Radiation vs. Surgery for Prostate Cancer | Ask a Prostate Expert, Mark Scholz, MD
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- เผยแพร่เมื่อ 30 มิ.ย. 2024
- The perennial decision for patients who require treatment for prostate cancer is whether they should have surgery (radical prostatectomy) or radiation therapy. Since urologists typically make the prostate cancer diagnosis and are oftentimes the ones who perform the surgery, and since radiation has only been a consistently effective treatment since the advent of IMRT in the last 20 or so years (remembering that studies take years to decades to complete and opinions take even longer to change) patients oftentimes automatically undergo surgery assuming it is the logical thing to do. However, clinical trials have demonstrated that radiation therapy has a lower side effect rate while achieving equal or better cure rates (depending on the stage of cancer).
0:05 Why is surgery usually the first (and sometimes the only) treatment offered to men for prostate cancer?
2:52 How do overall long-term cure rates compare between surgery and radiation?
4:06 Are there studies that compare surgery vs. radiation?
Don’t know your stage? Take the quiz: Visit www.prostatecancerstaging.org
To learn more about prostate cancer visit www.pcri.org
Who we are:
The Prostate Cancer Research Institute (PCRI) is a 501(c)(3) not-for-profit organization that is dedicated to helping you research your treatment options. We understand that you have many questions, and we can help you find the answers that are specific to your case. All of our resources are designed by a multidisciplinary team of advocates and expert physicians, for patients. We believe that by educating yourself about the disease, you will have more productive interactions with your medical professionals and receive better-individualized care. Feel free to explore our website or call our free helpline at 1 (800) 641-7274 with any questions that you have. Our Federal Tax ID # is 95-4617875 and qualifies for maximum charitable gift deductions by individual donors.
The information on the Prostate Cancer Research Institute's TH-cam channel is provided with the understanding that the Institute is not engaged in rendering medical advice or recommendation. The information provided in these videos should not replace consultations with qualified health care professionals to meet your individual medical needs.
#ProstateCancer #Prostate #MarkScholzMD
I have just had radiotherapy and it has been a complete walk in the park-he is right
That's how my Urologist was after my biopsy, "You need to do something now!". They would call every couple of days. I took a month to do research. My thanks to Prostate Cancer Research Institute and Prostate Cancer Foundation for great information. Once the word got out I had PC I had about eight guys I ride with told me they had been down this road. I asked them three questions. What treatment did you choose, why and knowing what you know now would you make the same choice. Half had radiation, all said they would do it again. The other half had surgery, only one would choose surgery again. And he had to have radiation six months later. Newly diagnosed patents have time. Do your research for doctors and treatments.
Wow I find it amazing you know 8 guys that had it done ,,I know one ,my neighbor ,he had radiation a few years back but I talked with him yesterday and his psa is at 2.5 and they want to do some kind of seed implant ,,I am in the same boat as User -kh ,,they want to treat it ,thats what they do ,my psa has been around 12-16 for 4 years, mri reveled some lesions ,,have had 3 mri, but until they mutate Im not doing shit ,its been 2 years since last mri and biopsy so im due ,,fingers crossed
@billhamilton7524 Since then I've had three more friends contact me saying they were recently diagnosed . PC is the most common cancer in men. Best wishes to you in your fight. Have you had a PSMA scan?
I was just diagnosed with Prostate cancer at 53 years old. Both Urologist Are pushing for prostate removal surgery.
I am Seeing for the first time the Radiation Oncologist this month July 21st. I really do not want to loose my prostate with surgery, I would like to keep my Prostate.
Had petscan today and Mri 3 weeks ago.
I had 12 pieces taken from my prostate with the biopsy that was performed on me.
4 pieces came back normal, and 8 came back adnormal.
7 of the adnormal came back with a gleason score of 3+3= 6
1 of the abnormal came back with a gleason score of 3+4= 7
However my PSA is 67. so both of the doctors were confused off that and are just pushing for surgery.
I want to keep my Prostate, but I do not want to die. Its not about me, it is about the people that rely on me.
is a 3+4= 7 with a PSA of 67 worth surgery? I am starting to doubt that.
