So, we've had some patients who have watched our videos and they've heard us say that, you know,
radiation is much safer now compared to how it used to be. They're wondering is that the same
across the board for IMRT, external beam, you know, brachytherapy? [Is] everything much safer?
The beam radiation technology has been immensely enhanced in the last 10, 15 years,
so that's certainly true. Brachytherapy as we know it today has been evolving,
but the essence of what they've been doing for brachytherapy has been pretty stable for
15 to 20 years now. So, I think it's nice to highlight how much different radiation is.
In people in my age group, and I'm sort of the average age of a prostate cancer patient,
we have really bad memories of people going through different types of radiation not only
for prostate but for other types of cancers back in the 70s, 80s, and 90s and radiation therapists
many times weren't accomplishing much and many times they were causing more
harm than good. You could say the same thing about chemotherapy back then.
The whole industry was in its baby stages. I mean we can say, thankfully, that they went through
those stages so we've arrived to where we are today, but the radiation does have a potential for
protracted, lingering, irreversible side effects, and a lot of that was seen back in the 80s, 90s,
even right after the turn of the millennium because the radiation that was available back
then was unfocused, and so they would give the dose of radiation at what the surrounding tissues
and organs would tolerate and it turned out that they had to reduce the dose and so a lot of times
radiation didn't get the job done but would damage the surrounding organs, so you get the bad without
the good. You know, there was a lot of radiation being done for prostate cancer back then,
elderly men that couldn't have surgery and who were greatly harmed and are suffering some of
them even to this day, sadly. The difference with modern beam radiation is that they
can target so accurately that they're only hitting the prostate; they're not hitting the bladder;
they're not hitting the rectum anymore, and that gives them the freedom to crank the dose up
to doses adequate to truly sterilize the cancer. So, the problem of the cancer coming back
in the gland, like used to happen so frequently, is quite unusual these days. Thus, rendering
these arguments from the surgeons who are saying, "Well do surgery first because you can always do
radiation later, but if you do radiation first you can't do surgery. You want to have a backup plan."
That was actually a sensible argument 20 years ago when the radiation was so terrible,
but it doesn't have much meaning in today's marketplace because most people that have
modern radiation will be cured by the radiation; they won't need a backup plan. To tell the truth,
you wouldn't want to do surgery under any circumstances; there's a lot of other
better backup plans if one is needed in that rare situation— laser, cryotherapy, HI-FU,
all these, even salvage radiation for radiation, so that argument has really
been rendered completely outdated, but we still hear it a lot, I think, because there's
fewer and fewer arguments to do surgery with the much enhanced radiation technology we have;
it's so much more accurate and decidedly less toxic than surgery.
Awareness needs to be raised about how different modern radiation is from what we had 10 years ago.
So, in regards to side effects, I know that one thing patients have been concerned about is the
concept of possibly side effects showing up a year or two years later when it comes to radiation. So,
even though radiation the accuracy has improved, are there things that
they can do to mitigate the radiation side effects, you know two years out? And how do
they watch for that? And is there any sort of monitoring that they should do in the meantime?
Radiation side effects that people are talking about are the damaged surrounding organs like
the rectum and the bladder. So, with the modern methodologies or with brachytherapy—and we've been
doing brachytherapy for over 20 years—if you don't radiate the bladder in the rectum, there is no
delayed effect on the bladder and the rectum. If you do radiate them, then you can develop delayed
problems with bleeding, non-healing wounds, and it can be a messy situation. The long-term side
effects that people are so frightened of are mostly due to the fact that the technology
that was previously available couldn't target the prostate itself and avoid the surrounding
organs. The prostate itself is quite forgiving. You can give large amounts of radiation and the
men don't need their prostate and so no great harm is caused. The urethra, the sensitive
passageway that goes through the prostate from the bladder out the penis for the urine to pass out,
is subject to damage with radiation. Doctors are very careful to try and reduce dose to the
urethra when they radiate the prostate but that would be the one area where you would
be concerned about long-term side effects, and my experience with modern types of radiation is
that maybe two to three percent of men can develop delayed problems with irritation,
bleeding; I haven't seen the issues of scarring, so-called stricture,
I think that modern radiation therapists are getting good at keeping dose off the urethra, but
in theory that is possible where scarring and even blockage of the urethra can occur.
This occurs of course with surgery in a couple percentage points of patients that undergo surgery
and in theory it can happen with radiation as well. It's thankfully very rare at least
when you're very selective about the radiation therapist that you pick to do your treatment.
When it comes to urinary constriction,
is there any sort of treatments that will be effective in opening up the passageway again?
Well, there's symptoms, irritation, and there are medications for that,
and you wait, and then and slowly over time it can improve, but surgical strictures are very tricky
and patients that are facing that rare but serious complication probably need to
search out one of the top surgeons in the world because if they're trying to
correct it surgically it is possible that in the process of healing that a new scar will form,
and you get on this merry-go-round of operating and then having the scar tissue come back,
and so there are certain centers of excellence that specialize in trying to correct this and
it is correctable with surgery, but it's it's a very difficult operation.
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