So Dr. Scholz, today we're talking about radiation versus surgery and the reason I'm bringing this
topic up again on our channel is because we do have many patients who are newly diagnosed that
have found us and really there's this massive debate between the two, and basically because
it seems like surgery is the first option they're being given as soon as they go to
a urologist and get that biopsy done. So, first of all, I guess my first question is—really—why
is surgery the first procedure that's pushed on a man as far as treatments go?
Why is there — like radiation's not even a concept or any other treatments for that matter?
Well, it has to do with the way medicine breaks down you have
these different specialties. People are familiar with obstetricians and psychiatrists and family
practitioners and they may not have heard that there's a specialty that works exclusively on the
genitourinary tract called urologists and what sets them apart is they're trained primarily
as surgeons and they've been in this role since the early 1900s, and surgery for many many years
was the only effective treatment for cancers, and so it was really not discussed, "should you have
surgery or not?" it's cancer, you cut it out, and so this policy I think was quite successful
and appropriate up to around the tinge of the millennium and there wasn't a good option because
even the best surgeons leave men incontinent and impotent all too frequently—not always, but
with a high degree of likelihood, but because it was cancer and there were no other options
there wasn't much discussion. People felt you had to cut it out and and that was the way
all the training was set up and continues to be set up. What's changed, of course, is the advent
of all the new computerized technology that allows pinpoint radiation as an alternative.
Radiation back in the 1990s was scary bad and I'd liken it to like a spray can—you just spray
some radiation around and and the surrounding structures—the bladder, the rectum—would get burned
and that could end up creating permanent problems for which there were no solutions,
but now with the advent of better targeting, the radiation therapists—in my opinion—have surpassed
the surgeons in the ability to cure the disease and to avoid some of these dreadful side effects
(leaking urine, impotence) that are now more common with surgery than they are with radiation.
Overall long-term cure rates with surgery versus radiation—can you
speak to that? Because I know a lot of men who are in this place where they're
deciding between the two. That's really the end game that they want to look at.
As we break prostate cancer into low, intermediate, and high-risk, so if you
look at the intermediate group, the cure rates are going to be the same and the cure rates are going
to be very very excellent with either approach. With the high-risk patients it's indisputable that
the cure rates are far better with radiation plus hormones than they are with surgery
and the surgical survival rates are probably almost as good as radiation plus hormone therapy,
but you'll find in the studies that that usually incorporates doing some radiation
after the surgery. So, the men have the surgery; they start to relapse; they get radiated,
or they have the surgery and things don't look good and they radiate them right away, and these
individuals are getting two treatments—radiation plus surgery—with all the attendant side effects
rather than simply doing radiation from the get-go. So, the cure rates are not that
different. The very best cure rates are being achieved with radioactive seed implants—either
permanent or temporary ones—and that would be the way I would go with a high-risk patient.
Can you speak to some of the studies that are comparing surgery versus radiation?
Well, there's a number of studies that have looked at this and the the best randomized perspective
study was where they looked at just beam radiation alone with hormones and beam radiation with
hormones with seed implant added, and at nine years the cure rates were 20 percent better when
you added the seed implant which makes sense because the doctors can safely give a higher
dose of radiation in the prostate where you want the radiation to be
and the higher the dose, the better the cure rates.
So, it sounds like the major takeaways are really that, you know, first of all I'd like
to discuss the fact that you really have to find experts in each field in order to treat you. The
fact who's doing the surgery or who's doing the radiation outside of everything else is a major
thought process that I think patients need to go into because, you know, not everybody has access
to top surgeons and a lot of times they're seeing a urologist where that's going to be the guy that
does the surgery and it's just the guy who did the random needle biopsy and, you know, it's not
from some major institution who's the head of the department and it's happening all over the U.S.,
all over the world, that's very frustrating obviously for us because, you know, we deal with
the side effects of all of that and talking to men on helpline who are trying to get help for all
these issues, and even in the radiation spectrum obviously you want to do your research about
doing that, but I would say to all the men who are considering surgery versus radiation I know a lot
of you have been been pushed by your urologist and maybe family members, "It's cancer, get it out,"
but I would definitely tell you to take your time, do your research, look at the statistics,
and really think about the quality of life that you want at the end of this. We think it's very
important here at PCRI that your quality of life matters and we want you to remember that
when you're choosing these treatments. You have time; prostate cancer is still slow growing,
and we just think that if you need help you should call us, you should do your research,
look online, talk to other people, and think about the outcome because as Dr. Scholz has just stated,
there are a lot of side effects to consider and we definitely want to help you.
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.
Do you like it? Yes. Say, "Come follow me," and don't forget to subscribe to
our YouTube channel. We come out with new prostate cancer videos every week.