biopsy". Hope this is helpful.
@@cancerbetter Thank you for taking time to answer!
@@cancerbetter I recently had 30 core biopsy which showed only one of five specimens to have cancer and of the one that did 7/8 cores had cancer resulting in a GS of 3 + 4 (10%) = 7 and T2. No perineurial invasion. My MRI showed a nodule in the anterior right and possible infection or uncertainty in the left (hence the 30 cores?).
I’m 68 and otherwise fit and in good health. PSA 6.5. 9 mm max tumour. All in anterior right. My urologist has ruled out focal therapy as a credible option and thinks surgery is the logical approach - deals with LUTS, removes the prostate to help monitoring zero % PSA subsequently, pathology report available subsequently of the prostate and keeps RT available as a salvage option. He’s offering me a modified form of Retzius sparing because of where the cancer is. Radiologist is of the same view.
While I’m not, of course, asking for any opinion from you, I would be interested in any thoughts you have about the above. Obviously, I’m being advised by my urologist/surgeon and the radiologist on my treatment options. Thank you for your fantastic series of videos. Really clear and helpful.
Very informative! Thanks!My husband is 75, and was diagnosed as early onset PC. His PSA was 6.28 and was caught early ( no symptoms)due to a yearly check up ( for his drivers) . So biopsy was gone and a lump was found , externally, apparently. And his Gleason report was confusing ( for us) but read this way , 6,7,8,7,10( from specific samples that were taken).
So needless to say it was cancer. He was given pills for a month and then injections every 3 months. Had ct scan which did not see that it had matastinized . So now the type of treatment that is most likely to happen is radiation. Seeing your videos, I’ll have a lot of questions for the GP( cancer doctor as well, where we live) . So my question also is would he be a good candidate for the radiation pebbles?
He will have treatments in a large city near us! Living in Canada.
I didn't discuss radiation pebbles, which is medically referred to as brachytherapy. It's a complex topic but the main points are that brachytherapy is a rather effective prostate cancer treatment with similar or slightly higher cure rates than external radiation but also has higher risks of urethral structures. Brachytherapy use has declined over time due to the extensive infrastructure needed to do these kinds of treatments. It's worth discussing with a radiation oncologist who does brachytherapy.
Thank You for your valuable time, and expert compassionate information.
It’s very near decision time for me: DaVinci surgery or triple therapy radiation.
61yo, No underlying health issues. I have a new health provider, and blood work results were normal except PSA 53, WoW….
Biopsy results Gleason 7 / 3+4, negative Dre, PSMA shows Prostate specific with no metastasis, or lymph node. Prostate MRI, and 8 weeks post biopsy PSA pending.
My question becomes: how to treat PSA 53, and why is it so very high. Despite all other results being Grade T1 or 2.
Unless pending information provides new insight, I’m leaning towards surgery and incontinence, vs triple therapy radiation and Hormone side effects.
Your response will be Greatfully appreciated.
That's a difficult situation give the PSA is much higher than we'd expect. However the PSMA scan shows no cancer outside the prostate which is reassuring. If the surgeon feels they can get all the cancer out after looking at the MRI then I generally think surgery is a reasonable option on these situations. Then after surgery if the PSA goes to undetectable levels you know you likely got it before it spread.
With radiation you might not get that information.
In the event that the cancer has spread consider radiation to the metastatic site when they become visible. This would likely slow the cancer considerably.
It beats the dirt nap
Dr Ahdoot, thank you for making this video. I’m 55 yo with PSA 12.1 and Group 4 with 2 cores with Gleason scores of 4+4, 2 at 4+3, and 2 at 3+3 (no perineural invasion identified). I’m scared to death of making the wrong decision as to what path to take. My urologist/surgeon recommends surgery but says there will NOT be any sparing of nerves due to the high scores. I meet with a radiologist on Monday to get his take. You have mentioned that someone my age, with few exceptions, should opt for surgery. Given my information above, is that your recommendation for me as well. I have to admit, I don’t feel ready to have what appears will be permanent ED. It also seems that I prefer the possible side affects of radiation but maybe I’m not seeing the whole, long-term picture. Would really appreciate any input you could give me.
Get another opinion!!! High grade group is not a reason to skip nerve sparing in all patients. It all depends where the cancer is located relative to the cancer. I've done nerve sparing successfully with grade group 4 people on multiple occasions. Find a high volume surgeon with experience using MRI in treatment.
