This is the type of informative video I have been looking for!...Thanks for this!...Two weeks ago, my oncologist had me do three sessions (only 3!) for a small but definite site of cancer, close to my prostate--which had been thoroughly radiated six years ago...After 5 years of very low PSA readings post-EBRT for a Gleason 7 rated prostate cancer situation, last year my PSA began to rise...from .05, to .31, then .99, and finally, 1.39.....So my original oncologist told me that SBRT would now be in order, as the amazing new PET scan technology had spotted two lymph nodes close to the prostate, that faintly reacted to the scan medication. The three sessions were done three days consecutively, no complications felt by me, whatsoever! At the age of 77, I am still able, after all this, to have an occasional erection, etc. This new SBRT tech is incredibly awesome! Your video answered a couple of questions I had, concerning side effects, the duration of them, etc. No problems at all since the SBRT experience, two weeks ago. I love modern medical technology!
Starting my 5 sessions of sbrt at Stanford next week. Completed a bunch of tests last week where they setup the machine. All very easy so far. My prostate cancer is one small spot and this will hopefully be the only treatment i need.
@@ikhideomo7407 my cancer was very early and treatable with only five sessions of the SBRT. On another machine, it would’ve been at least 15 sessions. I live two hours from Stanford so having only five sessions saved me a lot of trips.
I was diagnosed recently, (Gleason 3+4), came up during a physical. The first urologist was adamant that surgery was the only way to go, and dismissed SBRt and any forms of radiation treatment as causing more problems than solving them. A second surgeon told me the same. But a third one told me both are options... So I am seeing a radiation oncologist next. I was surprised by their refusal (2 out of 3) of even considering radiation, and it was not because of my particular case but across the board: the ONLY treatment for prostate cancer IS surgery! I wonder if this is normal. I am not in the States, but in Western Europe, with access to excellent medical care facilities. My PSA is 3.4. Next week I will have more information, and if surgery is the way to go, so be it. But I need to have an informed opinion, and not just "do this because it is the best for you". Thanks Dr. Haas for the clear overview of this form of treatment.
When you look at the long term effects caused by SBRT / IMRT, effects such as dry ejaculation, incontinence, ED, colon/rectum issues and what is generally termed as GU and GI toxicity you will understand why removal of the prostate is sometimes the best path. Many of the bad side effects turn up 5 or more years later. Nerve sparing prostate removal has a low incidence of ED in the long term. Of course, dry ejaculation is a given. Do your research.
Kindly make a video on senior woman after menopause. How to boost estrogen level. Which supplements are safe for long term use? What to do and what not to do. Which exercise is good and which is not. How to prevent and treat prolapse etc.
I am wandering why the great host never mentioned ADT, which looks like a standard therapy added to SBRT. Maybe Sbrt can take care of a localized prostate cancer on its own?
@@WallaceDunn Your research is flawed. Some docs will not use it for various reasons of their own, however, the studies and patients report show it is a very good idea to use SpaceOAR or an alternative barrier.
@@WallaceDunn I had recently had 5 treatments of adaptive SBRT and the first thing they did was the procedure to inject the spaceoar and placing gold chips on the prostate. The SBRT was done in a MRI machine that will plan each treatment after the MRI. All my symptoms (burning) have gone after 10 days of the last treatment. On each treatment they would scan my bladder so that it would have fairly full of liquid. Now I have to wait a few month to check my PSA
Good presentation gentlemen, I have an appointment next week with a local SBRT oncologist. I’m reasonably sure this is the choice for my early stage diagnosis.
Is this appropriate for a patient with kidney transplants? Is scatter a problem? What is the treatment modality (not activity surveillance) that poses the least risk to the tramsplant kidney/ureter?
Fascinating conversation thank you! Would love to read more about the antioxidant argument / 6 pounds point you guys mentioned if you have any links or references
I have had prostate cancer and have been using miami cyberknife with intermediate Gleason 7 psa13.7 I just found a lymph node with cancer and am treating it the same therapy do you think it will work
As a patient of Dr. Jonathan Haas I must say that from the first meeting with him I felt confident that I was talking to the right person and arrived at the right place to receive the best treatment possible for my prostate cancer diagnosis.
