In 2019 I was diagnosed with prostate cancer at the age of 54… I visited a number of cancer centers in my area and got different opinions. All of the surgeons wanted to do a radical prostatectomy. I had read many things about the surgery and wanted to avoid it if it all possible. After I found two radiation oncologist who said that radiation was a perfectly acceptable treatment for my cancer I went that route and couldn’t be happier! I do not have any incontinence or any other major issues -pretty much returned to normal after a healing process took place when I finished radiation… I am so glad I did not go with the first recommendations of surgery… The radiation oncologist devised a treatment plan for nine weeks with targeted radiation - my PSA is now at .5 which came down from double digits at the height of my cancer before treatment began… Modern radiation is a miracle!
Thank you for sharing your story since I’m in a very similar situation. I’m 54 years old and talking with my Urologist, he wanted to do surgery but did suggest I meet with a radiation specialist. As I do my research and met with a radiation specialist, I’m leaning more towards that procedure considering how the results show for my particular condition.
@RickJ9615, Thanks for sharing your story, may I ask you what was your Gleason score ? My husband was recently diagnosed with prostate cancer , with a Gleason score 9, which is a very aggressive cancer, but it is contained in the prostate. But the Doctor recomended surgery ,he said that he is not a candidate for radiation, due to his score.
The two of you are simply incredible. I'm 3 + 3 and on AS, but I want to see abreast of treatments just in case. There simply is no better source of information than PCRI. Thank you so much for caring to do this. 19:28
A magnificent series these are on Prostate Cancer..Dr Mark Scholz is just brilliant and explains everything so very well..The interviewer is magnificent also .👏
There are MANY of us in the alternative camp who are so happy we chose it. We do not experience the loss of life quality that many others experience. Also we have great success in not experiencing a return of the C, which many times is worse then before.
@Dr. Scholz, I'm a very healthy 65 Y/0 just recently diagnosed (after MRI and biopsy) with a Gleason 7 (3+4) in 4 out of 12 cores. I have always considered surgery as a last resort. Thank you so very much for making this very important video! In my opinion, too many men are scared into opting for unnecessary surgery.
I’m so happy that I found this site. I was diagnosed with non-aggressive Prostate cancer last year and have been on ‘active monitoring’. I only had four core samples with cancer out of 12 taken. Gleason scores were 3+3=6 for two cores and 3 + 4 = 7 for two other cores. I am due an anniversary biopsy and MRI next week. I was unaware of additional types of imaging. I’ve found your videos incredibly informative. Thank you so very much.
Thank you for your excellent report I had radiation for my prostate 5 years ago at age 70 … at the time it was a difficult decision … I think had your video been available it would have been a no brainer on choosing radiation I’m happy to report NO SIDE AFFECTS and with a PSA of .06 for the last 5 years my radiation is now considered a success
I had my prostatectomy 4 weeks ago and I couldn’t have scripted my recovery any better. I am 62 and work hard at maintaining a good fitness level. I prepare my body for the surgery by adopting a plant based diet and eliminating alcohol. I started pelvic platform exercises 6 weeks prior to surgery and performed them every day. I have not suffered any incontinence since the removal of the catheter and I am back to lifting weights. I have been very fortunate to recover from the surgery and I recognize not everyone choosing surgery will be as fortunate. However, what ever option you choose, prepare your body for your treatment….it is one thing that you can control in this process and I am convinced it help in my recovery.
@Steve Treacy That's great news! Any side effects. Episodes of urinary leakage when laughing, jumping, ect. I've have heard that can be common. Similar to you, my biopsy was just upgraded from 3+4 to 4+3 by John Hopkins. It is low volume(10% or less in 2 cores). Polaris tested good, genetics tested good, PSA@5.1 Can you share your diagnosis info? How did you decide between surgery, radiation and other treatment? Always ate healthy, eating even better now, exercising, appropriate weight. Exploring key supplements, broccoli sprouts, etc.
What a great summary! Dr Scholz is someone to listen to. I was pretty skeptical about radiation when I was doing life insurance underwriting, but that was 20 years ago. Then I got prostate cancer 6 years ago and discovered that the choices were now much better. My choice was High-dose-rate brachytherapy (similar to "seeds" but done under anesthesia and nothing left in place) + IMRT external beam radiation. I got an excellent outcome on all three of those "trifecta" criteria. My case is an anecdote, but I have reviewed the recent literature as a certified expert in assessing medical evidence, and agree completely with Dr Scholz.
My Urologist Dr is as discussed an old school who suggested surgery. I said yes & was scheduled to gave surgery a month later. I went home did my own research diligently. I even found someone who was doing radiation and they sold me on it. I went back to my Dr & told him reluctantly, I was going to do radiation. He said" I still think you should do the surgery and if anything is left we can do radiation, exactly as was mentioned in the video. He finally said it's your decision. that's the key it is your decision. Less side effects w the radiation. Recovering well. Glad I had the courage b4 surgery to change my mind.
Thank you for sharing your story. I’m 54 years old and was diagnosed with Gleason 7 (3+4) prostate cancer. My Urologist was telling me the same thing about doing surgery, your young, in overall great health so you should do well. He didn’t schedule anything though and suggested I talk to a radiation specialist just in case I need radiation treatment after surgery. He also recommended a radiation specialist. After doing my own research and meeting with the radiation specialist that he recommended, I told my urologist I’m thinking more about radiation therapy. I haven’t set up anything yet because I’m still going through medical tests with an upcoming MRI that the radiation specialist had requested.
Wow! This is so right on. I have been researching both radiation and surgery. I was immediately told about three oncologists who were great at what they do by the urologist who did my examination after my pcp saw a rise in my PSA this past May. All tests she did on me was negative but her examination she felt a small nodule and immediately started telling me I need an mri and biopsy. I wasn’t too thrilled how she was going at this on the quickness. My pcp examines me every year when I’m having my yearly physical and November 2022 he felt nothing but he didn’t do a PSA check at the time. It was by the grace of God he did it this time in May. I’m oblivious to how really serious prostate cancer is because I never researched it. My last PSA test was in 2020 and 2021 where it was 1.65. This time it doubled and my pcp wanted me to see a urologist. After the mri that indicated I had cancer the biopsy confirmed it. I just had my PSMA PET SCAN so I’ll see a Radiologist to go over the scans and treatment. I already talked with one of the surgeons and he examined me went over my grade and what he will do with the Robotic Surgery. I left his office with so many questions and felt like there was no compassion. I mean I have cancer and he was about getting the cancer out and very small conversation on incontenance and erectile dysfunction giving me paperwork on the pills and other contraptions to use for the penis to keep it from shrinking. Thank God I had time to research and get answers to what I’ll do now I will see how the Radiologist will be in our meeting. What discourages me about radiation is that hormone therapy. The side effects are horrible. So I have to choose what I’m going to do because honestly both treatments have horrible side effects. Thanks for these videos.
@@jerrymunroe5593 I made the decision to go the radiation route therefore my life can continue on not missing a beat. I already had the ADT injection last month and the hot flashes can be a nuisance but I know there’s others side effects that I will get with time. The end of January I start the radiation treatments all 45 days of it but what helped me make my decision was the Radiologist Oncologist showed interest and compassion answering all my questions with ease and not treat me like a number but a patient. He let me know that I should continue doing everything I’m doing now with my life and add more walking with my exercises in which I told him I’ll do all I can to meet these side effects head on. Thank God the cancer didn’t spread. Just two days ago I talked with the Doc again then met the two radiologist who set me up to get a Ct scan to see where they had to tattoo the area for the radiation beams to go through me. They were very sweet ladies lastly I met the nurse I’ll be in contact with who presented me with a few resources I could benefit from which I will take advantage of to help me mentally dealing with this cancer. In all I feel I’ll be in good hands with a team who shows compassion and concern unlike the surgeon and yes the urologist. I also didn’t want to be dealing with a catheter for two weeks after the surgery. To each his own but I chose what I thought would work for me. My sister has a coworker who had the surgery and who returned to work who told her he feels great just dealing with the leakage. Like I said both the surgery and radiation have their side effects and in my research radiation and the ADT injection have more but I’ll take my chances with this one. My birthday was late August the 28th I turned 68 and was told the news the biopsy confirmed I had cancer and now five months later January 29th I start my first treatment. God got us so I’m fearing no more. Good luck and do stay in prayer through this journey.
Hi, I’m also in the same place spoke to surges the other day advised with radiotherapy there is trend of cancer forming in other areas. Where as the surgery appears to remove the cancer completely as mine is localised prostate. This is really confusing. I’m aware of the down side of surgery I’m 42 and have a young family. I will be starting my pelvic exercises today to beat prepare for either route which I expect surgery will be in November if that route is chosen
@@weswilliamson7538 Good luck with your decision. So young having to go through this. I'm 69 now but last year when I found out I had cancer I was 68. Seems it got me regardless of how many years i've had the examination and started in 2020 having the blood test for PSA. I am doing well though the Hormone Therapy I'm still on. I get my third injection this coming December. I had my first last year in December. February to the first week in April I had my radiation treatments. I had no problems with getting the treatments as I continued to work and live my life normally. PSA test in June was down to 0.07. I'll have another in June to see how I'm doing. Side effects from the Hormone Therapy injection is hot flashes mainly and ugly rashes. I get cremes from my Dermatologist for the rashes when they appear. Still trying to get my diet right but I am good on not having any dairy. Sweets I cut down as well and still working on eating more veggies but I'm good with salads. Overall I feel great and I thank God daily for the blessings.
Great video, very informative as all your videos are. I’m very thankful that my urologist/surgeon was honest and straightforward about my diagnosis and recommended radiation plus ADT rather than surgery.
This is one of my favorite videos regarding this topic because many of the thing’s discussed in this video was what my urologist discussed with me. I’m 54 years old with Gleason 7 (3+4) prostate cancer. My urologist discussed heavily on the benefits of surgery and I was all set to do surgery but he suggested I should see a radiation specialist just in case I need radiation after surgery. After doing my own research and meeting with the radiation specialist he recommended, I told my urologist, I’m thinking more of radiation therapy. I could tell my urologist wasn’t happy hearing that because he went on to do a bit of a hard sell on the benefits of surgery over radiation therapy, and that I’m young and in great health so erection problems and/or leakage problems shouldn’t be very serious because of my age and overall health. He even mentioned a couple of time that he’s not trying to do a hard sell on surgery. No plans have been finalized yet on the type of treatment since I’m still in the testing phase. I have an upcoming MRI scheduled as requested by the radiation specialist. It’s great knowing there are other options rather than surgery only.
Mike, I'm 65, work out 3 - 5 times a week, very healthy and take no medications. So it came as a shock to learn after a 396 PSA and a "suspicious" MRI, and biopsy results confirming (just last week) a Gleason 7 (3+4). My father was also diagnosed when in his 60's, 30 years ago. He opted for radioactive seed implants, lived to age 87 and his cancer never came back. Everyone is different... but this video confirms for me that surgery is not the best option for me. My urologist is not steering me one way or the other but if he was trying to sell me on surgery I probably would never go back. I'm going for a 2nd opinion regardless... maybe you should too?
@@commonsenseisdead Thanks for the feedback. Since I made this post, I have recently completed my surgery (12 days ago). When I was doing my own research prior to surgery there have been other oncologists who said, younger patients, typically those under 60years old, benefit from surgery vs radiation treatment. Ultimately it’s a really difficult decision to make but I’m good with my choice.