You are very young for radiation. Take into account the late term side effects as you make this decision. It's not an easy one but with this video you now have the information you need.
I am just reading your post and I hope my input is not outdated. I found myself in your situation in June 2020. I opted for radical surgery but unfortunately the cancer was right behind the nerve and the surgeon could not spare the nerve, resulting in ED since 2020. Viagra and the rest did not help. Through my own online research, I stumbled upon "Vacurect" device sold online. That was my savior! It has been working perfectly for me. My only problem is the issue of a mild incontinence which is not going away. I have my PSA checked every 6 months and the level is OK. I hope this helps you or others.
What do you suggest for high volume ( entire right side ) of 4+3 as well as one core of 4+4?
Unfortunately that is not an easy question to answer. When I have a patient like this I look at the extent of the cancer on MRI, the proximity to the nerves, proximity to the urinary sphincter, the person's erection status, Gleason score, age and several other factors to try to give my best advice.
@@cancerbetter thank you for all your information. Much appreciated. We are thinking focal therapy with IRE from a clinic in Germany. If there is a recurrence we are thinking sbrt . Do you know of high volume sbrt centers ? Is cyber knife better than sbrt done on different types of machines ?
@@cancerbetter the information you provide in your videos is very helpful and much appreciated. Thank you
I JUST HAD A psma pet scan with this result: "Pelvis:
Prostate bed: Brachytherapy beads in the prostate. There is focal
increased tracer uptake in the posterior right lobe with max SUV 18.7,
concerning for recurrent neoplastic process.
This likely means there is an area of the prostate cancer that was not completely treated by the brachytherapy. Most common reason that I see Breaky therapy fail is that sometimes the beads are not spaced, perfectly leading to larger the desire gaps between the breaking therapy beads. The tissue between the brei therapy beats that are too far apart does not get enough of a radiation dose thus failing to kill the cancer in that area, you should speak with your radiation oncologist and your urologist to see what options they recommend.
THANK YOU, I'M SEEING THE UROLOGIST TOMORROW!
Thank you for the excellent videos. This is the first time I've seen them. I am 62 and considering Cyberknife radiation. I have had umbilical hernia surgery, which did not go well, and would have to have that redone if I had my prostate removed. What might your recommendation be considering all of this? I have a Gleason of 7 (3+4) and PSA never got over4.6 and had even dropped to 4.3 when last tested. Thank you again for your videos! Very informative!
You can still get prostate surgery if you choose after a hernia repair. All of us who are high volume surgeons have seen this many times. That being said there is no right answer here. As long as you are well informed (these videos are high quality evidence) either choice is ok.
You might want to also consider focal therapy. If the area of cancer in the prostate is small we have means of just burning only the tumor and keeping the prostate in. Focal therapy generally has the lowest risk of complications.
Can you give us some advised doctor, I don't have enough sleep thinking of these options. The doctor here in our country suggested to have an operation but we are worried if his body can make it.
I’m so sorry but I can not give medical advice on this platform. My goal is to educate people so they can begin to have a better understanding of how to find the best medical care possible. If the cancer is metastatic (ie has spread) prostate removal is usually not recommended.
Thank you..great information. I was wondering if nerve sparing radiation therapy is now generally available? Also, with more targeted radiation options like sbrt, is longterm ED still a concern?
There is no such thing as nerve sparing radiation. When they radiate the prostate they pass radiation into the gland from many angles resulting in an accumulation of radiation damage in a target area, in this case the prostate. Everywhere around that target area will also receive radiation but at decreasing doses as you get further from the targeted area. The nerves for erections wrap around the prostate so they always get a high radiation dose. It's just the physics. This is why even excellently targeted radiation still has side effects.
@@cancerbetter I saw something on the PCRI TH-cam channel..will see if I can find the link. What you say makes sense. consultqd.clevelandclinic.org/testing-the-ability-to-preserve-erectile-function-while-using-stereotactic-ablative-body-radiotherapy-for-localized-prostate-cancer/
@@cancerbetter But does your statement apply to proton beam therapy, and not just photon radiation?
@@cancerbetter sigh.. wow.. i wish we had more options by now..mine has returned...
@@dmcarden sorry to hear that but even when prostate cancer has returned there are very successful treatment options that can control it for many year.