I May ask for another biopsy to see if any scores are higher or the same
Respectfully asking for anyones opinion on this matter,
Thank You
Sorry I read this so late. Brachial therapy is a really good option hospitals and doctors don’t promote because it is generally less profitable for them. It’s something I would have looked into more closely in hind sight.
@@snozcocram
Do you think it is better than Radiotherapy for a locally metastatic Prostate Cancer in terms of success?
How about side effects of Branchytherapy in comparison to Chemo and Radiotherapy?
My father is suffering from this; the Dr. recommended 37 Radiotherapy. He has taken 5 so far.
@@Faiselmoha my layperson understanding is these are very different levels of treatment. Chemotherapy is meant to be a whole body therapy for metastatic cancer, it has serious side effects. Radiation therapy is for focused “poising” of the cancer, when it is localized or maybe metastasized to the seminal vesicles for instance. The side effects can be long lasting and during therapy, very uncomfortable. Brachial therapy can lead to prostatitis, possible infection but unlike radiotherapy does not need to pass through healthy tissue. Based on the data I have read brachial therapy is as effective as radiation therapy and is one outpatient procedure and not 20 or 37 treatments. Don’t forget all of these treatments work best with hormone deprivation therapy at some stage. Get at least three opinions from doctors who focus on the disease.
Fuja da cirurgia. Ela é boa somente para o urologista
From the bottom of my heart I want to thank this women from this institute for this video because i'm at that gate with cancer and my urologist is pushing for surgery i'm not dumb I know I have options for a better future life.
I am exactly where you are today. April 2024 in Texas. I have six months to educate myself and then make a decision. This specific video is a gift from Heaven. Going to do a focused type of radiation. Cost is a 6:32 consideration ;however, I can change insurance on January 1, 2025 and have it all covered. Education is key.
Urologista só pensa em cirurgia. Fuja deles!
I have hi risk 4+4=8 all 12 point cores on biopsy. Removal is the path I am going. The robotics surgeon has performed over 3000 procedures with this method.
I have researched and at 65 yo I am very uncomfortable with my cancerous prostate gland that is still contained.
All scans shows bone, nodes and tissue clear ( per, mri and ct scans)
Thanks for all you do for us and share. Grateful
George...I was just diagnosed with 4 + 3 ...and 4 cores on right lobe...with some intrusion on the right nerve. I don't want surgery, as I just turned 63...How are you doing ?? God Bless, btw. Do a ~90% all Whole Food plant diet
I believe this is one of the most important videos I have watched. The jump to one stop, git-er-out-and-done surgery was a train I was on, using radiation as a backup. That is, until I started watching these videos explaining the aftermath of either choice. Knowing the probabilities of recurrence, incontinence and ED all need to be explored before taking the jump. Listening to an oncologist without an axe to grind for me is what makes this so credible. Thank you, PCRI for this kind of education.
I'm 68 and my PSA within the last year has gone from 8 - 16.5. I had an MRI of the prostate done and it showed a 1.6 lesion with scattered suspicious areas associated with chronic prostatitis. My urologist is scheduling my biopsy next week and is leaning towards surgery. When I mentioned to him that removal certainly changes a mans life, he replied, "oh if that is important to you" Isn't sexual function (which would be nonexistent with removal of the prostate) and urinary function be important to any man? My father had prostate cancer but did not die of that but heart disease at 77. How much time do any of us have left and quality of life I believe is the ultimate answer..
@@jerrymunroe5593 My opinion only: Use of Androgen Depravation Technology for 18 months (blocks off the fuel for PC: testosterone), high dose brachytherapy and following up with 23 administrations of low dose radiation is what I opted for. Surgery is all about margins. How much to take. Too little, PC returns with a vengeance. Take too much? Kiss your sex life and continence goodbye. BTW... ADT does have side effects, but that is for the duration of the therapy. Small price to pay to stay alive. Talk to an experienced radiation oncologist. I talked to both sides of the fence... robotic surgeon felt that as my case was intermediate and had extended just outside the gland, I was not a good candidate for the reasons above. Educate yourself with these kinds of videos, there are lots of them.
@@jerrymunroe5593 you mean question ?