I made huge mistake with surgery!! I justvdid surgery on July 30, 2024, just 31 days ago,, & the nerves responsible for erections were damaged. I am only 63 years old, healthy, & my sex life was amazing with my wife. Now, the future is so frightful. I was a Gleason 9. Waiting two more months to see where PSA will be at. The surgeon right after surgery said, that in addition to being impotent, I will need further radiation treatment. PLEASE, view this video several times!
Thank you for this.... I am Stage T3b, Gleason 10, group 5, PSA 60+. Just finished targeted proton beam with SpaceOAR (the Dr who co-wrote the paper was my surgeon!). Went really well, some residual bowel issues at +5 days, urinary channel is fine. This talk gave me some expectations for how things will go at +1 year onwards. It is what it is, no point thinking too much about it. I have been very, very lucky this year in my journey. I have some residual issues with anaemia. I think that would be a good talk to cover - hormone therapy, radiation and impact on RBC etc. Thank you.
Thank you so much for these videos. You’re really helping the likes of me. I watched a few of the videos now but this one was the most important one for me so far. Thank you.
four doses of immune therapy, two times high dose Brachii therapy, five weeks of radiation for Gleason 9 prostrate cancer at Moffitt Cancer Center in Tampa Fl. absolutely no incontinence good erections, PSA 0.02, 4 years clear… I credit Dr. Scholz for leading me to search alternatives to surgery…
Was hormone therapy part of the treatment? I’m curious because the five weeks of radiation plus the Brachytherapy (and immunotherapy) seems like an attractive option to surgery.
Very helpful. I will be finding out about both radiation vs surgery in the next month. This has been most informative and has given me a new perspective. I have good questions to ask my urologist.
I was on hormone therapy for 1 year, had a gleason score of 3 + 4= 7, and opted for a radical prostatectomy. I did not want to stay on hormone therapy during radiotherapy because the orgoyvx and zytiga were affecting my blood pressure, blood sugar and cholesterol levels but with the radical prostatectomy I was able to end the hormone therapy. I had also gained 38 lbs in one year not to mention the dreadful hot flashes while on hormone therapy. I chose what was best for my situation
Excellent videos. I’m an 80 year old living in Vietnam so I’m a little nervous about treatment here. I’m getting hormone injections at the moment for Gleason 9 (3 times so far) it’s pretty nerve wracking.
excellent summary. PCRI videos have educated me, so whereas I would not have considered RT before due to old information putting me off, especially risk of secondary cancer and burns, now I all the information about surgery has completely put me off surgery. If I need treatment I am veering to RT
Agree, that searching through all the old information has been educational but time consuming. Radiation and ultrasound treatments have more outcome data. Cryo has focal use possibilities. Internal/external radiation in general have the most historical data overall. Have 2 core low volume 3+4. Taking time to search best option for possible future treatment. Right now leaning toward Brachytherapy or SBRT, but will continue active surveillance.
@@Jack-2day After much research and deliberation of options and timing for treatment, I chose HDR Brachytherapy @ UCLA just last month Oct.25th. The treatment was a process but definitely worth it and to have behind me. Initial side effects were mostly mild. After two HDR doses, left hospital on own caught flight the next day. Symptoms mild with some urgency first few days, all manageable. No ED issues. Went to work following Monday. Given my short term experience so far, I would do it all over again. For me it's estimated 98% cure. Long term time will tell. Ask any questions, I've been meaning to share my full treatment process. Honestly the hardest part was all the research and finalizing my treatment decision. Also met doctors for all treatment options.
I agree with her opening premise re: not being told enough about the likely aftermath/side effects... I'd do radiation if I had it to do over...I was 59 & Gleason 3/4, non-metastatic. 2.5 years out, PSA virtually undetectable, happily. It appears I will be mild/moderate incontinent w/severe ED for the rest of my days...the idea of the penile implant scares me; necessarily catheterized for 1month after surgery. About 2X longer than normal... Oh well! U pays your money & takes your chances.
MJ sounds like our diagnosis were similar, I'm 59 also soon to be 60. Had a complete bone scan and pelvis ct with and w/o contrast, going to see my doctor in a few hours.. I've been up all night giving myself a crash course on my options, doing a lot of what if questions.
I wish Dr. Mark Scholz would have expanded on Radiation complications like rectal bleeding, chronic, prostatitis and chronic bleeding from bladder. How is bladder cancer assessed in the presence of chronic blood in the urine since he mentioned tissue is not friable and want to avoid cystoscopy?
Radiation therapy is the gold standard local treatment for cancers. surgeries are invasive barbaric old way that result in devastating life changing consequences.
Thank You ... Again. Please do a follow-up video on " Re-Current Prostate Cancer with Cryotherapy". My Urologist states this is the best option after Radiation Initial treatment... and the safest. I have read other opinions... Please do a video on this specific topic. Thanks
I am a very healthy (otherwise) 71 yo. No other health issues, (other than a recently torn rotator cuff) no prescription drugs. I am not overweight having changed my diet and losing 40+ lbs over the past two years. I also take Testosterone twice weekly. I was recently diagnosed with PC - Gleason 4+3. I never had any symptoms and still do not (other than a high PSA) The surgeon who also did the biopsy is definitely biased toward surgery. I have a PSMA PET scheduled in two days and in two weeks will have consultation with a Radiologist. Like most, I am concerned about incontinence and ED (nerve sparing). The surgeon told me that there is strong likelihood that there could/would be nerve damage in spite of his best efforts. I am also concerned about resuming workouts and testosterone after treatment. I have read so many horror stories about ADT that that part of the treatment is what scares me away from any form of radiation therapy. At my age, long term ADT is out of the question. I hope I'll find some new strategies to deal with that.
I am 68, was on active survelliance in 2022 with Gleason 3+3 in 2 cores.. In September, 2023, I had another biopsy and now have Gleason 4+5 in one core. PMSA scan came back negative. Given the Gleason 9, I have listen to this video as a way to help me decide what is best way to proceed. I have chosen Radiation direct beam, brachytherapy plus 18 months of hormone therapy given the Gleason 9. I decided that the risk of cancer returning after surgery was too high (25% to 30%). I also know of a friend who have surgery, than 40 treatments of radiation after 2 years of have no PSA per se plus hormone therapy. In addition the location of my cancer puts the right nerve bundle in play. Want to try to put this behind me!
It’s unfortunate that the federal employee program Blue Cross Blue Shield appears to be behind the times with regard to prostate cancer treatment. Brachytherapy, Focal laser and High intensity focused ultrasound Are all categorized as experimental and therefore not eligible for coverage. On a Separate note, I am most impressed with the interviewer and Oncologist in this and other related videos.
Thanks so much for your great videos. It helped me make a better choice between treatments. I think people need to make a well researched choice rather than just go with “it’s cancer cut it out”.
Sometimes surgery is a good option especially if one is having urinary issues from the enlarged prostate itself. I had surgery with great results in terms of no complications, however my cancer came back and now I'm headed towards salvage RT which scares me.
so sorry to hear the cancer came back. how are you doing now? i hope you're doing well. where did it come back if there is no prostrate? can i also ask what was your gleason score before surgery?
With a GS of 4+3 I am looking at Tulsa Procedure and targeted radiation. This video really helps. I can ask more questions of the VA urologist of both of these although the VA does not conduct Tulsa Procedure they do pay for it at certain places like Mayo Clinic in Jacksonville Fl
Here's hoping this is a watershed moment. >>First patient with metastatic prostate cancer to receive 2 doses of Cu-67 SAR-bisPSMA achieves undetectable PSA level
Great video. Thanks. And thanks for being trustworthy. My limited experience with surgeons, and the medical system in general, they are sales people that want us to buy from them that can result in biased treatments and even obsolete treatments. It's hard to get to a treatment and a skilled team to give good treatment while being scared and feeling time pressure and fearing cost. And, it also seems the diagnostics are lacking, even though it's the best we may have. I guess that's why it kills so often. 😕
I just got the results from my biopsy yesterday and it was what I feared positive for prostate cancer . My doctor a surgeon discussed with me the options of surgery and radiation, fortunately he agreed with me that radiation was a better choice of the 2 choices I have for positive results and quality of life and cure f cancer . I see the oncology radiologist which also happens to be a highly recommended one Monday. I’am thankful of urologist wasn’t a pushy salesman for surgery even though that’s all he does ,because I’am scared enough .
@@donaldpiper9763 In process of same decision. At 63 years I'm concerned of potential cancer down the road. What is your age and can you elaborate on your decision process. Thanks so much!
@@marka9073 I’am 67 year’s old , I weighed the consequences of surgery and the consequences of radiation and hormone therapy . For myself I chose radiation for lesser side effects and better quality of life . Hope yours works out well .
@@donaldpiper9763Thanks for reply. I was diagnosed with small volume of 3+4, sent that to John Hopkins and it was upgraded to 4+3. Prolaris tested good, Genetics tested good, PSA@5.1. Can you share your info as above? Have you completed radiation treatment? What type of radiation: IMRT, SBRT, or was it Brachytherapy? What machine: Varian Trubeam, CyberKnife, MRidian or other? How are you doing, side effects, etc? Wishing you well, Thanks again
I believe many choose surgery over radiation because of the cost factor. Roughly four times as much for radiation as opposed to a prostatectomy. We need to bring down the cost of radiation therapy if it’s effective as claimed. Despite the cost I chose radiation and am glad I did. The radiation was a breeze. It’s the hormone therapy that’s way more troublesome.
As this video has been uploaded here one year ago, are there any new changes in cancer treatment in the mean time? I don't read too much about focal radiation of only the tumor instead of the whole prostate. How about that?
My Radiologist, after planning, says the SpaceOar was not advised due to size of my Prostate. AFTER ORGOVYX AND BICALUTAMIDE TREATMENT, my Prostate size has decreased and we could use Spaceoar but would need to reschedule and delay for weeks. Should I proceed without the sheld of Spaceoar, at Age 83 and a Gleason 9 in two locations and three Gleason 7's? Thanks. Don, in Tex.
I have been diagnosed Gleason 3+4 =7 with 3 small foci located inside not at the periphery. I chose surgery over radiation . Please guide me which is better option.
I was planning on having my prostate taken out up until I just watch this video thank you for your expert advice. Dr. Where are you located I would really love to sit down and talk with you. Jim Cinnaminson NJ
Dear Sir I follow your videos from France. We have a lot of problems, our health system is working more and more badly... I had to have surgery in a private clinic, although my PSA was undetectable at four months, there are 4 positives margins and the capsule was cut. I have a GS 4 5! Currently I am awaiting the decision of adjuvant or salvage RT. It is complicated. What to take? I am discouraged. Luckily I can find information in the USA. Thanks to you friends of the new world. Patrick
If you had opted for radiation (brachytherapy + beam) I wonder if IMRT could have covered those margins if ECE was suspected (predicted) from the MRI images? I think Dr. Scholz has said that. But at least you can go after the margin areas now via adjuvant or salvage radiation.
The discussion of professional bias was interesting. With radiation therapy and surgery, does ED routinely accompany incontinence or can one condition occur without the other or occur at disproportionate comparative degrees? In other words, are the odds better for return of concurrent (both) functions better with radiation therapy over surgery or should I concede to losing control over both to same or unknown degrees, regardless of the selected course of treatment?
Incontinence is caused by urethra damage, while ED is caused by nerve damage, so having one doesn't mean you will have the other. It comes down to the skill of your doctor and the location of the disease. If your cancer has involvement with the nerve bundles, it will be tough for a surgeon to remove it without cutting the nerves, but radiation can hit the same area and may kill the disease while sparing nerve function. But I'm just an internet dude, so discuss with your oncologist.