Just told I have a Gleason score of 7 (4+3) PSA 9.8, 71 years old. I had a PSMA scan and looks local. I am given the choice of surgery or radiation.They want to radiate part of my seminal vesicle because tumor is so close. I'm still undecided what I will go with. I had a stent put in my heart 18 years ago. I have been passing all my stress test. Should I just go radiation and not to worry?
That’s a personal choice. I try not to make these decisions for people but provide the information so you are empowered to make choices. On average most people do well with either option
@@cancerbetter Thanks !
How about Lutetium 177P5 Directed therapy (spreading other organs)?
Very promising early studies. I’ll make a video on the topic
Fantastic summary! Thanks.
I seem to recall somebody who had radiation treatment saying that it had effects upon his Immune System (not sure temporary vs. permanent). Is that a substantial risk factor?
Not anything I have heard of. Remember the radiation is to the pelvis so there is little immune effect as there are not immune organs there per say.
@@cancerbetter, even more excellent information. Thanks again!
@@cancerbetter, so I gather there aren’t even any substantial numbers of lymph nodes in that area?
@mr88cet I got you!
@mr88cet there are about 60 lymph nodes in that area but the removal of 60 nodes is insignificant in the context of >1000 in the body.
I.should have check it before I loosed my father,he died because of prostrate cancer.we gave him.keemo therapy he suffered a lot
So sorry for your loss.
As you know, there are several types of radiation. Can you do something comparing photon and proton radiation? I'm looking back the marketing aspect and what's best for my prostrate cancer and I'm leaning proton, but it's a moving target. So I have it down to three options: 1) Proton, 2) HDR Brachy, or 3), SBRT. Thanks for any help in that direction.
As a urologist I’m honestly not an expert in radiation technologies. I have read most of the proton literature though and my general conclusions are
1. We don’t have enough long term data on proton to say it’s truly better or worse
2. Secondary cancer risk in the earlier years might be lower with proton.
3. All other complications seem comparable based on very limited data
Brachy works well but has higher stricture rates which can be a big problem.
I have just been diagnosed with prostate cancer.
Also, the cancer is aggressive and metastasized onto the pelvic bone.
Radiation was dicussed, as well as hormonal therapy.
Ablation was not discussed.
I wish to learn more...
Side question: do you reccomend femara and or nipple radiation while under hormonal therapy or before it starts?
Thanks
Sorry but I can’t give medical advice on this platform. I’m sorry to hear about the diagnosis. I would speak with a urologist, radiation oncologist and an oncologist who specializes on prostate cancer. I’d collect advice from these people and then create a treatment plan. Even in cases of advanced cancer treatments are very effective.
@@cancerbetter
Many thanks.
I understand.
@@simondumoulin2254could you give us an update ?
Thank you for providing so much excellent information. I’m 61 and in otherwise good health with Gleason 7. 14 of 18 cores on biopsy were positive, with 8 cores being 3+4 and 6 cores being 4+3. I’ve been given an “unfavourable intermediate risk” diagnosis. My urologist is a top surgeon (does robotic surgery and nerve-sparing when possible) and the radiation oncologist is top notch too. The radiation oncologist wants to do both HDR brachytherapy and external beam with 6 months ADT. I currently have good erections, though somewhat low flow urination and somewhat frequent urge. I’m grateful to have good treatment options, but given my age and other considerations, I feel pretty torn between RP and RT + ADT. I keep flipping back and forth between the two. 🤷🏼 Any thoughts you feel comfortable adding would be greatly appreciated. Thanks again for the great video.
I’m glad to hear you have excellent doctors taking care of you. The one piece of data I would add that would be relevant to your situation is that in men with many positive cores like yourself the odds of prostate cancer growing beyond the capsule of the prostate is actually rather high. For this reason, in people with high volume prostate cancer (like yourself) the risk of a positive surgical margin is higher as the cancer grows beyond the typical boundaries of a nerve sparing surgery. I would have an honest conversation with your surgeon about what your MRI looks like and if the cancer might be growing outside the boundary of the prostate. If it’s growing outside the boundary of the prostate the success rate for surgery is reduced. Obviously surgery can still be successful but the surgeon will possibly have to make surgical modifications to go wide in the area of cancer. Depending on where they might need to go wide will determine possible side effects. Hope this is helpful and I hope my videos are able to help you make an informed decision. - Michael Ahdoot MD
Hi From Australia.. Im in the same boat...64 Fit n Healthy.. Gleason 4+3...PSA 6.3..Biopsy was 3 Positive Cores.. Urologist is wanting to do Full Removal..As the Cancer is Contained atm...PSMA PET Scan upcoming..