A question for Dr Hass..is he familiar with the Peterson cancer center in Lynchburg Virginia and is it reliable place to be treated? And also..does he recommend doing the space oar before the cyber knife treatment? Thanks
From Dr. Haas -I don’t know that center for good or bad so can’t give an educated comment. Majority of our patients are now getting hydrogel prior to CyberKnife if they have no extracapsular extension. SpaceOAR, Barrigel, and Bioprotecr are the companies now doing this. Hope that helps
I'm scheduled to do the space oar in the next couple of weeks and then SBRT still a little concerned about side affects with the bladder..and urinary issues..
I was diagnosed with 3+4 5 percent Gleason 4 in one core. Decipher score low. Treated with HDR BRACHYTHERAPY in St. Louis at Barnes. In and out in two days. No need for ADT due to low decipher Very happy with treatment
Treated in October of 2022 PSA last month .4 No side effects except decreased seminal discharge. Libido fine, sexual function the same. I exercise and don’t try to stay away from garbage foods, focusing on healthy Whole Foods.. not sure if it matters but heart health is prostate health.
Can they not use less radiation for the key nerve bundles and penile bulb? No offense, but not crazy about blaming age on the ED items..just speak specifically to what the procedure causes since you don't know exactly how much can be attributable to each. Also I understand that even medication will not help, you must end up with a penile implant or using injections. Can you confirm?
That is the huge problem of photon radiation, and to some degree proton radiation. There is significant damage to the penile bulb, the urethra, rectum, and surrounding tissues. That is even with the SpaceOAR. Doctors look at stats and say that since someone is 78 years old, their ED is from old age when in fact, it could well be from the radiation. The slope for side effects is an increasing ramp, for the most part, guaged against age, thus, some of the ED, low sex drive, etc are blamed on age. However, looking at younger men it is easy to see that someone age 48 has radiation and within 10 years he may have full on ED or other symptoms. People need to search NIH and other places for studies. I have prostate cancer and am bouncing back and forth on if I want proton IGRT or if I want to remove the prostate. I would rather be 78 without ED and other side effects I believe.
@crutchclargo I absolutely agree!!! I'm 62 and deciding between proton, mri-guided photon, and tulsa pro. It is just so frustrating when I talk to my photon radiologist and proton radiologist..both dismiss my concerns as basically be happy you are still alive.
@@dmcarden Precisely...they tell a patient to remove the prostate or destroy it like it really is an unneeded gland. I did not know about the Tulsa Procedure and have looked it up since you mentioned it. Oklahoma Proton Center does that and, of course Proton. It is hard to know which way to go. The various centers will tell a patient they do focal therapy and leave the remaining prostate untouched from radiation and ED and other effects are nearly nil. However, my Uro and a Rad Ocon said , "Oh no, we radiate the entire prostate and there are likely to be side effects show up years later". Hard to know who, or what to believe.
@crutchclargo yep, I did focal hifu 3 years ago and unfortunately two new 4+4 lesions right outside the treated area. But had no real side effects from focal. I'll have to do full gland now but even then, tulsa will try to avoid the nervovascular bundles though one of my tumors is right next to one of them so I may lose 1. Like you said, such a hard decision
In my uneducated opinion :) here are my thoughts. Interestingly he did not mention pencil beam proton therapy. They can do short cycle treatments just like SBRT, focused beam, works like smart bomb technology, does not travel through the target like SBRT. This could be more advantageous because you will theoretically have less collateral damage which could mean less chances for a secondary cancer down the road. The downside is that proton therapy is more expensive and most insurances will deny it.
@libdamastropietro4429 don’t be scared, put faith over fear! But remember your husband (with your help) is his best patient advocate! If HE doesn’t feel he’s getting the care he should, by all means request primary care and urology refer him for a second opinion! Do all the research ahead, which apparently YOU are in the process of if you watched this video. Prostate cancer treatment has come a long way in recent years, and there’s no need to give up hope! It’s the most survivable and most treatable form of cancer out there! If he’s early stage like me, it looks like this is perhaps the best choice! Best of luck to your hubby (and you) and I’ll certainly be praying for you! God already knows what his best course of treatment is, I firmly believe that with all my heart!