There are less side effects with radiotherapy. But as the doc says about 50% of surgery patients have ED or incontinence. You can have ED and incontinence with radiotherapy as well. I certainly did. But that is a function of NOT having any testosterone in my system rather than effects of radiotherapy. If you have no drive, its not a problem having ED.
My brother in law recently found he had prostate cancer with a Gleason score of 7. He worked with a medical group who steered him toward surgery rather than radiation. He was told if he chose radiation and the cancer returned at some point radiation could not be used again to treat the cancer.
I'm an 80 yr old man with a PSA consistently less than 1.0. However both my father and older brother both had prostate cancer. Should I still have a PSA test every year. Thank you
Thank you for your videos, they are fantastic. I am going to have RT, can you explain to me what is the gold fiducial markers. Is this pieces of gold will have any long term effect on the prostate.
The markers are used as "landmarks" to compensate for movement within the body and other variations so that they do not irradiate the wrong tissue. Some side effects have been reported, including potentially serious side effects in very rare cases (fever, for example) but these are reported to resolve within weeks. I am not knowledgeable about the possibility of any long-term side effects, and the SBRT with which they are used is relatively new, so there would not be any long-term studies looking at long-term effects in this context, but there may be a lot of studies about similar types of implants in other contexts, so I will add it to our list of questions for future videos. We have a helpline at pcri.org/helpline that may be able to provide you with that information (although I can not guarantee it), and then, of course, make sure that you ask your doctor -- he or she should be knowledgeable about the risks of these types of implants and the risks of not using them if radiotherapy is needed.
I am 66 years old. I was misdiagnosed. Upon seeking a 2nd opinion, the result came in at Gleason 9 i.o. the "routine" 3+4=7 as per the 1st opinion. Staging was 3a (cancer has pierced the prostate envelope, clearly visible on the mp-MRI). And this despite my PSA being only slightly elevated (6 i.o. max 4). Fortunately, a PSMA-PET/CT-scan returned N0, M0: no metastasis yet! It is clear that the surgeon who diagnosed Gleason 7 had his beautiful Da Vinci-robot in mind, rather than his patient. He avoided staging the cancer. And this was no accident. 8 out of the 12 cores of the prostate fusion biopsy returned 3+5 to 4+5 during the 2nd opinion. He did not discuss the mp-MRI with me. Given the size of the adenocarcinoma and the staging, the surgeon who gave the 2nd opinion referred me to a radiologist-oncologist. The surgeon claimed that in my case, prostatectomy was actually useless as there was not enough room to remove all the peripheral potentially cancerous cells. Besides, he no longer performed prostatectomies, unless at the insistence of patients (!). Advances in radiation therapy in the last 15 years have made prostatectomy obsolete, he claimed. As he put it: 50 years ago, we castrated, 30 years ago we removed the prostate, now we radiate. Given the high-risk nature and the size of my prostate cancer, I started ADT 8 months ago with a combination of 3-monthly leuprorelin injections and daily abiraterone acetate tablets (see STAMPEDE study, The Lancet, Nov? 2022). In September 2023, I had mild hypofractionation radiation (60 Grey over 20 sessions) since the oncologist also wanted to radiate the pelvic lymph nodes. She claims that this would have had to happen even after prostatectomy! The LINAC used for radiation is of the VMAT-type. It makes radiation of the pelvic lymph nodes much safer. The whole treatment is focused on avoiding the resurgence of Castration Resistant Prostate Cancer (CRPC) 5-10 years down the road. Prostatectomy is Big Business indeed. I was so lucky to have found a treatment centre which espouses the views of Dr. Scholz!
@@ckriverview I am doing very well in view of prolonged ADT, thank you. I am being treated at the Royal Marsden cancer hospital in London (UK). For GDPR reasons, I prefer not to name the doctors. Anyhow, at the RM a multidisciplinary team discusses every new patient. This is reassuring. I hope this helps.
thank you for all your work! is there a list of PCRI recommended radiation facilities in the Seattle area? what is the preferred MRI method in 2022 for first time scan?
Fred, I just went through SBRT(Radiation) treatment last Spring at Fred Hutch Cancer Center in Seattle (Formerly named Seattle Cancer Care Alliance). With SBRT you are done in 5 treatments, and I've had absolutely no side effects. My radiation Oncologist is Dr. Emily Weg, and she specializes in treating prostate cancer with radiation therapy. Dr. Weg also had me do a 3T MRI first to check the size of my prostate and to see if the cancer would show up on my MRI, which it did as PI-RADS 5, next I did a targeted biopsy to confirm the grade and decided to move forward with SBRT. (Note: I've found that many Urologists like to go to a biopsy first, however, a 3T MRI is a great first step so you can possibly avoid a biopsy) Dr. Scholz' videos educated me and helped me seek out Dr. Weg here in the Seattle area. (It can be difficult to find a facility that will do a 3T MRI in the Seattle area, so you'll want to find a center of Excellence as Dr. Scholz has suggested) - Hope this info will assist you.
@@hodshonf Dr. Weg is a super doctor and her focus is on prostate cancer, so you'll have her full attention! You will be in great hands with Dr. Weg and Fred Hutch Cancer Center!
I have a question for Dr.Mark Scholz, Dr, Yushen Qian, MD Radiation oncologist at Stanford Health Care told me that two death cases happened in CA state for that they are not using a hydrogel space in Sanford. Any comment or advice. I am watching all of your videos Thank you so much.
Great video. You didn't touch upon the side effects of radiation and hormone treatment. Weight gain, breast enlargement, loss of muscle mass, lack of motivation or energy to substain a regular exercise program. Eligard injections for three years. Incontinence and sexual desire is still a problem.
I would think that kind of intense hormone therapy would be reserved for those with metastases, and that would be equally true with surgery. But these days a PSMA PET scan can be used to show if you are clear and thus not needing multi-year hormone therapy.
My husband is on hormone therapy. Hates the hot flashes but has none of those other symptoms he’s very muscular, no weight gain, no breast growth, has good energy. He went through radiation.
I had radiation treatment in 2015. My psa has been rising for 18 months. I am now looking at salvage surgery with all the complications that come with that. What to do.
PCRI's RUclips clips are wonderfully informative and very helpful. One question on this video. Could Dr. Scholz please compare Proton Therapy vs SBRT for low and intermediate risk patents? While Proton Therapy as used today takes longer there appear to be some significant physics based advantages that could result in reduced side effects.
There is another video where Dr discusses proton. It's a good option though pretty much the same outcomes as photon with SpaceOAR. Biggest problem is getting your insurance to cover it.
@@theshastafarian There are numerous review articles on this. Just do a quick pubmed search (proton vs. photon would be a good search term). There isn't just one citation. This is a well established paradigm at the moment. Perhaps with IMPT proton therapy may pull ahead but conventional proton therapy is not superior to IMRT.
@@elitetrader5468But isn't the big feature of Proton Beam that it has fewer side effects, since protons stop at the cnx rather than continuing through other tissue until they exit the body?
11:01 - I had to replay this a few times and want to be clear. Are you saying there is a non-zero chance of impotence with radiation but the chance is much lower than it is with surgery?
Hi, My father 76 years old has been suffering prostate cancer with gleason score10(5+5) and he has been diagnosed with hormon therapy for first 3 month and how visiting doctors in Delhi,One doctor is suggesting to for for srgery and another doctor is suggesting for raido therapy.We are in confusion what we will do?Please advice.How can i get video consultancy with Dr Scholz? Thanks
I had a urolift procedure done 4 yrs. ago. Urinary symptoms did not improve . I was diagnosed with prostate cancer around 5 yrs ago . Last year ( 2022 ) my psa was 8.5 . Had a biopsy 2 yrs ago with a gleason score of 6 . Will my urolift make radiation more difficult . What are my best options ?
Three suggestions: (1) Look for a Radiation Therapy facility associated with an academic teaching center/medical school. (2) Make certain they have high patient volume so that they have developed considerable expertise over time. (3) As best you can, try to determine (or have your internist/urologist determine) which facility has the most modern, up-to-date radiation therapy equipment.
This is a bit long, but I'd just like to help those struggling to make a decision (as I was) on surgery vs radiation. I'm fortunate enough to live in London in the UK and be a patient at a world-class cancer hospital. After years on AS, my cancer progressed and treatment was recommended. I'd always been of the "cut it out" mentality, especially being relatively young, but my urologist surgeon consultant never steered me in that direction and although it is always made clear that it's your choice, they advised me to talk to their radiotherapists before coming to a final decision. When the time came, I'd done all the research on advancing radiotherapy technologies and plumped for VMAT. (an advanced form of IMRT). I can't speak for long-term side effects yet, but the treatment itself is a doddle and short-term side effects were non-existent for me. I was also prescribed 6 months ADT, and again I had ZERO side effects (apart from some, but by no means complete loss of libido). Fingers crossed that the long term outcome is as favourable, but so far, I'm so glad I didn't go down the surgery route. We in the UK are (in some cases justified) very critical of our nationalised health service, but it is standard practice for cases to be discussed by multi-disciplinary teams so we don't tend to have the biased advice spoken about in this video, nor the financial considerations, something I think would be borderline intolerable when trying to deal with a cancer diagnosis. When I started AS 10 years ago, the "surgery-first, radiation as a backup" c idea was still prevalent. Thankfully, that seems to be fading, so when you see videos on YT advising this strategy, check how old they are and who's advocating it! Also, thanks to the PCRI for all the videos - I'm so grateful that there are people like Mark and Alex in this world.
At 53 had sugery and i can tell you just a car crash 20months later wish i had just had radiation psa is now 0.52 and radiation is now on the way all i would say do not do sugery.
Excellent video and timely as I am just beginning this journey. How does one find a center of excellence in their area? I live in the Huntsville, AL area and although it has many high tech expertise I'm not sure if radiation therapy is one of them. The two urologist I've seen talk about robotic surgery.
Urologists are surgeons and will always recommend surgery. However, is they are ethical they will refer you to a radiation oncologist if you request it.
Almost 5 years ago I had a choice between surgery and radiation. I chose surgery. Good thing since my tumor was a 3A. It didn't show as such on the MRI. I don't think radiation would have stopped the cancer from spreading.
I’ve been recommended SBRT by 2 separate cancer centers .. I am intermediate 3+4 Gleason with a high risk Decipher genomic rating.. PSMA Pet Scan showed the cancer is confined within the prostate.. One of the centers uses Varian’s Truebeam, the other Accuray’s Cyberknife… I am struggling to find any data that would indicate if one of these is superior to the other in terms of the ”trifecta”mentioned in this presentation.. Is there a major difference between these 2 options or does it just boil down to the expertise of the radiation oncologists team ?? Thanks for your great presentation..
Dale, my Gleason was also 3+4. I had hypofractionated (28 doses) IMRT with Truebeam. So far (8 months later) I am a trifecta success. It is only my guess but your radiation team probably matters more than Truebeam vs Cyberknife. Best of luck with your treatment!
@@jimk7964Your Age when treated? How many cores positive? Percent of cancer in cores? Did they treat the whole prostate or target area? Thanks...I'm working thru this now with 2 cores 3+4(small total % of core)
@@marka9073 Age 66; three PI-RADS category 4 lesions identified on MRI; about half of biopsy cores were positive but mostly Gleason 3 and small amount of Gleason 4; peak PSA about 12. I had 3 fiducial markers and SpaceOAR placed under outpatient general anesthesia prior to treatment but that was easier for me than the biopsy for which I was awake. Whole prostate / only prostate was treated. I also took 3 x monthly leuprolide injections prior to treatment.
