Radical Prostatectomy for Basic Teal Prostate Cancer | Prostate Cancer Staging Guide
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- เผยแพร่เมื่อ 2 ก.ค. 2024
- PCRI’s Executive Director, Mark Scholz, MD, talks about radical prostatectomy as a treatment for men with Teal stage (intermediate-risk) prostate cancer. He compares it with other treatments, gives an overview of its side effects, and describes cases where it should be considered.
0:38 Surgery has been known as the gold standard in the past, and is well established. But nowadays it compares poorly with the other options that are available. Radiation technology has advanced immensely, whereas surgery technology has not. Men who choose other options can have higher cure rates and less long term side effects.
1:20 Disadvantages of surgery. Its an operation, so it has all the risks of a surgical operation that involves anesthesia. The risk of erectile dysfunction and incontinence are considerably higher with surgery than with the other options. Men rarely recover their erectile function to the same quality as before the treatment. 5-10% of men describe their erections as being like before the procedure. Urinary incontinence is rare with radiation options but is common with surgery. Men are completely incontinent after surgery and must wear catheters and pads for a few months after the operation. Most men recover but up to 15% of men will not.
2:45 Other urinary complications. Stress incontinence is another issue that comes with surgery. When men laugh, jump, cough, sneeze, they can squirt urine. Finally, men can ejaculate urine during orgasm, a problem known as climacturia, which occurs in up to 20% of men after surgery.
3:29 Advantages of surgery. Men with very large prostates with a lot of urinary blockage symptoms can experience relief from those symptoms while being cured of the disease. Giving radiation to large prostates can increase the side effects. Another small advantage of surgery is more accurate staging. When the prostate is removed, the pathologist can examine the entire prostate and determine the aggressiveness of the disease more thoroughly. Modern multiparametric MRI, though, is an accurate way to stage the disease. So this is less of an advantage than it used to be.
5:07 When considering surgery for intermediate-risk prostate cancer (Teal stage). Men with Basic Teal are the only candidates. Men with low Teal (low intermediate-risk) are candidates for active surveillance, and men with high Teal (high intermediate-risk) should consider combination therapy (IMRT, brachytherapy (radioactive seeds), and short course hormone therapy).
5:30 Addressing a common myth about prostate surgery. This myth used to be correct when 10-15 years ago radiation therapy had low cure rates and high side effects. The "sequence argument" goes like this: If you get surgery first you have a backup chance at a cure with radiation therapy if the surgery doesn’t work, but you can’t have surgery if radiation fails. This was a problem when prostate cancer would come back often after radiation. But cure rates of modern radiation therapy are higher than surgery, so the cancer isn’t likely to come back after radiation, especially for Basic Teal, perhaps about 5% likelihood. Additionally, there are options for men who relapse after radiation therapy such as HIFU, cryotherapy, and electroporation.
7:08 Summary, surgery has higher side effect profiles for similar cure rates and necessitates a major operation. If a patient does choose surgery as a treatment for their prostate cancer, it is important to find a skilled surgeon since the procedure takes both practice and talent to achieve optimal results.
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
Thank you for your video. I wish we had found it before our surgery. We would not have done it if we could have heard your information.
This guy is on top of his game He knows what he is talking about see his other videos.
Thank you for your comment, Vickie! It helps us know we are on the right track.
PCRI and Dr. Scholz have been great. You can call in and speak with a recovered patient too. Such good guidance. Helped to avoid the surgery and the external radiation. Scheduled for brachy next week. Low complications and great cure percentages. so glad.
Much obliged PCRI.
Can brauchytherapy give you bladder cancer?
My Radiology Oncologist (specializing in prostate cancer) asked me during my initial consult why I didn't just go with a Radical Prostatectomy. I started counting on my fingers as I explained my reasoning, most of which were based on Dr. Scholz's and other Doctor's info I had found at the PCRI. He nodded his head with understanding acknowledgement and began explaining his plan for my care. I have zero doubt about my decision. I start in December. I cannot thank the PCRI enough for keeping the new advances in the forefront of our awareness. You are changing lives!
I have to make a decision 😩 on which procedure to do. My prostate has a Gleason score of 7 3+4, intermediate prostate cancer, one year ago it was 3 + 3 , PSA 10.1, currently 14.4. Will have a CT scan and a bone imagery with contrast to see if it had spread beyond the prostate, will decide on procedure then, I'm 60 years old and overall good health,,, well except for the cancer.
My husband and I look to the Prostate Center Research Institute for trustworthy and helpful information on prostate cancer. We have attended every PCRI conference since Tim’s diagnoses with PC five years ago. The conference has outstanding medical experts who are willing to answer specific questions. Each conference has been informative, inspirational, and so much fun. There are always lots of laughs and we leave smiling.
BathtubPorsche Going to see them tomorrow, hope I get some good advise! BTW, love the old Porsche’s!
Thank you, BathtubPorche! (love the name) - your support means the world to us!
What did the two of you decide for treatment?
Crap! Dern it!
At 65 I am headed towards Robotics surgery. On 12 biopsy points I scored 4+4=8.
Thankfully nothing in the bone or tissue. My surgeon does more robotics surgery than anyone in Greenville Co so I am encouraged by that. I hate the reported side effects though, that’s terrible!
Thanks for the YT platform and all you do and share with us.
Good 👍 luck with the surgery, I'm scheduled for a CT scan and bone imaging to see if it has spread, will make a decision about what to do after that but still doing lots of research, can be overwhelming at times.
Please give me feed back of side effects of surgery if u had any now?
Very helpful video. Many thanks for this information.