The situation is just soooo confusing.Radiation Oncologist wants to do 5 weeks of treatment with 6 months of Hormones toooo.
@cabacronulla finding a highly experienced surgeon usually results in the he best possible outcomes.
Don't feel alone about the flipping back and forth. I've been flipping for 30 days.
Your video is very reassuring, I refer to it often when walking through my procedure choices. I am 69 years old and diagnosed with 3+4=7 on one side and 3 + 3 =6 on the other side of my prostate. My main concern is incontinence and ED. My age and MUL of 1.2cm leads me to believe I am more at risk of incontinence after radical prostatectomy. I am very healthy otherwise. I am concerned about the impact of incontinence 10-12 years after radiation therapy. I am considering Tulsa Pro procedure as there should not be any continence issues. I can only get the 3 + 4 = 7 side treated. I'm thinking if the cancer comes back 5 years from now I would consider radiation therapy as 15 years out from there I would be 89 years old and advancements in therapy may reduce the incontinence issues. What are your thoughts.
For limiting risk of adverse effects focal therapy such as HIFU and TULSA are ideal. However, these treatments are only appropriate in certain patient populations. Namely, patients with Gleason 6 of 7 cancer that is visible on MRI and limited to only one side of the prostate are ideal candidates for these therapies. HIFU is among one of the best studied focal therapies and often is my go to treatment.
TULSA in theory seems very promising but the data on TULSA for focal therapy is VERY limited as of now (sept 2022) and we don't know how well it actually performs.
For people considering focal therapy its important that you understand the limitations of this therapy (i.e. cure rates are lower and you might need additional treatments) and that after treatment follow up biopsies are very often needed to ensure the cancer is eradicated.
I have a focal therapy video ready to film but I simply have not had the time to film yet. I can see there is clearly a need for this information so I will work to get this out for you and the others trying to make a decision about prostate cancer treatment.
I hope this helps. As always, please consult with MDs about your particular case. There are always details regarding each individuals case that one should take into effect in making medical decisions.
@@cancerbetter Thanks again. You help consolidate what I hear separately from different institutions Mayo, U of Chicago, Northwestern, Yale and Scionti Cancer Center. Good luck with the next video.
i bought the book ( on ebay ) by dr mark scholz . " the invasion of the prostate snatchers " . its a damn fun read and it gives much credence to my belief that there is still too much overdiagnosis and overtreatment . for instance ( im 64 ) , if i can live 10 more years untreated or 11 - 12 more years treated and all fucked up -- which do you think im going to choose ? many times the gain is just too small for the amount of damage done .
Consider “targeted therapy” 3 different types. You “may” be a candidate. This could give you a good ED outcome.
Hi im 64 and overall fit and healthy..Im 180cm tall and weigh 70kg. Im a very active person who has been a professional surfer and still surf very regular. So for my age im considered fit...My PSA went up to 6.3 so my Urologist ordered a MRI. It came back with Gleason Score of 4+3. I just had a Prostate Biopsy and after the results came back my Urologist wants to do a Radical Prostatectomy. Im very worried about not just the surgery but also the Re-Hab....Thank you, I live on the East Coast of Australia.
Your health and fitness usually translates into better outcomes
I had no symptoms from my cancer. After 26 rounds of radiation, I have ED and rectal bleeding for the last 3 years.
Thank you for sharing your experience. Knowing what you know now would you make any different choices?
I think that I would have stuck with active surveillance. My tumor was shrinking from my holistic diet.
@hitechrr I appreciate you sharing. Just some ideas. You can ask about hyperbaric oxygen therapy to treat the bleeding. Urologists have options you can consider for the ED. Sorry to hear of your challenges and I hope things get better.