Thanks for sharing! My PSA 5.2. MRI showed 2 areas pirads 3 and 4. Targetted/Random Biospy showed both those targeted areas as 3+3, the random biopsy found two 3+4 cores. 10% of those two cores had 3+3 and 3+4 of which 15% was pattern 4. So seems to indicate small volume overall. None invasive
@@jimk7964 Thanks for the info.. So you escaped the side effects of the leuprolide ?? That’s impressive… I have made a decision NOT to accept any hormone treatments at this time… I’ll hold that in reserve if things get worse after the radiation treatments… SpaceOar seems to be the standard now with SBRT… I will say, my biggest concern are the potential side effects of this entire treatment process… Better than surgery though IMO.. Thanks again for sharing your experience and good health to you as well…
Excellent video, except I didn't see a discussion of the effects of hormone treatment with radiation therapy. I have Gleason score of 4+3 and a PSA of 10, but I also have congestive heart failure and do not want to go on ADT because of the possible negative side effects on heart function. So the choices are radiation alone or surgery. I'm waiting for my Decipher test results to point in one direction or the other. I think the radiologist here in Vermont may resist doing radiation alone because of "standard of care" arguments. Unfortunately, there is only one provider in the area so the choices are limited. Predictably, the surgeon says I would be a "good candidate for surgery.
Did the radiation. Did the brachytherapy. Did the surgery. Did the ADT. Still have cancer and no function. I don’t think people realize how devastating that is for a guy. Life hasn’t been worth living for years
20 months after prostate surgery the incontinence has massively damaged my life. Less social, more depressed. ED has not helped. I was much luckier than many and PSA remains zero. But the side effects are brutal.
@@artmaltman I have the same problems life is never the same again also 20months psa is now 0.56 and going for pet scan which i had just had radiation let me wish you well .
@@rogerembry4777 oh I do as well, give myself to God, live like Christ, spread the good news and you are right I was just venting a little. Wish I had all this information 4 years ago. Fantastic information. But you have to admit the loss of ability sure puts a hold on social interaction.
I am a cancer patient prostate removed six months ago I know how everyone feels I am still wearing pads however it's not as bad as just after the surgery on hormone therapy and sucks however I want to live and I hope all of you do to it's going to take some time I believe all of you have it in you to deal we are men suck it up I have still have my days we all will dealing with what we are dealing with live you life to the fullest no matter what
I had surgery almost a year ago at age 74. I still have occasional mild stress incontinence. A coughing fit with a full bladder will produce a wet spot on my underwear, but most days I stay completely dry. They say you have two years of recovery, so I'm hoping for further improvement. ED lasted a few months. At my age, it's difficult to say what to expect. Before surgery, I had begun to notice some softening and reduced duration. I think it's unreasonable to expect a return to where I was in that regard as a young man, or perhaps even as a sexagenarian. Currently, the quality depends on degree of arousal more than it used to. As with incontinence, I can hope for some further erectile improvement for another year or so. As for the tumor, it was anterior, already into the fibromuscular stroma, Gleason 3+4, pirad 5. PSA > 9. I could be wrong, but I believe that location would have made it relatively difficult to get an adequate beam on it without passing through a lot of other tissues. There was one tiny PSM, which sucks. The decipher score on the tumor was 0.45, on the edge between low & intermediate. It said risk of metastasis in 10 years 3.9%. Both 6 & 9 month PSA < .01, the next one is around 6 weeks away. So far, I have no regrets about choosing surgery. Being able to rely on PSA tests to spot recurrence is a big plus, as well as having had a pathology report, including decipher testing, on the whole gland. Oh, and not needing to worry about RT side effects showing up over the next few years, also a plus.
Thank you for these great videos and insight into prostate cancer. I was wondering what I can expect my PSA to return to post-radio therapy in 2019? It has recently climbed to 1.1 fairly quickly, is this normal.
@jys160 My husband is Gleason 8 & we are in the process of meeting with various doctors. I've been doing the research-info gathering, & it is common to have a slight jump after either surgery or radiation, which will then subside over the course of 4 to 6 months. Dr. Scholz talks about this in a RUclips titled "Understanding #ProstateCancer Prognosis:" it's called the PSA nater, which is "how low the PSA drops 4 to 6 months after the initial treatment." He says if by that time it is less than .1, the 10 year survival rates are 85 to 90%. Hope this helps! We are still trying to determine the best option for a 72 year old, biopsy 2 cores Gleason 8 (4+4) and 3 of Gleason 7 (3+4), no spread outside the prostate gland (thanks to the PSMA PET scan for that good news), but a strong family history. We are also getting a 2nd opinion from Mayo, so we can compare recommendations. Lots to assess!
I think there have been few studies on ASIAN Diets and Prostate cancer . All have been positive I recall . Reducing animal protein and massively increasing vegetable intake can only be a good thing for other reasons too
Hi. Thank you for all these amazing videos. I have a question. My husband is status post radical prostatectomy 14 month ago. Gleason 3+4. Positive PSMA at initial dx only in the prostate gland. Pathology stage pT3b Seminal vesicle invasion, pN1. P SA remained 0.04 until last Sept. it went up to 0.1, now PSA 0.27. PMSA scan negative. Question XRT+hormone treatment now? Or XRT now, and hormone tx if PSA remains elevated after XRT? Thank you
I have a friend who was in the same boat. He ended up getting just the proton beam radiation post surgery (about 30 visits), not the hormone treatment. His PSA went down and has remained low.
I am 67, and in otherwise great health, and have a PSA of 20 but will probably just let the cancer take me as none of the treatment options seem enticing. This is from someone who went through two hip replacement surgeries.
I was 66 when I received my prostate cancer diagnosis. After doing extensive background research I ruled out surgery and settled on Proton Radiation. I am very happy I chose this mode of treatment. I have no side effects . I had 5 days of treatment at Mayo Clinic in Rochester, Minnesota…. 5 treatments as opposed to 40 treatments. Please get treated, Death by Cancer is not the way to go…. Reconsider….. William A Feldner DDS
While radiation is no joke, it's very tolerable. IMRT and similar methods are painless though some short term side effects may be annoying, like fatigue, having to pee a lot, and maybe some bowel issues, but these go away within maybe 2 or 3 weeks after treatments are over.
I'm 66 and also have a 20+ PSA and am also going to take my chances. The ExoDx test gives me confidence on my path as it shows me to be in the safe zone. To each his own....
Given the recent updated data from British Columbia published in the Journal of Urology (July 2024) showing a 10% risk for the development of secondary malignancies at 20 years post brachytherapy, is radiation therapy still a good treatment option for healthy men under the age of 70?
He is neither a surgeon nor a radiation oncologist. He is a medical oncologist, so his opinions are as objective as you will find. Surgery works, but it is complex and has more long term side effects on average compared to modern radiation. It's not bias to tell the truth.
Dr,schol and Alex my problem is we have no capacity for financial ability to support all procedures what the oncologist requesteng all ! Can yuo help us ? We need financial support from your center of institution if theres we from phillippines island thks more!
Is IMRT plus a brachytherapy ‘boost’ considered sufficient for 3+4 that may have ECE? Or is ADT always part of that radiation equation? It seems ADT is so disliked that it may turn intermediate risk patients to surgery (of course, if positive margins occur, they may do radiation/ADT in any case but that’s another issue.)
I'm answering my own question because I just came from my radiologist who recommended either SRBT + HDR Brachytherapy or SRBT + 6 Months of Hormone treatments if going the radiation route. His preference seems to be for me to have surgery because I'm relatively young and if it fails I can do radiation (plus possibly hormones) to try to salvage things. My logic of going to radiation directly and avoiding the risks of surgery (especially considering possible ECE - and therefore positive margins - noted on an MRI re-read) to wind up at the same place seemed not to impress him. I told him my youth (I'm 60) was not the issue, the best course of curative treatment to knock out the cancer is the focus. We'll see.
I had surgery then 16 months after surgery my PSA was rising had radiation and ADT. I had total incontinence following the radiation. Five months after completing radiation I had and AUS implant that failed due to "erosion of the urethra" as a result of the radiation. The AUS was removed. I am waiting one year from the removal of the AUS before a second attempt of an AUS implant will be put in me. The doctor said in this video .that the damage to the urethra from radiation is always there. Did I misunderstand his comment? The persistent and total incontinence is difficult to live with. Am I making a poor choice to have a second attempt at an AUS implant? The doctor doing the surgery is a world class surgeon whose primary practice is urinary reconstruction for transgender patients. I am told the the cuff will be padded with muscle tissue to prevent a repeat AUS failure. Comments on my situation would be greatly appreciated.
Dr Scholz gives the best honest advice. He describes my Surgeons.
In 2019 I was diagnosed with prostate cancer at the age of 54… I visited a number of cancer centers in my area and got different opinions. All of the surgeons wanted to do a radical prostatectomy. I had read many things about the surgery and wanted to avoid it if it all possible. After I found two radiation oncologist who said that radiation was a perfectly acceptable treatment for my cancer I went that route and couldn’t be happier! I do not have any incontinence or any other major issues -pretty much returned to normal after a healing process took place when I finished radiation… I am so glad I did not go with the first recommendations of surgery… The radiation oncologist devised a treatment plan for nine weeks with targeted radiation - my PSA is now at .5 which came down from double digits at the height of my cancer before treatment began… Modern radiation is a miracle!
Thank you. I am about to go for brachytheraphy soon. You take care of yourself please
Thanks for the comment. What health institution to you get your radiation treatment from? Many thanks!!
Thank you for sharing your story since I’m in a very similar situation. I’m 54 years old and talking with my Urologist, he wanted to do surgery but did suggest I meet with a radiation specialist. As I do my research and met with a radiation specialist, I’m leaning more towards that procedure considering how the results show for my particular condition.
@RickJ9615, Thanks for sharing your story, may I ask you what was your Gleason score ? My husband was recently diagnosed with prostate cancer , with a Gleason score 9, which is a very aggressive cancer, but it is contained in the prostate.
But the Doctor recomended surgery ,he said that he is not a candidate for radiation, due to his score.
Could you tell us which radiation treatment you decided to go with, thank you.
The two of you are simply incredible. I'm 3 + 3 and on AS, but I want to see abreast of treatments just in case. There simply is no better source of information than PCRI. Thank you so much for caring to do this. 19:28
A magnificent series these are on Prostate Cancer..Dr Mark Scholz is just brilliant and explains everything so very well..The interviewer is magnificent also .👏
Agree 100%. 1000 times thanks for these presention and making our decision making process palatable.
There are MANY of us in the alternative camp who are so happy we chose it. We do not experience the loss of life quality that many others experience. Also we have great success in not experiencing a return of the C, which many times is worse then before.
@Dr. Scholz, I'm a very healthy 65 Y/0 just recently diagnosed (after MRI and biopsy) with a Gleason 7 (3+4) in 4 out of 12 cores. I have always considered surgery as a last resort. Thank you so very much for making this very important video! In my opinion, too many men are scared into opting for unnecessary surgery.
Another option is hormone deprivation therapy. It doesnt cure but can suppress the cancer forvyears. However it foesnt cure
I am 65 as well. Also G7 (3+4) however I am leaning towards Focal laser ablation or Tulsa Pro.
@@db_carguy4833 I was considering Tulsa but its not really ready for Prime time and recurrence is high. Yearly biopsy is also probably indicated
I’m so happy that I found this site. I was diagnosed with non-aggressive Prostate cancer last year and have been on ‘active monitoring’. I only had four core samples with cancer out of 12 taken. Gleason scores were 3+3=6 for two cores and 3 + 4 = 7 for two other cores. I am due an anniversary biopsy and MRI next week. I was unaware of additional types of imaging. I’ve found your videos incredibly informative. Thank you so very much.