Thank you DR for your unbiased advice on this topic it is very needed.
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Well done! Every man needs to watch this video early in their journey. I was diagnosed with prostate cancer in 2017 at age 57 and opted for surgery, and my dad was diagnosed in 2018 at age 85 and opted for active surveillance. Keep up the good work!
Why did you opt for surgery? How is it gone for you?
@@javar888 I opted for surgery too quickly. Even my urologist recommended that I seek multiple opinions and not to rush into treatment. There are several factors to consider, such as your test results, age, general health, life expectancy, personal preferences, prostate size and available treatment options for your particular case. Even though I did research other options, surgery was in the back of my mind. So I don't think I assessed the alternatives fairly. That said, the surgery worked well for me, and I'm not suffering from long term side effects. Even though the surgery went well for me, I'm not happy with how I made my decision. If my surgery failed, I would have regretted that I didn't follow my doctor's advice to seek multiple opinions and research other options with an open mind. Also, please keep in mind that even if one treatment option works for one man, it doesn't necessarily mean it will work for another. Every case is different, and you need to understand your unique situation.
@@GogsGagnon I have a biopsy coming for a PSA level of 3.8 , im 57 , family history . How can I get ahold of you direct . Maybe I can chat with you ? James . im at javar88@yahoo.ca .
@@GogsGagnon I agree. I just can't risk the chance of a problem with leakage or urinating inside of my wife. Those are quality of life issues that are most concerning for me. I'm also afraid of the other risks of surgery, like delayed healing, infection, immediate loss of intimacy with my wife (which might not ever return), problems with a catheter, or peripheral edema. I personally know a man who struggles with this edema every day after his surgery.
@@SinnerSince1962 Hi Bryan, your concern for the quality of life is such an important issue and making a decision is not something to take lightly. It's good to know that several options are available, and it's best to research and understand the risks and benefits of each one based on your particular case. I wish you success in whatever treatment you decide.
All of the videos by PCRI are helpful as is talking with a counselor at PCRI.
In my case, Fusion biopsy (mri +traditional 12 core) graded the cancer 4+4. Second opinion at JHU kept this level. However, after surgery at JHU this was downgraded two levels to 3+4.
If I did radiation I would always be a 4+4. Who knows if I will relapse, and perhaps I'd be less likely to relapse with initial RAD treatment, but there is def a head (thinking) benefit to the more accurate biopsy.
It All comes down to your Doctors skill set, whether it's a urologist or radiologist.
My particular case had the unique complication that if my prostate was left in place then radiation would not be allowed, the prostate was too close to my small intestines.
Once the prostate was removed I would then move on to radiation.
Some say that likelihood for cancer to come back for basic teal is closer to 20% or even higher. Most likely in 10 to 15 years?
I need to find a good surgeon i live in Houston, Texas.
Im recently diagnosed with Gleason score 7, three 3+4 and two 4+3. Im definitely going with radiation, im 55. I did research and surgery or radiation both outcomes were the same, so why would i want surgery and more than likely end up impotent.
What about people in their early 50’s, stage 2 favourable with urinary constriction symptoms, radiotherapy side effects come on more slowly, so at 15 years is radiotherapy option really that great?
Radiation side effects, if they occur, come on slower than with surgery, but they are not certain to occur and happen at a lower rate than with surgery.
If you want to speak with a patient advocate about your case, you are welcome to contact our free helpline here: pcri.org/helpline
I've heard that continence diminishes substantially a couple of years after radiation, whereas it gets better over time with surgery. No?
@@justdoesntaddup8620 what’s the alternative? I hate to get caught up in the “ medical cancer wheel “ that keeps you coming back.
❤️
How do I find the best doctors for the treatment of prostate cancer?
Hello MBS, our prostate cancer helpline can help you find a information for your area. Please feel free to contact us here: pcri.org/helpline
@@ThePCRI i need help in making a decision.
If I have to choose a treatment for pCa I will not choose surgery. Side effects are just not worth it, especially since there is no difference in overall cure rates.
In Texas in April 2024, few prostate cancer patients know the truth of this video. In Texas we-------Cut first and ask questions later. 💥🙏
Is this doctor a spokesperson for the radiation oncology industry? Seems to spend a lot of time talking down surgery but little time talking about the problems with radiation and the potential problems with reoccurring cancer.... which can be a more serious problem than he states depending on your age and how advanced (contained) your cancer is. He needs to talk more about age and how it relates to the path you take be it surgery, radiation, or active surveillance.
Yes. I worry that he does not discuss the problems with radiation longer term. I’ve been told also that ED is similar between radiation and surgery after two years.
@@artmaltman Age on initial diagnosis and treatments and possible reoccurrence and needed follow up treatment options are important things to consider. I've heard it said surgery has the worst impact (side effects) initially and gets better in time.... radiation has the least side effects initially with worse longterm possible side effects.
All things to consider..... no doubt radiation therapy targeting and delivery has gotten better.... but it's still radiation.
No, he doesn’t do surgery or radiation: he’s an oncologist. Surgery is a big $$$ business and lots of people are shoehorned into it for nefarious reasons.
Very few men get secondary cancers from radiation nowadays unless they’re old and or smokers.
Are you a spokesperson for surgery $$$ industry? Do you think you know better than a 60 year old oncologist?
@@peacefulruler1 There's just as big a payday in the radiation business of cancer treatment.
This guy is against surgery. Radiation is bad.
Yes, we have a few videos explaining his position. If you have any questions about it, feel free to contact our helpline at pcri.org/helpline.
@@phil9331 me too 5 months ago, how are you doing?