@@jerrymunroe5593 th-cam.com/video/cd_t0KlCJh4/w-d-xo.html
Awesome advice - thank you!
Thanks so much again.
Great advice from both of you!
Melbourne Australia
I’m in that boat, where I jumped on getting it out with prostatectomy. Now there’s traces and I need to find a high quality doctor (prostate oncologist) for future undetermined treatments. Not really to keen on my surgeon doing that.
Watch all of your videos..Always excellent advice! Thank you!
Hi thank you so much for the video. You guys are amazing for doing these videos.
Thank you for this video.
Extremely helpful. I cannot thank you enough.
Thank you so much for the channel
I went for surgery to avoid 3 years of hormone therapy. In the UK, that is the deal in the NHS: if you opt for radiotherapy it comes with 3 years (no less) of hormone therapy. Please don't downplay the side effects of hormone therapy because that would be misleading. Otherwise I love these videos and thank you for all you're doing 🙏🏻
Haf Ben, that's not quite true. I am in the UK and right now in the middle of 20 fraction radiotherapy in conjunction with hormone therapy. HT started in Feb and will end in July - 6 months in total. I would go on to say that the treatment I am receiving on the NHS is excellent. My company provided medical insurance only covered me for diagnosis, something I found out as quite a shock. I transferred back into the NHS with the same excellent oncologist.
Whole heartedly agree that these videos are superb and helped me make my decision.
The best prostate cancer advice on the internet! Thank you both so much for bringing hope, understanding and alternatives to people seeking answers in this fight!
Thank you
Dr. S, Alex & Hunter,,,
OUTSTANDING AS
USUAL!!!
THANK YOU 🙏
You should address what I think is the biggest issue: if radiation fails, a follow-up surgical intervention is difficult. If surgery fails, radiation as a follow up is quite easy. With radiation, you don't actually remove the entire prostate, so that subsequent PSAs would be much more difficult to use as a guide for micro/oligo metastases. With surgery, the PSA goes to zero and can be much more accurately followed for any recurrence.
You have asked the most important questions. In reply, there are a half dozen non-surgical treatments available in the case of recurrence after primary radiation. These include cryotherapy, HIFU, FLA, both types of brachytherapy, SBRT, and pencil beam protons. Surgeons usually fail to mention these effective, but competitive salvage treatments.
The threshold for recurrence after primary radiation has been well-defined since about 2007. Please Google "prostate Phoenix Definition" for details.
@@harrynewman560 Thanks for your input. I still wonder about the post-treatment PSA baseline. Surgery really seems the better path to get you to a 'clean slate.' You know the entire prostate is gone because it's in the pathology lab. If, after surgery, PSA is detectable, then you know immediately that something else is already percolating. Not so with radiation where you have to ask if post-treatment PSA is coming from some of the residual prostate gland that was not the target of the radiation or distant metastases. And it takes a long time to establish your own, new baseline PSA as it tends to fluctuate a lot after radiation and any detectable PSA is always a question mark. Appreciate your comments ! Would love to hear Dr Sholz address this.
@@bayfilly1 - with the new PSMA scans, they will be able to determine if the PSA rise after radiation is because of distant spread. Also from what I understand all radiation treatments, treat the whole gland plus I believe some Doctors even treat the lymph nodes.
I had the surgery and my PSA skyrocketed 12 weeks after surgery. I got as high as 165.5, yes, that is correct.
@@bgharvey wow are you ok, was it a psa bounce or left over prostate?...hope alls well brother
This advice is the best argument for radiation. I want to keep my prostate if possible
Really like that tie !
Thanks! I just completed 23 IMRT zaps with SpaceOar followed by two HDR Brachyboosts while on ADT for four months. I simultaneously went on a plant-based/vegan lifestyle. Finished in January and I feel great! I have my prostate and everything works. Today was my first day back at the gym. Working nautilus to build up my strength. I should have all my Testosterone back by July. Life is good!
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@@cummingkerry6840 Funny...too funny.
Hello Michael: Would you mind telling me what you prognosis (Gleason score, etc.) was that determined your treatment plan? Thank you.
I had Proton Radiation Therapy at Mayo Clinic in Rochester, Minnesota, 5 sessions in 1 1/2 weeks. 20 months later my PSA is now .47. I am very pleased with the results.