Hi, what was the result? And how long you were on AS. I'm almost like your results and searching what to do. Thanks
Thank you for your excellent report
I had radiation for my prostate 5 years ago at age 70 … at the time it was a difficult decision … I think had your video been available it would have been a no brainer on choosing radiation
I’m happy to report NO SIDE AFFECTS and with a PSA of .06 for the last 5 years my radiation is now considered a success
That's great news, could you pass on what type of radiation? Thank you
What type of radiation did you get ?
I had my prostatectomy 4 weeks ago and I couldn’t have scripted my recovery any better. I am 62 and work hard at maintaining a good fitness level. I prepare my body for the surgery by adopting a plant based diet and eliminating alcohol. I started pelvic platform exercises 6 weeks prior to surgery and performed them every day. I have not suffered any incontinence since the removal of the catheter and I am back to lifting weights.
I have been very fortunate to recover from the surgery and I recognize not everyone choosing surgery will be as fortunate.
However, what ever option you choose, prepare your body for your treatment….it is one thing that you can control in this process and I am convinced it help in my recovery.
If you don't mind, what was your Gleason score and was your cancer prostate-confined?
@@robertmonroe3678
My Gleason was 7 (4+3) and PSA 10.
I had a PSA test last week and my score is .1
@Steve Treacy That's great news! Any side effects. Episodes of urinary leakage when laughing, jumping, ect. I've have heard that can be common.
Similar to you, my biopsy was just upgraded from 3+4 to 4+3 by John Hopkins. It is low volume(10% or less in 2 cores). Polaris tested good, genetics tested good, PSA@5.1
Can you share your diagnosis info?
How did you decide between surgery, radiation and other treatment?
Always ate healthy, eating even better now, exercising, appropriate weight. Exploring key supplements, broccoli sprouts, etc.
@@sttreacy I'm sorry to hear that. 0.1 is no good and you should discuss salvage RT with your doctor.
Could you share if you had a MRI and if so what was your PIRAD score. Thanks
What a great summary! Dr Scholz is someone to listen to. I was pretty skeptical about radiation when I was doing life insurance underwriting, but that was 20 years ago. Then I got prostate cancer 6 years ago and discovered that the choices were now much better. My choice was High-dose-rate brachytherapy (similar to "seeds" but done under anesthesia and nothing left in place) + IMRT external beam radiation. I got an excellent outcome on all three of those "trifecta" criteria. My case is an anecdote, but I have reviewed the recent literature as a certified expert in assessing medical evidence, and agree completely with Dr Scholz.
Where did you have your radiation treatment?
@@m8kmida Kaiser Kaiser Permanente Santa Clara Medical Center for the HDR-brachy and Kaiser Oakland Specialty Offices for the IMRT EBRT,
My Urologist Dr is as discussed an old school who suggested surgery. I said yes & was scheduled to gave surgery a month later. I went home did my own research diligently. I even found someone who was doing radiation and they sold me on it. I went back to my Dr & told him reluctantly, I was going to do radiation. He said" I still think you should do the surgery and if anything is left we can do radiation, exactly as was mentioned in the video. He finally said it's your decision. that's the key it is your decision. Less side effects w the radiation. Recovering well. Glad I had the courage b4 surgery to change my mind.
Thank you for sharing your story. I’m 54 years old and was diagnosed with Gleason 7 (3+4) prostate cancer. My Urologist was telling me the same thing about doing surgery, your young, in overall great health so you should do well. He didn’t schedule anything though and suggested I talk to a radiation specialist just in case I need radiation treatment after surgery. He also recommended a radiation specialist. After doing my own research and meeting with the radiation specialist that he recommended, I told my urologist I’m thinking more about radiation therapy. I haven’t set up anything yet because I’m still going through medical tests with an upcoming MRI that the radiation specialist had requested.
What type of radiation did you get ?
Wow! This is so right on. I have been researching both radiation and surgery. I was immediately told about three oncologists who were great at what they do by the urologist who did my examination after my pcp saw a rise in my PSA this past May. All tests she did on me was negative but her examination she felt a small nodule and immediately started telling me I need an mri and biopsy. I wasn’t too thrilled how she was going at this on the quickness. My pcp examines me every year when I’m having my yearly physical and November 2022 he felt nothing but he didn’t do a PSA check at the time. It was by the grace of God he did it this time in May. I’m oblivious to how really serious prostate cancer is because I never researched it. My last PSA test was in 2020 and 2021 where it was 1.65. This time it doubled and my pcp wanted me to see a urologist. After the mri that indicated I had cancer the biopsy confirmed it. I just had my PSMA PET SCAN so I’ll see a Radiologist to go over the scans and treatment. I already talked with one of the surgeons and he examined me went over my grade and what he will do with the Robotic Surgery. I left his office with so many questions and felt like there was no compassion. I mean I have cancer and he was about getting the cancer out and very small conversation on incontenance and erectile dysfunction giving me paperwork on the pills and other contraptions to use for the penis to keep it from shrinking. Thank God I had time to research and get answers to what I’ll do now I will see how the Radiologist will be in our meeting. What discourages me about radiation is that hormone therapy. The side effects are horrible. So I have to choose what I’m going to do because honestly both treatments have horrible side effects. Thanks for these videos.
Im right there with you. Dont know how old you are but I am older and I do not wish to have surgery.
@@jerrymunroe5593 I made the decision to go the radiation route therefore my life can continue on not missing a beat. I already had the ADT injection last month and the hot flashes can be a nuisance but I know there’s others side effects that I will get with time. The end of January I start the radiation treatments all 45 days of it but what helped me make my decision was the Radiologist Oncologist showed interest and compassion answering all my questions with ease and not treat me like a number but a patient. He let me know that I should continue doing everything I’m doing now with my life and add more walking with my exercises in which I told him I’ll do all I can to meet these side effects head on. Thank God the cancer didn’t spread. Just two days ago I talked with the Doc again then met the two radiologist who set me up to get a Ct scan to see where they had to tattoo the area for the radiation beams to go through me. They were very sweet ladies lastly I met the nurse I’ll be in contact with who presented me with a few resources I could benefit from which I will take advantage of to help me mentally dealing with this cancer. In all I feel I’ll be in good hands with a team who shows compassion and concern unlike the surgeon and yes the urologist. I also didn’t want to be dealing with a catheter for two weeks after the surgery. To each his own but I chose what I thought would work for me. My sister has a coworker who had the surgery and who returned to work who told her he feels great just dealing with the leakage. Like I said both the surgery and radiation have their side effects and in my research radiation and the ADT injection have more but I’ll take my chances with this one. My birthday was late August the 28th I turned 68 and was told the news the biopsy confirmed I had cancer and now five months later January 29th I start my first treatment. God got us so I’m fearing no more. Good luck and do stay in prayer through this journey.
You need a Decipher Test 22 Genome to see if you actually need hormone treatment.
Hi, I’m also in the same place spoke to surges the other day advised with radiotherapy there is trend of cancer forming in other areas. Where as the surgery appears to remove the cancer completely as mine is localised prostate. This is really confusing. I’m aware of the down side of surgery I’m 42 and have a young family. I will be starting my pelvic exercises today to beat prepare for either route which I expect surgery will be in November if that route is chosen
@@weswilliamson7538 Good luck with your decision. So young having to go through this. I'm 69 now but last year when I found out I had cancer I was 68. Seems it got me regardless of how many years i've had the examination and started in 2020 having the blood test for PSA. I am doing well though the Hormone Therapy I'm still on. I get my third injection this coming December. I had my first last year in December. February to the first week in April I had my radiation treatments. I had no problems with getting the treatments as I continued to work and live my life normally. PSA test in June was down to 0.07. I'll have another in June to see how I'm doing. Side effects from the Hormone Therapy injection is hot flashes mainly and ugly rashes. I get cremes from my Dermatologist for the rashes when they appear. Still trying to get my diet right but I am good on not having any dairy. Sweets I cut down as well and still working on eating more veggies but I'm good with salads. Overall I feel great and I thank God daily for the blessings.
Great video, very informative as all your videos are. I’m very thankful that my urologist/surgeon was honest and straightforward about my diagnosis and recommended radiation plus ADT rather than surgery.
This is one of my favorite videos regarding this topic because many of the thing’s discussed in this video was what my urologist discussed with me. I’m 54 years old with Gleason 7 (3+4) prostate cancer. My urologist discussed heavily on the benefits of surgery and I was all set to do surgery but he suggested I should see a radiation specialist just in case I need radiation after surgery. After doing my own research and meeting with the radiation specialist he recommended, I told my urologist, I’m thinking more of radiation therapy. I could tell my urologist wasn’t happy hearing that because he went on to do a bit of a hard sell on the benefits of surgery over radiation therapy, and that I’m young and in great health so erection problems and/or leakage problems shouldn’t be very serious because of my age and overall health. He even mentioned a couple of time that he’s not trying to do a hard sell on surgery. No plans have been finalized yet on the type of treatment since I’m still in the testing phase. I have an upcoming MRI scheduled as requested by the radiation specialist. It’s great knowing there are other options rather than surgery only.
You do not t
Mike, I'm 65, work out 3 - 5 times a week, very healthy and take no medications. So it came as a shock to learn after a 396 PSA and a "suspicious" MRI, and biopsy results confirming (just last week) a Gleason 7 (3+4). My father was also diagnosed when in his 60's, 30 years ago. He opted for radioactive seed implants, lived to age 87 and his cancer never came back. Everyone is different... but this video confirms for me that surgery is not the best option for me. My urologist is not steering me one way or the other but if he was trying to sell me on surgery I probably would never go back. I'm going for a 2nd opinion regardless... maybe you should too?
@@commonsenseisdead Thanks for the feedback. Since I made this post, I have recently completed my surgery (12 days ago). When I was doing my own research prior to surgery there have been other oncologists who said, younger patients, typically those under 60years old, benefit from surgery vs radiation treatment. Ultimately it’s a really difficult decision to make but I’m good with my choice.
I made huge mistake with surgery!! I justvdid surgery on July 30, 2024, just 31 days ago,, & the nerves responsible for erections were damaged. I am only 63 years old, healthy, & my sex life was amazing with my wife. Now, the future is so frightful. I was a Gleason 9. Waiting two more months to see where PSA will be at. The surgeon right after surgery said, that in addition to being impotent, I will need further radiation treatment.
PLEASE, view this video several times!
Thank you for this.... I am Stage T3b, Gleason 10, group 5, PSA 60+. Just finished targeted proton beam with SpaceOAR (the Dr who co-wrote the paper was my surgeon!). Went really well, some residual bowel issues at +5 days, urinary channel is fine. This talk gave me some expectations for how things will go at +1 year onwards. It is what it is, no point thinking too much about it. I have been very, very lucky this year in my journey. I have some residual issues with anaemia. I think that would be a good talk to cover - hormone therapy, radiation and impact on RBC etc. Thank you.
Thank you so much for these videos. You’re really helping the likes of me. I watched a few of the videos now but this one was the most important one for me so far. Thank you.
four doses of immune therapy, two times high dose Brachii therapy, five weeks of radiation for Gleason 9 prostrate cancer at Moffitt Cancer Center in Tampa Fl. absolutely no incontinence good erections, PSA 0.02, 4 years clear… I credit Dr. Scholz for leading me to search alternatives to surgery…
Was hormone therapy part of the treatment? I’m curious because the five weeks of radiation plus the Brachytherapy (and immunotherapy) seems like an attractive option to surgery.
Did you have bone metastasis?
@Nicks9j 9jFlix2011
@@NicksFlix2011 exactly, good question.
