A Medical Oncologist Compares Surgery and Radiation for Prostate Cancer | Mark Scholz, MD | PCRI

In the United States, men newly diagnosed with prostate cancer are usually offered sugery or radiation. Here, medical oncologist, Mark Scholz, MD, explains how radiation has changed over the last 20 years and why he usually recommends radiation to most his patients who need radical treatment due to its favorable side effect profile which includes almost no risk of incontinence.

0:07 Can you provide a brief history of surgery versus radiation for prostate cancer?

3:03 Is it possible to get surgery after radiation?

4:47 How simple or difficult is it to resolve persistent incontinence, should it occur, after radical prostatectomy for prostate cancer?

6:07 What percent of men will have persistent side effects after surgery?

7:11 What percent of radiation patients will have persistent side effects?

8:39 What percent of radiation patients have erectile dysfunction?

11:09 Is surgery or radiation better for higher Gleason scores?

13:14 Can a person have radiation twice if it fails the first time?

13:30 Does radiation have delayed side effects? How does that work?

16:24 Why is surgery so frequently recommended if radiation is effective with a relatively favorable side effect profile in most men?

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The information on the Prostate Cancer Research Institute's YouTube channel is provided with the understanding that the Institute is not engaged in rendering medical advice or recommendation. The information provided in these videos should not replace consultations with qualified health care professionals to meet your individual medical needs.

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[pirouette]

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

[michaelclennan]

Dr Scholz gives the best honest advice. He describes my Surgeons.

[paulbryant]

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 .👏

[rickj]

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!

[muddymarine]

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.

[commonsenseisdead]

@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.

[jetmango]

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

[Ike-]

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.

[Steveo]

What would be great is if we had one website to research all Doctors and better yet it would free to patients.

[Agentandrewfriscojones-swkj]

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

[ericteunissen]

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.

[dwinsemius]

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.

[tomjon]

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.

[sttreacy]

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.

[John-fnj]

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.

[rchizzle]

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.

[Geno]

Wow. Wish I’d seen this in 2013. Dr Scholz absolutely nailed my conversation with my surgeon and how I felt about it.

[davide]

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.

[Vincent]

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.

[mikemahon]

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.