I was able to bring my PSA levels back to 4 by dieting, Keto diet. Does that mean I stop cancer from growing? Do I still have cancer?
@@TheJamingjoe If you have had a biopsy of your prostate with a confirmed positive result by a trained pathologist you still have the disease….. Please seek care from a urologist. My PSA never got over 4.0 however the rate of increase was about .5 a year…. I seriously doubt you can cure this disease without intervention……….
I was diagnosed last June with a PSA of 45 and a 10 on the yellow scale I went through radiation and hormone treatment my doctor said that surgery was not the ideal situation for me I thank him everyday for it my PSA is down to down below 0.5 is unreadable I am feeling better I'm doing fine I have 73 years old I'm looking forward to seeing my grandchild graduate from high school and he's only two
Good to hear ,,
Big push toward surgery - livelihoods are based on yanking and snatching. That is the first option offered without explanation of the alternatives. Bit strange.
Appreciate your help line. Grateful.
Go to a surgeon, he’ll say surgery is best. Go to radiologist he will tell you to do radiation!
It’s like a painter will tell you to paint, a tile man will tell you tile your room.
Best advice I got was a cancer center where TEAM of Doctors decide the best course of treatment based on your stage and their experience!
@@michaelfrascati7610 Team? What team? Where does one obtain a team? Not being a smart-a***, but living in a small, somewhat isolated town following a PC diagnosis, securing a "team" has been rather . . . problematic.
@@carlmerkle8483 If you go to a large hospital such as memorial Sloan Kettering New York City they specialize in cancer only. Your first visit you will see a Surgical Oncologist, a Radiologist Oncologist, and a Medical Oncologist the ‘Team’ will the consult with each each other and their colleagues, and determine the best course of action, and include your input as well if desired…they saved my life. I was diagnosed with an aggressive form of prostate cancer.
BTW my PSA was 11 and Gleason was 9. 5+4
Sam here, it felt like a sales pitch, and the Dr. talking to me was going to do the surgery $$$
I just completed 39 fractions of proton therapy. I do have one biopsy core that came back 4+4 90%, prior to proton therapy. I asked my oncologist about a seed implant if there was still active PSA or cancer cells after radiation, she said she wouldn’t do it, and said I could end up with an ostomy bag. Hmmm I’m dubious about her assessment. Would you share your thoughts on this. I also opted for radiation without hormone therapy, just completed my radiation therapy 7/20/22.
I had both in 2019. 1st the surgery, then 8 weeks of radiation therapy to “clean up” anything left behind
My urologist is the head of robotic surgery at a big institution and is considered an artist with the thing. But he recommended me for radiation and hormone therapy. My PSA is now
I don't have diapers than taking the hormone treatments which you will get depression in all the side effects.. Which can make you feel like you want to die. Wearing diapers ...and so what. Then I don't have to go to the bathroom all the time when i'm sleeping. Huh.
@@ricknowak4582 having a prostatectomy does not relieve you of ever needing radiation or hormone therapy. You’re not wrong about the depression, but even that weight can be delt with. BTW I’m done with HDT and am working on getting my strength back. I’ve been doing a lot of traveling. PSA still undetectable as is testosterone, but it’s only been since February.
I find your videos comprehensive and accurate. I did not find these videos prior to my surgery (03-23-20 that last day that surgery in NYS was permitted due to the pandemic. The pandemic is why I chose surgery. Did not want to take public transportation five days a week for 8 or 9 weeks during, at that time, a poorly understood pandemic.). I take some exception to "prostate cancer is slow growing." I had a "inconclusive" MRI December of 2018, the second MRI early December, 2019 showed, two tumors in my prostate. My MRI guided biopsy showed three tumors in the prostate, Gleason score 9 late December 2019. Eight weeks after the biopsy, I had my surgery and one of the tumors was pushing out of the prostate capsule. The nerves were "mush" and had to be removed. That to me seems like a pretty fast growing prostate cancer. Now, I have a low but rapidly rising PSA and I am undergoing hormone therapy coupled with direct beam radiation. Perhaps, the fact that I was diagnosed with Melanoma in May, 2018 had a role in this. I would like to hear your take on melanoma and its relationship to prostate cancer.