Would like to see a glossary of acronyms used here. Googling brings up many far reaching lists that are not very helpful. If anyone can help it will be appreciated. Thank you. Stan Stevens.. Missouri
Hi Michael
I’m 66 and healthy. However, I have Gleason 7 4+3 prostate cancer. I’ve been told I have to choose between Surgery or Radiation. I’ve had an appointment with a Radiation Oncologist who told me about that treatment. I have to have a PSMA a Pet scan soon. In two weeks I go back to my Urologist to give him a decision on what treatment I will have. It looks like I have to choose which treatment will have the lesser side effects on me in the long term. Either urinary incontinence with surgery or bowel problems with Radiation. Out of the two urinary incontinence seems the lesser of two evils. It’s an awful choice to make as the surgery will have the greater impact on me holistically. I was leaning to Radiation, but now the thought of bowel incontinence in the long term is a huge downside. Am I over emphasizing the negatives of Radiation?
Chers
Ben, Sydney Australia
The rates of bowel incontinence are very low with radiation. Likewise the rates of urinary incontinence are very low with surgery. The most likely outcome is you will do well. The videos focus on the possible bad outcomes but in net these bad outcomes are actually not that common.
For some people focal therapy such as HIFU is an option with lower risks but this is reserved for patients with small volumes of cancer.
@@cancerbetter Thanks for the reassurance. I have chosen to have External Beam radiation treatment. It all starts very soon.
Hi .Ben How are You doing now? Did you have any seminal vesicles involvement?
@@tanvirnayeem3560 I chose to have External Beam. I’ve had 9 treatments so far. So far so good.
@@cancerbettersmall? Would that be .8 by .6 by .2?
I was reading about photodynamic therapy and it seems like a great option. Do you have any thoughts about it?
It’s one of the technologies I glossed over bc it has worse erection preservation than the other techniques mentioned. Not a bad technology at all and well studied.
Is there data on urinary and bowel function with PDT? Those are my biggest concerns.
Hi, I am 73 and have cancer that has not spread and is localized to the prostrate. Two area are an a Gleason 8, then 2 are at 6 and I have 4 at 7. I am being told I need radiation but I have had open heart surgery in the past and I take coumadin every day because of a heart valve and a water pill. I can not be bleeding while taking a blood thinner and the water pill does not help with urinary leak. What should I consider doing?
It wouldn't be right to give direct medical advice here given that I don't know a person's full history and never seen them. The goal of my channel is to try to educate people so that they can have informed discussions with their doctors about what would be the right treatment course. I would recommend you speak with both radiation oncologist and an experienced urologist who specializes in oncology. Collect the advice of these people and then make a decision based on your values.
@@cancerbetter Hi Doctor and thank you for your time. I guess my true question is not really about me but about someone who has to stay on coumadin for the rest of their life. Should they risk bleeding issues both short term and even years later. Bleeding is a real problem for some and maybe another procedure is wiser? Can you reply to that problem? Again, thank you for your time.
If you can not stop anticoagulation then surgery would have very high bleeding risks and radiation would usually be preferred
If you can be off anticoagulation for 1 week for surgery then surgery has the potential benefit of less bleeding in the long term. I didn't discuss this in a video yet but radiation can cause severe bladder bleeding several years after radiation in rare cases. Anticoagulation would increase the risk of bleeding.
@@cancerbetter Thank you, this is what I needed to make a proper choice.
It seems I'm the oldest member in the comments group, at 78. I'm not facing the difficult decision of surgery vs radiation. As of now, my urologist is "not recommending" surgery. I'm leaning towards radiation, but; with a genetic tendency of me reaching 100...its a difficult choice.
It's rare I operate on someone in their late 70s for prostate cancer but cases like this do come up. In my experience they have done well and you shouldn't consider your age alone as a reason to not get surgery. More important factors to looks at are if your surgeon feels they can confidently remove all the cancer based on the tumor location on MRI..
Question: if you have surgery and the cancer recurs you can then have radiation, but if you have radiation and it recurs you cannot have radiation again - is this true? Thanks, Tom
Radiation failures are a bit complicated and difficult to treat. If you get radiation to an area you cannot radiate that area again. However, you can, in some situations, do focal brachytherapy or focal therapy, like HIFU, to a small area of the prostate if the cancer recurs in a small focal area.
Generally complication rates are high when retreating after failed radiation but early data is showing HIFU has the lowest complication rates. Other options are post radiation prostatectomy but incontinence and erectile dysfunction rates are high.
This presentation is 3 years ago so I feel that my question might not get answered, and that's fine. maybe someone reading it will answer it. Cyberknife is a fairly new technology for administering radiation just to the prostate. The radiation stops at the prostate and does not navigate outward. Would you feel that this is the safest way to have radiation treatment rather than surgery?
