Radiation and Surgery Side Effects for Prostate Cancer | Ask a Prostate Expert, Mark Scholz, MD

Alex asks medical oncologist Mark Scholz, MD to compare the risks of side effects between prostate surgery (radical prostatectomy) and radiation therapy for prostate cancer.

0:05 What is the side effect rate of radical prostatectomy for prostate cancer?

1:14 What percentage of radiation patients will experience negative side effects?

4:19 How permanent are the side effects of radical prostatectomy?

6:32 How often does radiation cause rectal burns? How effective is SpaceOAR for preventing them?

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[robertmizek]

After a positive biopsy with 6 Gleason score I had brachytherapy with Dr. Brian Moran through DuPage Medical near Chicago. Near identical urinary and sexual function afterwards. My urologist was eager to do RP and advised against IBRT and I had to seek out brachytherapy independently. Glad I did and I suggest that anyone needing treatment for PC consider other options.

[snozcocram]

I went into my diagnoses, Gleason 8 without the benefit of a medical education. I was lucky when I reached out to friends who sent me to doctors who had proven results without surgery. I also fell upon a urologist (head of robotics surgery) who said “we want a medical victory not an emotional one”. After 20 sessions of Kylipso guided radiation and Lupron and Abiraterone acetate my PSA went from 30.2 to <0.03.
I’m not completely sure what this means honestly, but the oncologists are happy with the results.
The side effects are worse than words can say. Not having testosterone is a nightmare. I go one day at a time looking forward hoping this struggle with these hormone, steroid laced medications won’t get worse. All in a days work, right fellas?

[scottj]

Thank you so much for the information you provide. Your channel rocks! I just finished my radiation. Very hopeful for a long term positive outcome.

[mperloe]

This explains why it is so important for people to get multiple opinions from a variety of physician many of whom do not specialize in gu oncology.

[martinthompson]

Thank you both for your useful knowledgeable discussions answering many of the questions we have .

[michaelrose]

This is another great explanation. Thanks.

[danielkoher]

1:29 You’ve got that right I NEVER had ANY of the side effects of radiation ☢️ explained.
Let alone discussed with me.
It’s a horrible procedure, I was given a stricture when I was catheterized.
The biopsy has no sedation.
I was scolded by a RN the entire time while having 13 pieces torn off of my prostate.
Not to mention radium seed implantation, which is totally emasculating.
I got rectal proctitis from radium seed leakage.
Which resembled a heavy flow period.
I had meatal dilation, which is having a shaving blade that’s inserted into the urethra and opens filleting away tissue on it’s way out.
All these procedures are done without sedation for reasons I will never understand.
Other than being told by a female RN it’s much more painful when coming out of sedation from these procedures.
Seriously I would rather be given a choice of my pain induction.
I have been a heavy sweater since childhood, I feel like I am in womanspause all the time.
I never wear a coat, nor as much as a jacket in the dead of winter.
I scrape ice without gloves or a jacket, ‘yes I get that hot.’
Only now it’s like I am microwaved from within outward.
Everyone should begin a familial cancer list.
Trust me you will be amazed at how much there is, as I was.
I now found a competent urologist that actually deals with me in person.
I appreciate that, I’m a patient that enjoys conversation, as well as being communicated with.
I now have night sweats, no ejaculation, I have to use Flomax.
After the painful dilation left me unable to urinate in a steady stream.
I have to sit like a woman to have control of my flow.
With the use of Flomax I am capable of making it to the restroom.
It’s embarrassing to be mid~50s when I continuously pleaded with my PCP.
I was constantly told it wasn’t necessary, after several years.
He finally ordered a PSA drawn, which came back positive.
That I should be checked because my Dad had prostate cancer.
(In all seriousness I hope my post isn’t deleted.)
I would have never had this surgery done, possibly the reason it’s never discussed.

[josefperry]

how about secondary cancers of the bladder and rectum as a result of radiation?

[jim]

You guys are absolutely wonderful thank you so much for what you're doing.

[rolfeliason]

I am SO grateful for these videos from PCRI and Dr. Scholz! This video in particular has given me further solace that ADT and high dose brachytherapy, followed by low dose external radiation is definitely the correct direction for me. Especially with perinueral and periprostatic invasion, Gleason 3+4 and T-3 upper end intermediate ratings. With that status, the real question is whether surgery would "get it all". Without this type of education, where would I be? In the camp of the unaware. THANK YOU for helping me on this journey.

[keithwilson]

You should really mention the possibility of patients suffering lymphedema after surgery, as I learned after mine. When so many lymph nodes are removed in the central thoracic area, there is the small chance that the lymphatic system becomes compromised in the lower extremities. I’m upset that this risk wasn’t explained to me prior to the path I chose, not that it would have changed my decision, but it would have possibly steered me in the direction of radiation. I now have mild periods of swelling in one leg, such that I can’t put on certain boots or shoes comfortably, and sandals are discouraged altogether with this condition, which is permanent and supposedly gets worse over time.

[MrGuitar]

Excellent information as always. Thank you both! 😊

[benth]

When you speak of surgery, I am assuming you mean having the prostate removed. Is this correct? I was diagnosed with prostate cancer in August of 2020 and went through "high Dose" 5-day radiation treatment in November. The team at SCRIPPS in San Diego were exemplary in the orderliness of their processes. Now over a year later I am still on Flomax but do have a small amount of ejaculate with my orgasms. My PSA test before the radiation was 11.2 and then within three months of the treatment my PSA went down to 5.29. Four months later it went down to 1.5. I am scheduled for my next PSA within February this year, and will have one every six months until it is apparent that the cancer is not coming back. The worst part was when they put the four Gold Seeds in my prostate so the MRI and other machines could track then lock onto exactly where to aim the treatment. The actual biopsy was not all that uncomfortable if not a Little embarrassing.

[duposflies]

I read all the comments below I wonder why my case is so different? I came to know last week that I have an agressive pc gleason score of 9 but why my psa is so low only 3.8? I am so worried that will spread anytime soon. The expert in the Hospital still discussing what the best treatment they will give me.

[Benb]

I had 20 radiation treatments in May 2022. So far I don’t have any side effects whatsoever. At my first blood test my PSA went down from 5.7 to 1.3. My Radiation Oncologist was very happy with that result.
Will side effects possibly develop down the track or I will I stay the same?

Cheers
Ben

[bluenose]

I was told that after radiation you could not have surgery. I had surgery because i just wanted it out

[hitechrr]

I had no symptoms from my cancer. After 26 rounds of radiation, I have ED and rectal bleeding for the last 3 years.

[offgridseven]

Does the patient feel any side effects after radiation, or is it just like getting an x-ray, where you feel nothing afterwards?

[gavinfoster]

Thanks Again. Great information!
Melbourne Australia

[rogeruk]

Ive heard that with radiotherapy men can get secondary cancers a few years later, is that common? Thank you