I had LDR focal brachytherapy with Dr. Brian Moran in June 2020. I highly recommend him as he’s one of the best in the IS. My tumor was small and a good candidate for focal. Zero problems with elimination, incontinance, or ED. PSA is low again and feeling great. I even sleep through the night regularly without having to get up to urinate.
What was your Gleason score?
@@Mel0400 my Gleason score was 6. I’m told that some 3 + 4 Gleason 7 score patients with localized disease can also be good candidates for focal Brachytherapy.
@@robertmizek3315 I am newly diagnosed with a Gleason score of 8, only 2 cores tested positive. My doctor suggested surgery, how long did you have to do hormone therapy afterwards?
@@robertmizek3315 Why when 6 is total active surveillance
If going with localized radiation treatment, how does the radiation effect (in the future) current symptoms while urinating, such as slow start, flow rate variation, use of flow max and finasteride, constriction of urethra, future possibility of having to surgically remove prostate tissue to enlarge urethra channel? Looking forward to reply, thanks.
I have a gleason 4+3, and am shortly getting a suprapubic catheter installed, is it possible to have radiation of the prostate whilst the SPC is in place?
My friend had the radioactive seed implants and he had terrible complications with his rectum. He could not poop without pain and was on a constant diet of PEG 3350 to soften his stools. It is too easy to overdo the stool softeners and now you have to wear diapers, and his rectum still hurt every time he passed a stool.
Hi sir, thanks for your input. May I ask what year he had his procedure?
@@blluenote Around 2003 I think. I could be wrong.
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The date of 2003 is important. Technology advances over the next 21 years! 💥
@@michaelclennan8425 Point is, he was told that this is really wonderful procedure, using advanced technology, less invasive than removing the entire prostate, and with less side effects and the radiation is targeted at any number of still small tumors you may have, so there is very little damage to surrounding tissue from the radiation. So if that were true, then why was he in so much discomfort for so many weeks? It is the same old story. You are told "this isn't going to hurt" and then it hurts. Or "there will be minimal discomfort from the procedure" and you find that you are in pain for weeks, and sometimes you have permanent pain. Plus, in 2003 you could get opioids to help you deal with the pain, but today, you can't. So the procedure now cause more disruption of you life than they did 20 years ago. Well the "advanced technology" claim was true. Ultrasound probe to locate the tumors combined with CT scan or MRI to help the technician understand what she is looking at on the ultrasound. Special tools to get the radioactive seeds into the prostate.
Thank you!
Is stage 4 prostate cancer which reached nearby lymph nodes and testicles completely curable?
Actually my first option was Radiotherapy and Hormone Therapy. I chose prostatectomy.
Hello, What is your opinion on focal laser ablation, HIFU? Thank You.
Hello, we have a few videos on HIFU and TULSA-PRO (which is MRI guided HIFU). If you search "PCRI HIFU" or "PCRI TULSA" that should bring those up.
What is the success rate for retaining Erectile Function,post-Radiation?-Thanks!
No problem for me. Everything works, however, my libido is down...this should improve as the T comes back in.
Patients should start talking/asking about natural killers of cancer cells extracted from Marine Sponges. University of Florida has been focussing on these.
I think surgery first runs the demonstrable risk of spreading cancer cells. Why not use first use an ablative technique with a therapeutic pharmaceutical? Is there any rationale for using hormone therapy and leaving the prostate in place, in high risk? I have seen PSA over 1000 brought to >0.04 on ADT.
I am a prostate cancer survivor. In 2017 -18 I underwent the process of prostatectomy then hormone treatments and 40 treatments of radiation. PSA has been 0.1 for 2 years now. Wondering if I could have just done radiation and hormone treatments. Gleason was 4+3. Side effects are disheartening
Sir what side effects have u experienced?..
@@markbrown5117 the surgery created total ED. Hormone shots gave bad depression and bad hot flashes like women experience. Radiation made me very tired with severe constipation. It will pass but it takes time
Can I ask what type of hormone therapy you took?
In Australia urology is one of the greediest specialities.
Urologists don't so much treat cancer as profiteer from it.