Very helpful. I will be finding out about both radiation vs surgery in the next month. This has been most informative and has given me a new perspective. I have good questions to ask my urologist.
Wow. Wish I’d seen this in 2013. Dr Scholz absolutely nailed my conversation with my surgeon and how I felt about it.
What would be great is if we had one website to research all Doctors and better yet it would free to patients.
I was on hormone therapy for 1 year, had a gleason score of 3 + 4= 7, and opted for a radical prostatectomy. I did not want to stay on hormone therapy during radiotherapy because the orgoyvx and zytiga were affecting my blood pressure, blood sugar and cholesterol levels but with the radical prostatectomy I was able to end the hormone therapy. I had also gained 38 lbs in one year not to mention the dreadful hot flashes while on hormone therapy. I chose what was best for my situation
how is today your PSA?
@@alliaj1undetectable
Excellent videos. I’m an 80 year old living in Vietnam so I’m a little nervous about treatment here. I’m getting hormone injections at the moment for Gleason 9 (3 times so far) it’s pretty nerve wracking.
most timely and and helpful
Best information available. Thank you!
Excellent Video. Love to hear the truth.
Great interview and great information. Thanks for posting this!
Thanks you helped me decide on going with radiation
Best video yet. Thanks
excellent summary. PCRI videos have educated me, so whereas I would not have considered RT before due to old information putting me off, especially risk of secondary cancer and burns, now I all the information about surgery has completely put me off surgery. If I need treatment I am veering to RT
Agree, that searching through all the old information has been educational but time consuming. Radiation and ultrasound treatments have more outcome data. Cryo has focal use possibilities. Internal/external radiation in general have the most historical data overall.
Have 2 core low volume 3+4. Taking time to search best option for possible future treatment. Right now leaning toward Brachytherapy or SBRT, but will continue active surveillance.
@@marka9073 hope your doing well. May I ask which path you took & if there were any side effects? Thank you
@@Jack-2day After much research and deliberation of options and timing for treatment, I chose HDR Brachytherapy @ UCLA just last month Oct.25th. The treatment was a process but definitely worth it and to have behind me. Initial side effects were mostly mild. After two HDR doses, left hospital on own caught flight the next day. Symptoms mild with some urgency first few days, all manageable. No ED issues. Went to work following Monday. Given my short term experience so far, I would do it all over again. For me it's estimated 98% cure. Long term time will tell. Ask any questions, I've been meaning to share my full treatment process. Honestly the hardest part was all the research and finalizing my treatment decision. Also met doctors for all treatment options.
I agree with her opening premise re: not being told enough about the likely aftermath/side effects... I'd do radiation if I had it to do over...I was 59 & Gleason 3/4, non-metastatic. 2.5 years out, PSA virtually undetectable, happily. It appears I will be mild/moderate incontinent w/severe ED for the rest of my days...the idea of the penile implant scares me; necessarily catheterized for 1month after surgery. About 2X longer than normal... Oh well! U pays your money & takes your chances.
MJ sounds like our diagnosis were similar, I'm 59 also soon to be 60. Had a complete bone scan and pelvis ct with and w/o contrast, going to see my doctor in a few hours.. I've been up all night giving myself a crash course on my options, doing a lot of what if questions.
I wish Dr. Mark Scholz would have expanded on Radiation complications like rectal bleeding, chronic, prostatitis and chronic bleeding from bladder. How is bladder cancer assessed in the presence of chronic blood in the urine since he mentioned tissue is not friable and want to avoid cystoscopy?
I am in the process of radiation treatment now. Very positive as is my Radiation Oncologist.
Radiation therapy is the gold standard local treatment for cancers. surgeries are invasive barbaric old way that result in devastating life changing consequences.
Thank You ... Again. Please do a follow-up video on " Re-Current Prostate Cancer with Cryotherapy". My Urologist states this is the best option after Radiation Initial treatment... and the safest. I have read other opinions... Please do a video on this specific topic. Thanks
Very valuable information. Thank you both.
Excellent talk.
What treatment modality would be preferable in a 55 year old paraplegic who's recently diagnosed cancer is confined to the prostate?
I am a very healthy (otherwise) 71 yo. No other health issues, (other than a recently torn rotator cuff) no prescription drugs. I am not overweight having changed my diet and losing 40+ lbs over the past two years. I also take Testosterone twice weekly. I was recently diagnosed with PC - Gleason 4+3. I never had any symptoms and still do not (other than a high PSA) The surgeon who also did the biopsy is definitely biased toward surgery. I have a PSMA PET scheduled in two days and in two weeks will have consultation with a Radiologist.
Like most, I am concerned about incontinence and ED (nerve sparing). The surgeon told me that there is strong likelihood that there could/would be nerve damage in spite of his best efforts. I am also concerned about resuming workouts and testosterone after treatment. I have read so many horror stories about ADT that that part of the treatment is what scares me away from any form of radiation therapy. At my age, long term ADT is out of the question. I hope I'll find some new strategies to deal with that.
Im wondering what your decision was
I am 68, was on active survelliance in 2022 with Gleason 3+3 in 2 cores.. In September, 2023, I had another biopsy and now have Gleason 4+5 in one core. PMSA scan came back negative. Given the Gleason 9, I have listen to this video as a way to help me decide what is best way to proceed. I have chosen Radiation direct beam, brachytherapy plus 18 months of hormone therapy given the Gleason 9. I decided that the risk of cancer returning after surgery was too high (25% to 30%). I also know of a friend who have surgery, than 40 treatments of radiation after 2 years of have no PSA per se plus hormone therapy. In addition the location of my cancer puts the right nerve bundle in play. Want to try to put this behind me!
It’s unfortunate that the federal employee program Blue Cross Blue Shield appears to be behind the times with regard to prostate cancer treatment. Brachytherapy, Focal laser and High intensity focused ultrasound Are all categorized as experimental and therefore not eligible for coverage. On a Separate note, I am most impressed with the interviewer and Oncologist in this and other related videos.
Thanks so much for your great videos. It helped me make a better choice between treatments. I think people need to make a well researched choice rather than just go with “it’s cancer cut it out”.
Sometimes surgery is a good option especially if one is having urinary issues from the enlarged prostate itself. I had surgery with great results in terms of no complications, however my cancer came back and now I'm headed towards salvage RT which scares me.
so sorry to hear the cancer came back. how are you doing now? i hope you're doing well. where did it come back if there is no prostrate? can i also ask what was your gleason score before surgery?
Can you talk about the cyberknife or similar treatment for the prostate?
Thank you for your advice. Appreciated
With a GS of 4+3 I am looking at Tulsa Procedure and targeted radiation. This video really helps. I can ask more questions of the VA urologist of both of these although the VA does not conduct Tulsa Procedure they do pay for it at certain places like Mayo Clinic in Jacksonville Fl
Here's hoping this is a watershed moment.
>>First patient with metastatic prostate cancer to receive 2 doses of Cu-67 SAR-bisPSMA achieves undetectable PSA level
Great video. Thanks. And thanks for being trustworthy. My limited experience with surgeons, and the medical system in general, they are sales people that want us to buy from them that can result in biased treatments and even obsolete treatments. It's hard to get to a treatment and a skilled team to give good treatment while being scared and feeling time pressure and fearing cost. And, it also seems the diagnostics are lacking, even though it's the best we may have. I guess that's why it kills so often. 😕
I just got the results from my biopsy yesterday and it was what I feared positive for prostate cancer . My doctor a surgeon discussed with me the options of surgery and radiation, fortunately he agreed with me that radiation was a better choice of the 2 choices I have for positive results and quality of life and cure f cancer . I see the oncology radiologist which also happens to be a highly recommended one Monday. I’am thankful of urologist wasn’t a pushy salesman for surgery even though that’s all he does ,because I’am scared enough .
@@donaldpiper9763 In process of same decision. At 63 years I'm concerned of potential cancer down the road. What is your age and can you elaborate on your decision process. Thanks so much!
@@marka9073 I’am 67 year’s old , I weighed the consequences of surgery and the consequences of radiation and hormone therapy . For myself I chose radiation for lesser side effects and better quality of life . Hope yours works out well .
@@donaldpiper9763Thanks for reply.
I was diagnosed with small volume of 3+4, sent that to John Hopkins and it was upgraded to 4+3. Prolaris tested good, Genetics tested good, PSA@5.1.
Can you share your info as above?
Have you completed radiation treatment?
What type of radiation: IMRT, SBRT, or was it Brachytherapy?
What machine: Varian Trubeam, CyberKnife, MRidian or other?
How are you doing, side effects, etc?
Wishing you well, Thanks again
I believe many choose surgery over radiation because of the cost factor. Roughly four times as much for radiation as opposed to a prostatectomy. We need to bring down the cost of radiation therapy if it’s effective as claimed. Despite the cost I chose radiation and am glad I did. The radiation was a breeze. It’s the hormone therapy that’s way more troublesome.
As this video has been uploaded here one year ago, are there any new changes in cancer treatment in the mean time? I don't read too much about focal radiation of only the tumor instead of the whole prostate. How about that?
My Radiologist, after planning, says the SpaceOar was not advised due to size of my Prostate. AFTER ORGOVYX AND BICALUTAMIDE TREATMENT, my Prostate size has decreased and we could use Spaceoar but would need to reschedule and delay for weeks. Should I proceed without the sheld of Spaceoar, at Age 83 and a Gleason 9 in two locations and three Gleason 7's? Thanks. Don, in Tex.
Same thing here, doctor recommends bicalutamide and zoladex to shrink prostate before RT. So far no side effects (on them for 2 weeks).
@@cathum what size was your prostate
I have been diagnosed Gleason 3+4 =7 with 3 small foci located inside not at the periphery. I chose surgery over radiation . Please guide me which is better option.
I was planning on having my prostate taken out up until I just watch this video thank you for your expert advice. Dr. Where are you located I would really love to sit down and talk with you.
Jim
Cinnaminson NJ
I agree. All three urologists are recommending surgery like it is a must. Going to get a fourth opinion on the seed implants. Seems like the way to go
Dear Sir
I follow your videos from France.
We have a lot of problems, our health system is working more and more badly...
I had to have surgery in a private clinic, although my PSA was undetectable at four months, there are 4 positives margins and the capsule was cut.
I have a GS 4 5!
Currently I am awaiting the decision of adjuvant or salvage RT.
It is complicated. What to take?
I am discouraged.
Luckily I can find information in the USA.
Thanks to you friends of the new world.
Patrick
Yes, I follow PCRI from Hong Kong and the education has been invaluable in not being bounced into wrong treatment
If you had opted for radiation (brachytherapy + beam) I wonder if IMRT could have covered those margins if ECE was suspected (predicted) from the MRI images? I think Dr. Scholz has said that.
But at least you can go after the margin areas now via adjuvant or salvage radiation.
The discussion of professional bias was interesting. With radiation therapy and surgery, does ED routinely accompany incontinence or can one condition occur without the other or occur at disproportionate comparative degrees? In other words, are the odds better for return of concurrent (both) functions better with radiation therapy over surgery or should I concede to losing control over both to same or unknown degrees, regardless of the selected course of treatment?
Incontinence is caused by urethra damage, while ED is caused by nerve damage, so having one doesn't mean you will have the other. It comes down to the skill of your doctor and the location of the disease.
If your cancer has involvement with the nerve bundles, it will be tough for a surgeon to remove it without cutting the nerves, but radiation can hit the same area and may kill the disease while sparing nerve function.
But I'm just an internet dude, so discuss with your oncologist.
