When it comes to surgery, you know, you mentioned
the side effects of those—are those going to happen to every man who has surgery?
What is the percentage likelihood of a man receiving those side effects?
There are some men that will come through surgery relatively unscathed. A certain percentage of
men will have the operation, of course, right after the surgery they have problems but they
slowly heal over a period of weeks or months, and then other than the fact that there's,
you know, dry orgasms—the prostate makes semen and so they don't create any semen when they
have an orgasm—they could emerge relatively normal. Unfortunately, when you query people
with surveys after surgery—say wait a year, wait two years until they have time to heal—only
about five percent of men say that it's like it was before and that's that's a pretty dreadful
statistic. If you compare that to radiation statistics, as many as half of men will describe
their sex life and their urinary function as identical to what it was like before treatment. So
radiation is not perfect, but the outcomes are certainly a lot better than they are with surgery.
So, that's actually interesting that you bring that up because I think a lot of men when it
comes to surgery versus radiation they talk about, you know, with surgery you know the side effects
right away, but with radiation you don't because it can be a year or two out. But in reality,
with 95 percent of men kind of getting these results it seems like surgery is not really the
best case considering radiation, even if it is one or two years out, the percentage likelihood
seems far less of having side effects. So can you talk about what is that percentage likelihood?
So yeah, of course, you have to compare same-age patients. Patients who have surgery oftentimes
are younger and therefore they're going to have better outcomes because of their youthfulness,
but if you compare same age patients— And you also have to compare the quality of the surgeon
and the quality of the radiation therapist. So let's assume the very highest quality of
surgeon and the very highest quality of radiation therapist—numbers
degenerate quickly with older people and with poor quality doctors—but
if you have a relatively young person say around 55 or 60 who's got good pre-treatment functioning
goes to a superstar surgeon, world famous surgeon, or a really qualified radiation therapist,
the incidence of of leaking urine afterwards for these people is going to be probably around
five percent five to seven percent with surgery, and it'll be less than one percent with radiation.
As many as twenty percent of men ejaculate urine afterwards, unfortunately. This isn't talked about
too much it's a phenomena called climacturia, not a whole lot you can do about it, and that
doesn't occur with radiation; it does occur with surgery. The problems with impotence are
probably twice as high with surgery as they are with radiation. You're looking at maybe
20-25% incidence of erectile dysfunction that doesn't respond to Viagra in the radiation group
and more like you know 35-40% risk of erectile dysfunction in the surgery group,
and so it's just on pretty much every metric the outcomes with radiation are better.
There are sometimes issues raised about well if treatment fails you can do
radiation after surgery but you can't do surgery after radiation, and this was an argument that was
valid 15, 20 years ago when the radiation was really rotten and a lot of men were relapsing.
Modern radiation — relapses within the prostate itself are incredibly rare and if they happen—I
almost never see that—but if they happen, then we do something like laser
cryotherapy or HI-FU. We don't worry about certain doing surgery, and so it's
hard to find an argument to do surgery. If you could know that you were going to be the—say—one
out of three men that has a really nice result, surgery would be fine, but it's a crapshoot. You
don't really know if you're going to be in the good one-third or the bad two-thirds.
So, you know, you mentioned climacturia and these different side effects and you said that a lot of
times there's not much they can do, so is this on a permanent basis? Does it ever go away or is it
just for the rest of the man's life? I mean, a 65 year old getting something like ejaculating
urine for the rest of his life—let's say he you know lives another 30 years, that's awful.
It is and I don't know why it isn't talked about more. Another thing that doesn't come up in these
discussions is the recovery period after surgery. All the men are impotent and then they slowly
recover over a period of 3, 6, 9, 12, 15 months. During that time, the absence of getting erections
can cause permanent atrophy and so anyone that's contemplating doing surgery should
have a discussion before the operation with his urologist about arranging to get penile injections
with the prostaglandins to create artificial erections while you're waiting for the recovery
period so that atrophy doesn't set in, and this conversation never seems to come up I think as
the surgeons know if you start describing to men that you're going to have to take injections
in your penis right after the operation, that you may need to do that for 3,
6, 12 months to give you the self the best chance to recover, who would do surgery?
But, you know, it seems like the whole idea is to try and slide people into surgery as
quickly as possible and as you know I'm not a radiation doctor nor a surgeon, I just see
this lack of of careful analysis that leads people into making quick decisions for surgery
when I think if they were better informed they'd be picking some form of radiation.
When in regards to using making sure the penis has use after, you know,
surgery, would that be the same in radiation?
People who undergo radiation unless they're getting hormone treatment with the radiation
are not going to experience immediate problems with erectile dysfunction. A percentage of
men will develop erectile dysfunction over a period of one to two years after the radiation
and at that point, people try Viagra and Cialis if that's ineffective then
the fallback position is injection therapy. Obviously, not a very desirable thing but
only a small percentage of men are going to end up in that situation when they have radiation.
So I know a major fear I hear quite often is the concept of radiation burns to the rectum. So,
first of all, can you describe that and then also talk about the advent of spaceOAR because
I think that it's being you know used across the nation now and it's obviously helped many men.
Yeah that was one of the scary things that would
happen in skillfully administered radiation perhaps less than five percent would develop
non-healing wounds in their rectum — a pretty dreadful problem called proctitis.
That's essentially been eliminated with the advent of a gel that they can squirt between
the prostate and the rectal wall pushing it out of the radiation field. So,
I consider that routine now and so problems with the rectal burns have been essentially eliminated.
Hey everyone, it's Alex and Hunter from the PCRI. He has his own Instagram now:
Sirhunterthedal, so go ahead and check him out for prostate cancer information and men's health.
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