Unfortunately all radiations technologies expose adjacent tissues to some radiation exposure. More focal treatments like IMRT and cyberknife can reduce the dose but there is still risk.
Similarly surgical treatments have improved resulting in reduced risks of complications.
Do you consider IMRT an older type of radiation?
IMRT is pretty modern technology. With radiation it's all about quality of targeting and limiting collateral radiation to other tissues in the area of the prostate. Despite the technology advances it's unavoidable that tissue around the radiated target will get some radiation and the closer the tissue is to the prostate the higher the dose it will receive.
Oddly enough, the wider ‘margin’ hit by radiation (vs the surgeon’s scalpel) may be a benefit to those with ECE. And MRI’s are not necessarily definitive when it comes to ECE. So, if there is any suspicion of ECE at all, is radiation the preferred modality (vs surgery)?
That’s a great point. It all depends on the location of the cancer and if the surgeon thinks it’s something they can get out. I have had many patients with negative surgical margins after prostatectomy with ECE. However when ECE is present the odds of a surgical margin increase and depending on the location where the surgeon has to go wide, it could comprise function. This is something to discuss with your surgeon. Someone who is good will be able to look at your MRI and make predictions about what will likely be needed at the time of surgery.
Thank you Dr. Ahdoot. All your videos have been a huge help towards my final decision, when ever that will be.
I am turning 69 in July and four months ago was diagnosed with prostate cancer. My Gleason is 3+4, PSA 11, cancer contained in 1 (out of 12) core, with no perineural invasion (they hope-the biopsy was performed with an ultrasound only).
From this presentation, the take away for me is your "60 and below do surge and above 60 years radiation." My question is what radiation would you recommended? I live in the Houston area, so assume the I have all the options available to me. And...do you know any radio therapy doctor(s), and surgery doctor(s), you can recommend?
Oh, and would you recommend a PET scan when I go for my second opinion?
Again, thank you so much for your work.
I would say 60 and below def surgery. 70 and above slightly favors radiation on average. 60-70 could go either way. Of course this is a general concept and is over simplistic.
PSMA PET scans are better than bone scan and CT scan for detecting metastatic prostate cancer. Usually these are recommended for people with grade group 3 and above cancer but again there are exceptions. A urologist specializing in oncology should have no trouble answering these questions for you.
What do you know about nano knife?
Fancy marketing name for standard external radiation. Collateral damage will still occur from the radiation.
What is your thinking about the effectiveness and side effects of proton radiation therapy?
I'M 62 years old in excellent shape. Ive only had 1 PSA test of 29 with a 1 month follow up at 27 my Gleason score is 7 some 3+4 a couple 4+3. it seems age wise I'm kind of in the middle between radiation or removal. Do you think observation is even a choice for me?
I would not recommend observation for grade group 3 cancer. It can be dangerous.
In general for a 62 year old in good health I'd encourage surgery with an experienced surgeon. If you can find someone doing Retzius sparing technique continence can return very fast after surgery.
@@cancerbetter Dr. Ahddot, thank you so much for your prompt reply. My doctor is recommending surgery but I still have a meeting with radioligist also. I had a ct scan and a bone scan no spread observed. I asked about a PSMA scan and he didn't feel it was necessary.
@@cancerbetter I have been reading the comments section and ran across your Retzius sparing technique. My main concern is incontinence and I had never heard of this procedure. I just signed up for an appt at MDAnderson. I am 69 years old, with localized prostate cancer 3+4=7. 2 of 12 cores had some 3+4, one core had 3+3. So glad you referenced the RS-RARP. Thank you.
Check out my video on focal therapy for prostate cancer. You might be a candidate and that has the best continence outcomes.
Doctor, thank you so much for your videos. You explain things very well, even the nuances of the various treatments.
I am 65 years old and in very good health, but recently diagnosed with Grade 2, 3+4 Gleason score. 20% of 1/12 TRUS biopsy cores came back positive. A subsequent MRI showed the lesion is 13x8 mm located in the peripheral zone apex. It “abuts the capsule without definite extracapsular extensions”. My PSA is in low 4’s.
My urologist recommends surgery because of my age and good health, but but he has done only around 200 RP. I understand outcomes are better with surgeons who have done a lot of RP, so I plan on talking to another more experienced urologist next month at Emory University.