There are less side effects with radiotherapy. But as the doc says about 50% of surgery patients have ED or incontinence.
You can have ED and incontinence with radiotherapy as well. I certainly did. But that is a function of NOT having any testosterone in my system rather than effects of radiotherapy.
If you have no drive, its not a problem having ED.
My brother in law recently found he had prostate cancer with a Gleason score of 7. He worked with a medical group who steered him toward surgery rather than radiation. He was told if he chose radiation and the cancer returned at some point radiation could not be used again to treat the cancer.
I'm an 80 yr old man with a PSA consistently less than 1.0.
However both my father and older brother both had prostate cancer.
Should I still have a PSA test every year.
Thank you
Thank you for your videos, they are fantastic. I am going to have RT, can you explain to me what is the gold fiducial markers. Is this pieces of gold will have any long term effect on the prostate.
The markers are used as "landmarks" to compensate for movement within the body and other variations so that they do not irradiate the wrong tissue. Some side effects have been reported, including potentially serious side effects in very rare cases (fever, for example) but these are reported to resolve within weeks. I am not knowledgeable about the possibility of any long-term side effects, and the SBRT with which they are used is relatively new, so there would not be any long-term studies looking at long-term effects in this context, but there may be a lot of studies about similar types of implants in other contexts, so I will add it to our list of questions for future videos. We have a helpline at pcri.org/helpline that may be able to provide you with that information (although I can not guarantee it), and then, of course, make sure that you ask your doctor -- he or she should be knowledgeable about the risks of these types of implants and the risks of not using them if radiotherapy is needed.
I am 66 years old. I was misdiagnosed.
Upon seeking a 2nd opinion, the result came in at Gleason 9 i.o. the "routine" 3+4=7 as per the 1st opinion. Staging was 3a (cancer has pierced the prostate envelope, clearly visible on the mp-MRI). And this despite my PSA being only slightly elevated (6 i.o. max 4). Fortunately, a PSMA-PET/CT-scan returned N0, M0: no metastasis yet!
It is clear that the surgeon who diagnosed Gleason 7 had his beautiful Da Vinci-robot in mind, rather than his patient. He avoided staging the cancer. And this was no accident. 8 out of the 12 cores of the prostate fusion biopsy returned 3+5 to 4+5 during the 2nd opinion. He did not discuss the mp-MRI with me.
Given the size of the adenocarcinoma and the staging, the surgeon who gave the 2nd opinion referred me to a radiologist-oncologist. The surgeon claimed that in my case, prostatectomy was actually useless as there was not enough room to remove all the peripheral potentially cancerous cells. Besides, he no longer performed prostatectomies, unless at the insistence of patients (!). Advances in radiation therapy in the last 15 years have made prostatectomy obsolete, he claimed. As he put it: 50 years ago, we castrated, 30 years ago we removed the prostate, now we radiate.
Given the high-risk nature and the size of my prostate cancer, I started ADT 8 months ago with a combination of 3-monthly leuprorelin injections and daily abiraterone acetate tablets (see STAMPEDE study, The Lancet, Nov? 2022). In September 2023, I had mild hypofractionation radiation (60 Grey over 20 sessions) since the oncologist also wanted to radiate the pelvic lymph nodes. She claims that this would have had to happen even after prostatectomy!
The LINAC used for radiation is of the VMAT-type. It makes radiation of the pelvic lymph nodes much safer.
The whole treatment is focused on avoiding the resurgence of Castration Resistant Prostate Cancer (CRPC) 5-10 years down the road.
Prostatectomy is Big Business indeed.
I was so lucky to have found a treatment centre which espouses the views of Dr. Scholz!
I hope you are doing well now. Would you mind sharing where you were treated and the names of your doctors?
@@ckriverview I am doing very well in view of prolonged ADT, thank you. I am being treated at the Royal Marsden cancer hospital in London (UK). For GDPR reasons, I prefer not to name the doctors. Anyhow, at the RM a multidisciplinary team discusses every new patient. This is reassuring. I hope this helps.
thank you for all your work!
is there a list of PCRI recommended radiation facilities in the Seattle area?
what is the preferred MRI method in 2022 for first time scan?
There is a new non-invasive multiparametric MRI which could help avoiding the initial prostate biopsy. Found this information in Men’s Health Advisor
@@Rayh423 i mentioned that to my current urologist, she wouldn't even talk to me about it.
time for a new doctor.
Fred, I just went through SBRT(Radiation) treatment last Spring at Fred Hutch Cancer Center in Seattle (Formerly named Seattle Cancer Care Alliance). With SBRT you are done in 5 treatments, and I've had absolutely no side effects. My radiation Oncologist is Dr. Emily Weg, and she specializes in treating prostate cancer with radiation therapy. Dr. Weg also had me do a 3T MRI first to check the size of my prostate and to see if the cancer would show up on my MRI, which it did as PI-RADS 5, next I did a targeted biopsy to confirm the grade and decided to move forward with SBRT. (Note: I've found that many Urologists like to go to a biopsy first, however, a 3T MRI is a great first step so you can possibly avoid a biopsy) Dr. Scholz' videos educated me and helped me seek out Dr. Weg here in the Seattle area. (It can be difficult to find a facility that will do a 3T MRI in the Seattle area, so you'll want to find a center of Excellence as Dr. Scholz has suggested) - Hope this info will assist you.
@@williamcox6043 I just submitted and appointment request with Dr. Weg.
thanks William!
@@hodshonf Dr. Weg is a super doctor and her focus is on prostate cancer, so you'll have her full attention! You will be in great hands with Dr. Weg and Fred Hutch Cancer Center!
I have a question for Dr.Mark Scholz, Dr, Yushen Qian, MD Radiation oncologist at Stanford Health Care told me that two death cases happened in CA state for that they are not using a hydrogel space in Sanford. Any comment or advice. I am watching all of your videos Thank you so much.
Great video. You didn't touch upon the side effects of radiation and hormone treatment. Weight gain, breast enlargement, loss of muscle mass, lack of motivation or energy to substain a regular exercise program. Eligard injections for three years. Incontinence and sexual desire is still a problem.
I would think that kind of intense hormone therapy would be reserved for those with metastases, and that would be equally true with surgery. But these days a PSMA PET scan can be used to show if you are clear and thus not needing multi-year hormone therapy.
My husband is on hormone therapy. Hates the hot flashes but has none of those other symptoms he’s very muscular, no weight gain, no breast growth, has good energy. He went through radiation.
I had radiation treatment in 2015. My psa has been rising for 18 months. I am now looking at salvage surgery with all the complications that come with that. What to do.
PCRI's RUclips clips are wonderfully informative and very helpful. One question on this video. Could Dr. Scholz please compare Proton Therapy vs SBRT for low and intermediate risk patents? While Proton Therapy as used today takes longer there appear to be some significant physics based advantages that could result in reduced side effects.
Unfortunately while proton therapy looked great on paper, it hasn't panned out in clinical trials. It is no better/worse than IMRT using photons.
There is another video where Dr discusses proton. It's a good option though pretty much the same outcomes as photon with SpaceOAR. Biggest problem is getting your insurance to cover it.
@@elitetrader5468 Citation?
@@theshastafarian There are numerous review articles on this. Just do a quick pubmed search (proton vs. photon would be a good search term). There isn't just one citation. This is a well established paradigm at the moment. Perhaps with IMPT proton therapy may pull ahead but conventional proton therapy is not superior to IMRT.
@@elitetrader5468But isn't the big feature of Proton Beam that it has fewer side effects, since protons stop at the cnx rather than continuing through other tissue until they exit the body?
11:01 - I had to replay this a few times and want to be clear. Are you saying there is a non-zero chance of impotence with radiation but the chance is much lower than it is with surgery?
Hi,
My father 76 years old has been suffering prostate cancer with gleason score10(5+5) and he has been diagnosed with hormon therapy for first 3 month and how visiting doctors in Delhi,One doctor is suggesting to for for srgery and another doctor is suggesting for raido therapy.We are in confusion what we will do?Please advice.How can i get video consultancy with Dr Scholz?
Thanks
Has anyone used "Cyberknife" radiation treatment? I did not hear the Dr. mention this.
I had a urolift procedure done 4 yrs. ago. Urinary symptoms did not improve . I was diagnosed with prostate cancer around 5 yrs ago . Last year ( 2022 ) my psa was 8.5 . Had a biopsy 2 yrs ago with a gleason score of 6 . Will my urolift make radiation more difficult . What are my best options ?
How does a lay person determine whether a radiation therapy facility is “high quality”?
Three suggestions: (1) Look for a Radiation Therapy facility associated with an academic teaching center/medical school. (2) Make certain they have high patient volume so that they have developed considerable expertise over time. (3) As best you can, try to determine (or have your internist/urologist determine) which facility has the most modern, up-to-date radiation therapy equipment.
@@dlphcoracl9645 Excellent advice
This is a bit long, but I'd just like to help those struggling to make a decision (as I was) on surgery vs radiation. I'm fortunate enough to live in London in the UK and be a patient at a world-class cancer hospital. After years on AS, my cancer progressed
and treatment was recommended. I'd always been of the "cut it out" mentality, especially being relatively young, but my urologist surgeon consultant never steered me in that direction and although it is always made clear that it's your choice, they advised me to talk to their radiotherapists before coming to a final decision. When the time came, I'd done all the research on advancing radiotherapy technologies and plumped for VMAT. (an advanced form of IMRT). I can't speak for long-term side effects yet, but the treatment itself is a doddle and short-term side effects were non-existent for me. I was also prescribed 6 months ADT, and again I had ZERO side effects (apart from some, but by no means complete loss of libido). Fingers crossed that the long term outcome is as favourable, but so far, I'm so glad I didn't go down the surgery route. We in the UK are (in some cases justified) very critical of our nationalised health service, but it is standard practice for cases to be discussed by multi-disciplinary teams so we don't tend to have the biased advice spoken about in this video, nor the financial considerations, something I think would be borderline intolerable when trying to deal with a cancer diagnosis. When I started AS 10 years ago, the "surgery-first, radiation as a backup" c idea was still prevalent. Thankfully, that seems to be fading, so when you see videos on YT advising this strategy, check how old they are and who's advocating it! Also, thanks to the PCRI for all the videos - I'm so grateful that there are people like Mark and Alex in this world.
Will the urine flow return after radiation therapy thanks😊
What if someone had cancer and an enlarged prostate?
Hello sir, what happens after 4 years of radiation therapy causing scarring and all kinds of side effects?
At 53 had sugery and i can tell you just a car crash 20months later wish i had just had radiation psa is now 0.52 and radiation is now on the way all i would say do not do sugery.
I'm sorry to hear that. I wish you a good outcome.
Excellent video and timely as I am just beginning this journey. How does one find a center of excellence in their area? I live in the Huntsville, AL area and although it has many high tech expertise I'm not sure if radiation therapy is one of them. The two urologist I've seen talk about robotic surgery.
Urologists are surgeons and will always recommend surgery.
However, is they are ethical they will refer you to a radiation oncologist if you request it.
Rodney, what did you end up doing? not far from Huntsville.
Thank you. Your information always straight up brilliant.💚
Almost 5 years ago I had a choice between surgery and radiation. I chose surgery. Good thing since my tumor was a 3A. It didn't show as such on the MRI. I don't think radiation would have stopped the cancer from spreading.
good point, this is correct. I think it depends how far spread the cancer is, as to if radiation will be the best option.