I had radiation in 2010 for colorectal Cancer. I now have been diagnosed with gleason 8 PC in only a single core on the right side. Does the prior radiation exclude me from having SBRT? Or is Cyberknife so precise that it could be an option?
I think radiation can be repeated after a minimum of 3-4 years. It’s possible that radiation to prostate would affect the rectum and bladder to some extent. Besides modern radiation techniques are precise and more effective these days.
NanoKnife would be preferable. I would love to do NK but I have two small tumors on one side, and very small spots on the other side. I could NK the tumors and radiate the smaller stuff. Toss up for me, but if I had only one tumor I would do NK.
![Focal Therapies for Prostate Cancer with Stephen Scionti, MD [EP 65]](http://i.ytimg.com/vi/RVv4ubzeR4E/mqdefault.jpg)
This is the type of informative video I have been looking for!...Thanks for this!...Two weeks ago, my oncologist had me do three sessions (only 3!) for a small but definite site of cancer, close to my prostate--which had been thoroughly radiated six years ago...After 5 years of very low PSA readings post-EBRT for a Gleason 7 rated prostate cancer situation, last year my PSA began to rise...from .05, to .31, then .99, and finally, 1.39.....So my original oncologist told me that SBRT would now be in order, as the amazing new PET scan technology had spotted two lymph nodes close to the prostate, that faintly reacted to the scan medication. The three sessions were done three days consecutively, no complications felt by me, whatsoever! At the age of 77, I am still able, after all this, to have an occasional erection, etc. This new SBRT tech is incredibly awesome! Your video answered a couple of questions I had, concerning side effects, the duration of them, etc. No problems at all since the SBRT experience, two weeks ago. I love modern medical technology!
Starting my 5 sessions of sbrt at Stanford next week. Completed a bunch of tests last week where they setup the machine. All very easy so far. My prostate cancer is one small spot and this will hopefully be the only treatment i need.
Pls why did you select this treatment type
@@ikhideomo7407 my cancer was very early and treatable with only five sessions of the SBRT. On another machine, it would’ve been at least 15 sessions. I live two hours from Stanford so having only five sessions saved me a lot of trips.
I was diagnosed recently, (Gleason 3+4), came up during a physical. The first urologist was adamant that surgery was the only way to go, and dismissed SBRt and any forms of radiation treatment as causing more problems than solving them. A second surgeon told me the same. But a third one told me both are options... So I am seeing a radiation oncologist next. I was surprised by their refusal (2 out of 3) of even considering radiation, and it was not because of my particular case but across the board: the ONLY treatment for prostate cancer IS surgery! I wonder if this is normal. I am not in the States, but in Western Europe, with access to excellent medical care facilities. My PSA is 3.4. Next week I will have more information, and if surgery is the way to go, so be it. But I need to have an informed opinion, and not just "do this because it is the best for you". Thanks Dr. Haas for the clear overview of this form of treatment.
Were the ones saying surgery was the only option surgeons who would perform the op?
When you look at the long term effects caused by SBRT / IMRT, effects such as dry ejaculation, incontinence, ED, colon/rectum issues and what is generally termed as GU and GI toxicity you will understand why removal of the prostate is sometimes the best path. Many of the bad side effects turn up 5 or more years later. Nerve sparing prostate removal has a low incidence of ED in the long term. Of course, dry ejaculation is a given. Do your research.
Kindly make a video on senior woman after menopause. How to boost estrogen level. Which supplements are safe for long term use? What to do and what not to do. Which exercise is good and which is not. How to prevent and treat prolapse etc.
First 12 minutes is trivia about this guys career. Actual treatment info starts at 12 minutes (+)
Thanks for the comment.
The DRs experience level is super important in choosing your provider.
@@WallaceDunn This is true, but this is a video on SBRT/Cyber knife, not on how to choose a Doctor.