My radiation oncologist recommends HDR (high dose rate) radiation therapy, but I understand HDR is usually done in conjunction with other therapies. Do you know what the 10-15 year outcomes are when HDR is used as a monotherapy. He says the side effects are less than seeds radiation.
Have you any thoughts about which way I should choose?
Are you familiar with Proton therapy treatment @ UF Jacksonville Florida
Yes but data is still not very mature it seems
There are lots of different types of radiation - sbrt, seeds, imrt and there is proton therapy. Do you have a video comparing those ?
No videos on those topics yet. I'd like to get there but I'm too busy with my clinical practice and I make these videos in my free time.
Short version
Brachy- great for cancer treatment but higher risk if urinary complications like scaring in the urethra.
Sbrt- stand radiation described in the video
Proton - similar to sbrt in most outcomes. Data is immature to know 15 year complications rates. Early data shows possibly declined secondary cancer rates.
@@cancerbetter what do you know about nano knife / vittus prostate clinic In Germany? They use electromagnetics to damage cells not tissue . Claims to be lower side effects ??
Never heard of it
@@cancerbetter they are using it in the uk and Australia and at some prostate clinics in the US and canada. (Tulane , McGill, UCI , Sloan Kettering). They insert needles and kill the cancer with electricity with minimal side effects. Vitus prostate clinic in Germany ( Prof Stehling) offers it for high risk Gleason whereas in the US it seems to be used mainly for Gleason 7. My husband was first diagnosed with Gleason 4+3 in canada but had his slides reviewed at the Mayo and they classified it as 4+5 ( or maybe 5+4 - not sure ). He is only 60 and in otherwise excellent health and very fit. He is devastated by the thought of losing his vitality to cancer treatment and of course terrified at the same time. Surgery seems awful and recurrence rate seems high. Radiation seems awful as well. He does not want to lose his lymph nodes. He has had a clean psma pet and his PSA has declined from 12 at the time of original diagnosis to 7.4. He has radically changed his diet and even though was very trim he has lost 25 lbs. the surgeon said losing weight was a good thing. But I worry. We dont know what to do.
@@sandraredmond4812 surgery sounds like it had a chance of cure. It's not fun to make a tough decision like this but you may be able to cure him. Don't miss the opportunity.
Yes erection loss is a risk but we have ways to help people get erections again. Keep gathering information to help you make your decision. I wish him an excellent outcome.
what about robotic surgery?
When I mention surgery in this video I am referring to robotic prostatectomy, which is the current standard of care in the United States and Europe. Clinical trials comparing open prostatectomy to robotic prostatectomy found that robotic prostatectomy results in less blood loss, fewer strictures, and shorter hospitalization. There were no substantial differences in cure rates of erectile function in those older studies.
While there have not been modern studies comparing contemporary robotic surgical techniques to robotic techniques in the early days, based on my experience I can say continence rates are definitely better with modern techniques and erectile function rates are likely better(though not substantially).
- Michael Ahdoot MD
With surgery one will need to commence erection treatments with injections and meds to prevent "atrophy" and encourage blood-flow, as long as necessary -- perhaps years. Focal therapy is also an option in some cases.
That banana on the splash screen is a bit harsh considering the topic.
I really need to find some time to give a talk on focal therapy. It's really a great topic and is a great treatment in certain situations. I wrote a paper on the topic in 2019. It's intended for physicians but it's pretty understandable. Google "Ahdoot Focal Therapy" and it should be the first hit. It will give a good overview on the topic. - Michael Ahdoot MD
@@cancerbetter Does your article address prostate size? I think my husbands urologists said his prostate is too large for focal therapy.
There is no size cut off for focal therapy but each technology has its limits. HIFU for example uses energy passed through the rectum to burn the prostate and has a limitation of approximately 4cm from the rectum.
The main limitation for most cases is the volume of cancer. If the volume of cancer is substantial then focal therapy is not an excellent choice generally.
It’s a flip a coin situation as you don’t know how you’ll respond . Urinary and fecal urgency and incontinence are radically different situations to me and radiation doesn’t contribute to loss of control. . Wearing pads for a year or more is problematic at the least..I love how the stats talk about your outcome at ten years.. I’m not interested in ten years, talk to me about twenty..
At 20 years the side effects of radiation would increase and those of surgery would be unchanged from the 10 year data.