I’ve been recommended SBRT by 2 separate cancer centers .. I am intermediate 3+4 Gleason with a high risk Decipher genomic rating.. PSMA Pet Scan showed the cancer is confined within the prostate.. One of the centers uses Varian’s Truebeam, the other Accuray’s Cyberknife… I am struggling to find any data that would indicate if one of these is superior to the other in terms of the ”trifecta”mentioned in this presentation.. Is there a major difference between these 2 options or does it just boil down to the expertise of the radiation oncologists team ?? Thanks for your great presentation..
Dale, my Gleason was also 3+4. I had hypofractionated (28 doses) IMRT with Truebeam. So far (8 months later) I am a trifecta success. It is only my guess but your radiation team probably matters more than Truebeam vs Cyberknife. Best of luck with your treatment!
@@jimk7964Your Age when treated? How many cores positive? Percent of cancer in cores? Did they treat the whole prostate or target area? Thanks...I'm working thru this now with 2 cores 3+4(small total % of core)
@@marka9073 Age 66; three PI-RADS category 4 lesions identified on MRI; about half of biopsy cores were positive but mostly Gleason 3 and small amount of Gleason 4; peak PSA about 12. I had 3 fiducial markers and SpaceOAR placed under outpatient general anesthesia prior to treatment but that was easier for me than the biopsy for which I was awake. Whole prostate / only prostate was treated. I also took 3 x monthly leuprolide injections prior to treatment.
Thanks for sharing! My PSA 5.2. MRI showed 2 areas pirads 3 and 4. Targetted/Random Biospy showed both those targeted areas as 3+3, the random biopsy found two 3+4 cores. 10% of those two cores had 3+3 and 3+4 of which 15% was pattern 4. So seems to indicate small volume overall. None invasive
@@jimk7964 Thanks for the info.. So you escaped the side effects of the leuprolide ?? That’s impressive… I have made a decision NOT to accept any hormone treatments at this time… I’ll hold that in reserve if things get worse after the radiation treatments… SpaceOar seems to be the standard now with SBRT… I will say, my biggest concern are the potential side effects of this entire treatment process… Better than surgery though IMO.. Thanks again for sharing your experience and good health to you as well…
Excellent video, except I didn't see a discussion of the effects of hormone treatment with radiation therapy. I have Gleason score of 4+3 and a PSA of 10, but I also have congestive heart failure and do not want to go on ADT because of the possible negative side effects on heart function. So the choices are radiation alone or surgery. I'm waiting for my Decipher test results to point in one direction or the other. I think the radiologist here in Vermont may resist doing radiation alone because of "standard of care" arguments. Unfortunately, there is only one provider in the area so the choices are limited. Predictably, the surgeon says I would be a "good candidate for surgery.
Did the radiation. Did the brachytherapy. Did the surgery. Did the ADT. Still have cancer and no function. I don’t think people realize how devastating that is for a guy. Life hasn’t been worth living for years
20 months after prostate surgery the incontinence has massively damaged my life. Less social, more depressed. ED has not helped. I was much luckier than many and PSA remains zero. But the side effects are brutal.
Life is always worth living, I’m pretty much the same, but I just live everyday for Jesus
@@artmaltman I have the same problems life is never the same again also 20months psa is now 0.56 and going for pet scan which i had just had radiation let me wish you well .
@@rogerembry4777 oh I do as well, give myself to God, live like Christ, spread the good news and you are right I was just venting a little. Wish I had all this information 4 years ago. Fantastic information.
But you have to admit the loss of ability sure puts a hold on social interaction.
I am a cancer patient prostate removed six months ago I know how everyone feels I am still wearing pads however it's not as bad as just after the surgery on hormone therapy and sucks however I want to live and I hope all of you do to it's going to take some time I believe all of you have it in you to deal we are men suck it up I have still have my days we all will dealing with what we are dealing with live you life to the fullest no matter what
I had surgery almost a year ago at age 74. I still have occasional mild stress incontinence. A coughing fit with a full bladder will produce a wet spot on my underwear, but most days I stay completely dry. They say you have two years of recovery, so I'm hoping for further improvement. ED lasted a few months. At my age, it's difficult to say what to expect. Before surgery, I had begun to notice some softening and reduced duration. I think it's unreasonable to expect a return to where I was in that regard as a young man, or perhaps even as a sexagenarian. Currently, the quality depends on degree of arousal more than it used to. As with incontinence, I can hope for some further erectile improvement for another year or so.
As for the tumor, it was anterior, already into the fibromuscular stroma, Gleason 3+4, pirad 5. PSA > 9. I could be wrong, but I believe that location would have made it relatively difficult to get an adequate beam on it without passing through a lot of other tissues. There was one tiny PSM, which sucks. The decipher score on the tumor was 0.45, on the edge between low & intermediate. It said risk of metastasis in 10 years 3.9%. Both 6 & 9 month PSA < .01, the next one is around 6 weeks away.
So far, I have no regrets about choosing surgery. Being able to rely on PSA tests to spot recurrence is a big plus, as well as having had a pathology report, including decipher testing, on the whole gland. Oh, and not needing to worry about RT side effects showing up over the next few years, also a plus.
Had prostate removed 5years ago. Cancer came back. Taking radiation now 33 of them.
I wonder if Dr Scholz' opinion is the same about surgery with the newer robotic surgeries?
After radiation treatment my husbands urgency to urinate is frequent, any suggestions?
Thank you for these great videos and insight into prostate cancer. I was wondering what I can expect my PSA to return to post-radio therapy in 2019? It has recently climbed to 1.1 fairly quickly, is this normal.
@jys160 My husband is Gleason 8 & we are in the process of meeting with various doctors. I've been doing the research-info gathering, & it is common to have a slight jump after either surgery or radiation, which will then subside over the course of 4 to 6 months. Dr. Scholz talks about this in a RUclips titled "Understanding #ProstateCancer Prognosis:" it's called the PSA nater, which is "how low the PSA drops 4 to 6 months after the initial treatment." He says if by that time it is less than .1, the 10 year survival rates are 85 to 90%. Hope this helps! We are still trying to determine the best option for a 72 year old, biopsy 2 cores Gleason 8 (4+4) and 3 of Gleason 7 (3+4), no spread outside the prostate gland (thanks to the PSMA PET scan for that good news), but a strong family history. We are also getting a 2nd opinion from Mayo, so we can compare recommendations. Lots to assess!
Can you discuss the new "Tulsa - Pro" treatment. I hear it is revolutionary.
Here is our latest video on Tulsa Pro: ruclips.net/video/TjdV5qAEbdA/видео.htmlsi=_t1ruf7DavWEiQut
I think there have been few studies on ASIAN Diets and Prostate cancer . All have been positive I recall . Reducing animal protein and massively increasing vegetable intake can only be a good thing for other reasons too
@dinkohrvat344
What about Chiclen?
7:35 Modern Radiation
Which radiation is best if prostate cancer is located Near the urethra?
Hi. Thank you for all these amazing videos. I have a question. My husband is status post radical prostatectomy 14 month ago. Gleason 3+4. Positive PSMA at initial dx only in the prostate gland.
Pathology stage pT3b Seminal vesicle invasion, pN1. P SA remained 0.04 until last Sept. it went up to 0.1, now PSA 0.27. PMSA scan negative. Question XRT+hormone treatment now? Or XRT now, and hormone tx if PSA remains elevated after XRT? Thank you
I have a friend who was in the same boat. He ended up getting just the proton beam radiation post surgery (about 30 visits), not the hormone treatment. His PSA went down and has remained low.
I am 67, and in otherwise great health, and have a PSA of 20 but will probably just let the cancer take me as none of the treatment options seem enticing. This is from someone who went through two hip replacement surgeries.
I was 66 when I received my prostate cancer diagnosis. After doing extensive background research I ruled out surgery and settled on Proton Radiation. I am very happy I chose this mode of treatment. I have no side effects . I had 5 days of treatment at Mayo Clinic in Rochester, Minnesota…. 5 treatments as opposed to 40 treatments.
Please get treated, Death by Cancer is not the way to go…. Reconsider…..
William A Feldner DDS
While radiation is no joke, it's very tolerable. IMRT and similar methods are painless though some short term side effects may be annoying, like fatigue, having to pee a lot, and maybe some bowel issues, but these go away within maybe 2 or 3 weeks after treatments are over.
@@williamfeldner9356 Wish all of us were fortunate enough to be able to go to places like Mayo etc. Thousands of us cannot.
I'm 66 and also have a 20+ PSA and am also going to take my chances. The ExoDx test gives me confidence on my path as it shows me to be in the safe zone. To each his own....
@@williamfeldner9356 Sadly proton is not available for Canadians.
Given the recent updated data from British Columbia published in the Journal of Urology (July 2024) showing a 10% risk for the development of secondary malignancies at 20 years post brachytherapy, is radiation therapy still a good treatment option for healthy men under the age of 70?
The doctor is against surgery, I’m glad I did my surgery.
He is neither a surgeon nor a radiation oncologist. He is a medical oncologist, so his opinions are as objective as you will find. Surgery works, but it is complex and has more long term side effects on average compared to modern radiation. It's not bias to tell the truth.
Dr,schol and Alex my problem is we have no capacity for financial ability to support all procedures what the oncologist requesteng all ! Can yuo help us ? We need financial support from your center of institution if theres we from phillippines island thks more!
Thank you for this video.
My hubbie will be starting radiation.
Great info.
I just want someone to answer the question about ADT. With Gleason 8 they are saying two years of ADT.
Because its high grade aggressive, most likely to escape and have
Is IMRT plus a brachytherapy ‘boost’ considered sufficient for 3+4 that may have ECE?
Or is ADT always part of that radiation equation?
It seems ADT is so disliked that it may turn intermediate risk patients to surgery (of course, if positive margins occur, they may do radiation/ADT in any case but that’s another issue.)
I'm answering my own question because I just came from my radiologist who recommended either SRBT + HDR Brachytherapy or SRBT + 6 Months of Hormone treatments if going the radiation route. His preference seems to be for me to have surgery because I'm relatively young and if it fails I can do radiation (plus possibly hormones) to try to salvage things. My logic of going to radiation directly and avoiding the risks of surgery (especially considering possible ECE - and therefore positive margins - noted on an MRI re-read) to wind up at the same place seemed not to impress him. I told him my youth (I'm 60) was not the issue, the best course of curative treatment to knock out the cancer is the focus. We'll see.
@@robertmonroe3678 Hope you’re doing well. What is ‘ECE? Also which route did you decide upon? Thnx
Are there any different situations with a younger man with an ATM mutation?
Given the choice I would go for radiation and accept some degree of voiding problems rather than impotence following surgery.
It seems that radiation therapy is better than with surgery if the procedure is done earlier
Surgery is one and done why would I do radiation when it takes multiple toxic radiations
Different side effects.
Because it is not one and done - that is a lie
@@poodletalk5608 liar liar pants on fire....both my buds having rising psa, did 45 rounds radiation
Wearing diaper long time .....
When Scholz the trifectomy left problems he avoided mentioning the percent of each problem individually,
I had surgery then 16 months after surgery my PSA was rising had radiation and ADT. I had total incontinence following the radiation. Five months after completing radiation I had and AUS implant that failed due to "erosion of the urethra" as a result of the radiation. The AUS was removed. I am waiting one year from the removal of the AUS before a second attempt of an AUS implant will be put in me. The doctor said in this video .that the damage to the urethra from radiation is always there. Did I misunderstand his comment? The persistent and total incontinence is difficult to live with. Am I making a poor choice to have a second attempt at an AUS implant? The doctor doing the surgery is a world class surgeon whose primary practice is urinary reconstruction for transgender patients. I am told the the cuff will be padded with muscle tissue to prevent a repeat AUS failure. Comments on my situation would be greatly appreciated.