Not trivia!...Very interesting to get to know physicians as being real folks!
@@alanaldpal950 Your problem is obvious...remove the stick!
I am wandering why the great host never mentioned ADT, which looks like a standard therapy added to SBRT. Maybe Sbrt can take care of a localized prostate cancer on its own?
Dr Haas, what about SpaceOAR? Do you implant a spacer to protect the rectum from radiation burns?
My research shows DRs are steering away from the various “shield” methods.
@@WallaceDunnthat is untrue. We do not perform sbrt prostate without spaceoar or something similar.
We use spaceoar for all prostate sbrt. It makes a huge difference in dose to the rectum when implemented properly
@@WallaceDunn Your research is flawed. Some docs will not use it for various reasons of their own, however, the studies and patients report show it is a very good idea to use SpaceOAR or an alternative barrier.
@@WallaceDunn I had recently had 5 treatments of adaptive SBRT and the first thing they did was the procedure to inject the spaceoar and placing gold chips on the prostate. The SBRT was done in a MRI machine that will plan each treatment after the MRI. All my symptoms (burning) have gone after 10 days of the last treatment. On each treatment they would scan my bladder so that it would have fairly full of liquid. Now I have to wait a few month to check my PSA
Good presentation gentlemen, I have an appointment next week with a local SBRT oncologist. I’m reasonably sure this is the choice for my early stage diagnosis.
Do you have a free place for prostate cancer patients and their family
Is this appropriate for a patient with kidney transplants? Is scatter a problem? What is the treatment modality (not activity surveillance) that poses the least risk to the tramsplant kidney/ureter?
Fascinating conversation thank you! Would love to read more about the antioxidant argument / 6 pounds point you guys mentioned if you have any links or references
Would appreciate hearing your thoughts on MRI LINAC. Do you think this will be the future gold standard in high dose radiation delivery?
I have had prostate cancer and have been using miami cyberknife with intermediate Gleason 7 psa13.7 I just found a lymph node with cancer and am treating it the same therapy do you think it will work
As a recent patient with the same situation as you have, I can tell you that it will work! It worked for me.
Dr. Haas stressed getting a second opinion. So, will the 2nd urologist require another biopsy or will they give opinion using the existing results?
As a patient of Dr. Jonathan Haas I must say that from the first meeting with him I felt confident that I was talking to the right person and arrived at the right place to receive the best treatment possible for my prostate cancer diagnosis.
He is special doctor and a great human.
A question for Dr Hass..is he familiar with the Peterson cancer center in Lynchburg Virginia and is it reliable place to be treated? And also..does he recommend doing the space oar before the cyber knife treatment? Thanks
From Dr. Haas -I don’t know that center for good or bad so can’t give an educated comment. Majority of our patients are now getting hydrogel prior to CyberKnife if they have no extracapsular extension. SpaceOAR, Barrigel, and Bioprotecr are the companies now doing this. Hope that helps
I'm scheduled to do the space oar in the next couple of weeks and then SBRT still a little concerned about side affects with the bladder..and urinary issues..
I was diagnosed with 3+4 5 percent Gleason 4 in one core. Decipher score low. Treated with HDR BRACHYTHERAPY in St. Louis at Barnes. In and out in two days. No need for ADT due to low decipher
Very happy with treatment
How is it going now? My understanding is that some side affects don't show up until later..
Treated in October of 2022
PSA last month .4
No side effects except decreased seminal discharge. Libido fine, sexual function the same. I exercise and don’t try to stay away from garbage foods, focusing on healthy Whole Foods.. not sure if it matters but heart health is prostate health.
Typo on Don’t try. lol
Can they not use less radiation for the key nerve bundles and penile bulb? No offense, but not crazy about blaming age on the ED items..just speak specifically to what the procedure causes since you don't know exactly how much can be attributable to each. Also I understand that even medication will not help, you must end up with a penile implant or using injections. Can you confirm?