I assume you were talking about older radiation methods and not cyberknife?
Cyberknife is just a brand name for similar technology. These results would be representative for cyberknife.
@@cancerbetter thank you for taking the time to reply.
Good to know. I had read "cyberknife" methods typically use require up to 5 visits/sessions where older radiation not deemed cyberknife may require up to 30 visits, so good to know your synopsis is related to cyberknife type of radiation.
Thanks again
As someone who is under 50, I keep reading the surgery was worse than the radiation therapy.
The data simply does not support that statement.
Lucky me … I am having 35 rounds of radiation after having been through the surgery
Sorry to hear that but the success rates in terms of cancer control are usually very good even in people who failure sure. Wish you a speedy recovery
👍🏼👍🏼👍🏼👍🏼👍🏼👍🏼
Is proton beam therapy noticeably safer (less damage to other organs) than modern external beam radiation?
All early studies say it’s about the same.
ive been dx'd 3+4 , grade 2 cancer found in 1 of 12 cores . the VA isnt interested in subgroupings , they have no intention of doing any imaging and said they dont care to attempt nerve sparing . im 64 and thinking strongly about just letting nature run its course . the VA has a huge population of prostate cancer patients and i think theyre too overwhelmed to offer anything but the hatchet . theres a lot of information out here indicating that RP is overused .
I am a 72 yo veteran dealing with prostate cancer. I have also experienced the same attitude that you have.
You can request “Community Care” and if you are approved, you can choose your own private urologist. No matter what you hear, you can choose the treatment you want.
You sound like a potentially good candidate for focal therapy.
@@cancerbetter I would most certainly be interested in focal therapy. from what I've read, it is a better alternative to surgery or radiation. Now I need to find some one to do it.
Where are you located?.
@@cancerbetter martinsville indiana
Why no mention of HIFU? Radiation, don’t downplay the risk of secondary cancer’
HIFU no radiation, no removal of prostate, I still have mine 6 years cancer free.
What is HIFU?
@@paulasusan63 High Intensity Focused Ultrasound
No radiation, or removal of the prostate.
HIFU is a reasonable option in some situations. HIFU is when we use high energy ultrasound to burn only the area of cancer in the prostate and leave the rest of the prostate alone. When a person has just a small focus of cancer it can be a great treatment. I've been very busy caring for my patients in my practice but I'm planning to make a whole video about HIFU.
@@cancerbetter I had complete gland treatment, I’m now cancer free for 10 years.
im interested in hifu also . medicaid will partially pay for it . if my providers will work with me id be willing to pay what medicaid / hip will not . the procedure costs 25 k .
My problem is so many men have a 40% chance of recurrence after RP that they end up getting radiation anyway. Though Surgery gives you a accurate pathology seems better, radiation your psa never drops so you're constantly living in fear of the unknown... instead of going to a urologist or a radiologist..go to a cancer center and have them build you a non bias plan if removal, then go to your uro or ro...
Your number is an overestimate. If a person has prostate confined cancer then about 10% risk of a positive surgical margin. If the cancer has grown out of the capsule of the prostate then the positive margin rate is about 30-35%. But yes this is a real risk.
To be fair radiation has near identical rates of recurrence.
@@cancerbetter so if the cancer is confined, then you get the same outcome from radiation as well as surgery?
You bring up a good point that scans are not yet perfect and a good number of surgeries are (inadvertently) performed where there may be ECE/EPE leading to a relatively high PSM rate in these particular surgeries. Which leads to a relatively high reoccurrence rate.
Since the goal is to kill/remove the cancer one would imagine surgeons would err on the safe side and refer possible ECE cases instead to radiation where the broader beam (beyond the margin of the prostate) may kill the (possible) ECE.
Robert, you bring up a good point. When extraprostatic extensions is seen on MRI the the risk of a positive surgical margin at surgery is higher than in organ confined disease. You would need to talk to your surgeon about whether they think the area of EPE can be removed without bad side effects. In some cases it’s possible and in others it not. Alternatively you can negate the uncertainty and get radiation.
what about laser surgery is that good my husband is unsure he is 57 years old the laser surgeon is considered gold standard whatever that means
Focal laser ablation is a way of treatment prostate cancer by burning the area of cancer. Look at my video entitled "Is there a better treatment for prostate cancer". Focal laser ablation is a very new technique which is mostly being studied right now with mixed results