Just was listening to a podcast with a guy that had stage 4 prostate and bone cancer. Doctors told him he was going to die and there was nothing they could do for him. He ended up doing over a month long fast which threw his body into autophagy and ended up killing off the cancer.
Are u serious my husband has cancer and he is very scared so I'm trying to talk to him to do radiation
@@ermarivers2834 TH-cam search "Dr Berg Stage 4 Cancer Success Story"
Dr Berg
What kind of diet?
So just diagnosed with 3+4=7, and urologist wants me to do surgery, because at 55, radiation of any type (his words) will put me at risk for bladder/rectal cancer in 10-15+ years possibly....he would recommend radiation to someone much older has potentially shorter time frame remaining and risk is worth it....so as a 'young' prostate cancer patient...does this make sense? My options living in Chattanooga TN may be limited...
Research current rates of recurrence. Your uro sounds like he may be using out of date info. Current studies show similar recurrence and survival rates between surgery and radiation. Newer radiation procedures almost eliminate the bowel and bladder issues of the past.
What did you decide ? I just got diagnosed with 4 + 3 = 7
@@jeff6899 my husband was just diagnosed with 4 + 3= 7 . Have you decided what to do? We’re having a hard time with a decision.
I was just diagnosed with 3+4=7 at 53 years and deciding which path to take. My dad at 70 had prostatectomy with rupture followed by months of radiation, hormone therapy and lots of complications/side effects. I really don’t want my prostate removed at 53 with almost certain side effects of impotence and incontinence.
Went ahead with prostatectomy November 29th- margins were clean and was 95% continent at catheter removal - and have had sex several times (definitely a different finish sensation)… feel very lucky and confident for the future
The radiation side effects after 5-10 years are devastating, and sad part is the radiation oncologists don’t follow the patients, it’s the Urolgists who follow then and see these terrible complications ( radiation cystitis, urethra stricture, secondary bladder and rectal cancer, incontinence, erectile dysfunction,…)
What are you drawing this information from. Is this a personal experience? What year was the radiation done, was it done with Kilipso guidance? Thanks
What about Proton Treatment?
Hello,
We have a video on proton therapy here: th-cam.com/video/K4IoSy-nTqI/w-d-xo.html
I've read that Radiation can also cause incontinence, erection problems, rectal leakage, bladder damage, and give rise to secondary cancers. Thoughts, anyone? Thanks
I haven't heard about all those side effects in my research. Better to ask a professional.
Don’t go to Rosewell Park for cancer treatment
Can you explain why, if you would?
I asked my urologist about the radiological treatment and the answer was that if it failed to completely eliminate the cancer, surgery would no longer be an option. Early removal however means certainty. While the potential side effects are scary, I don’t want to go through all this again in five or ten years time.
Ask him why some men have their prostrate remove and the cancers comes back, if it is 100 percent? Also it is not true that prostate can not be remove after radiation www.mskcc.org/cancer-care/types/prostate/treatment/radical-prostatectomy. Actually, I know a device called Cyberknife(can be used for initial cancer treatment) did a clinic study on recurrent prostate cancer. There is even studies on Cybeknife as monotherapy. I am not a doctor, But I have researched until my eyes hurt.
@@bbaxton I have since changed my opinion having become much more informed about alternatives to surgery.
@@harleyd9180 I'm in the middle of my decision, if you don't mind what swayed you in your decision...thanks in advance
@@RH-xd3nxwhat decision did you make? How are you now?
@alanwittenberg4833 I doing well, chose rp.
But with radiation, you need to take the medication.The hormone treatments which make you sick and depressed F o r .3 years. Or more. The worst case scenario with process.Dexter me would be wearing a diaper . I would rather wear a diaper than take hormone treatments and be depressed. Gaining weight . Loss of appetite. Fatigue. Hopelessness.
in my experience its best to avoid Germany !!
Can you explain why? Did you have a negative experience?
@@seascape35 you could say that yes . I was effectively held hostage there Last year for 8 months by some seriously deranged Neo Nazis . Never going back to that country !!
Why?
Is this an advert for radition? It sounds like it. No Dr 'pushes' any treatment.
Thank you