That is the huge problem of photon radiation, and to some degree proton radiation. There is significant damage to the penile bulb, the urethra, rectum, and surrounding tissues. That is even with the SpaceOAR. Doctors look at stats and say that since someone is 78 years old, their ED is from old age when in fact, it could well be from the radiation. The slope for side effects is an increasing ramp, for the most part, guaged against age, thus, some of the ED, low sex drive, etc are blamed on age. However, looking at younger men it is easy to see that someone age 48 has radiation and within 10 years he may have full on ED or other symptoms. People need to search NIH and other places for studies. I have prostate cancer and am bouncing back and forth on if I want proton IGRT or if I want to remove the prostate. I would rather be 78 without ED and other side effects I believe.
@crutchclargo I absolutely agree!!! I'm 62 and deciding between proton, mri-guided photon, and tulsa pro. It is just so frustrating when I talk to my photon radiologist and proton radiologist..both dismiss my concerns as basically be happy you are still alive.
@@dmcarden Precisely...they tell a patient to remove the prostate or destroy it like it really is an unneeded gland. I did not know about the Tulsa Procedure and have looked it up since you mentioned it. Oklahoma Proton Center does that and, of course Proton. It is hard to know which way to go. The various centers will tell a patient they do focal therapy and leave the remaining prostate untouched from radiation and ED and other effects are nearly nil. However, my Uro and a Rad Ocon said , "Oh no, we radiate the entire prostate and there are likely to be side effects show up years later". Hard to know who, or what to believe.
@crutchclargo yep, I did focal hifu 3 years ago and unfortunately two new 4+4 lesions right outside the treated area. But had no real side effects from focal.
I'll have to do full gland now but even then, tulsa will try to avoid the nervovascular bundles though one of my tumors is right next to one of them so I may lose 1.
Like you said, such a hard decision
In my uneducated opinion :) here are my thoughts.
Interestingly he did not mention pencil beam proton therapy. They can do short cycle treatments just like SBRT, focused beam, works like smart bomb technology, does not travel through the target like SBRT. This could be more advantageous because you will theoretically have less collateral damage which could mean less chances for a secondary cancer down the road. The downside is that proton therapy is more expensive and most insurances will deny it.
Proton has been approved by Medicare. Your provider team can file an appeal if your insurance denies it. Pretty common now.
I believe I just saw a report/data indicating protons may not be as effective as photon sbrt. I’ll see if I can find that.
I don’t feel my husband is getting the care he should get. I’m scared.
@libdamastropietro4429 don’t be scared, put faith over fear! But remember your husband (with your help) is his best patient advocate! If HE doesn’t feel he’s getting the care he should, by all means request primary care and urology refer him for a second opinion! Do all the research ahead, which apparently YOU are in the process of if you watched this video. Prostate cancer treatment has come a long way in recent years, and there’s no need to give up hope! It’s the most survivable and most treatable form of cancer out there! If he’s early stage like me, it looks like this is perhaps the best choice! Best of luck to your hubby (and you) and I’ll certainly be praying for you! God already knows what his best course of treatment is, I firmly believe that with all my heart!
What about semen loss will there be any semen when your treatment is finished, nobody ever talks about this
Why do you feel this way?
@@hyway62testicles are usually excluded from the treatment field.
@@ElCidPhysics90 what about seminal vesicles? if they are treated then no semen? i too heard that there will be no semen
I had radiation in 2010 for colorectal Cancer. I now have been diagnosed with gleason 8 PC in only a single core on the right side.
Does the prior radiation exclude me from having SBRT? Or is Cyberknife so precise that it could be an option?
I don't think so but see a SBRT specialist. And practice aggressive lifestyle inteventions. All the best
I think radiation can be repeated after a minimum of 3-4 years. It’s possible that radiation to prostate would affect the rectum and bladder to some extent. Besides modern radiation techniques are precise and more effective these days.
Good talk.
Small spot- SBRT or nanoknife IRE???
Nano if u want no side effects
NanoKnife would be preferable. I would love to do NK but I have two small tumors on one side, and very small spots on the other side. I could NK the tumors and radiate the smaller stuff. Toss up for me, but if I had only one tumor I would do NK.
ECGC and curcumin