Historically radiation side effects and cure rates were not comparable to what surgery could achieve. However, with breakthroughs in radiation, computerized beam radiation now rivals surgery for cure rates and minimizes the risk of side effects.

This episode of PROSTATE PROS compares and contrasts the three types of computerized beam radiation: IMRT, IMPT, and SBRT. The episode also covers how to prevent and manage side effects of radiation therapy.

his episode explores and defines brachytherapy from the difference between HDR (temporary) and LDR (permanent) seeds, to who is eligible and why seeds might be an appealing treatment choice.

Gleason 6 prostate cancer may sound like a dangerous type of prostate cancer. Luckily that is not the case, Gleason 6 prostate cancer does not spread. This means men with Gleason 6 can be safely monitored through active surveillance and avoid the side effects that come with treatment.

Active surveillance is not synonymous with watchful waiting, and it no longer means periodic random biopsy. Learn the active surveillance protocol and discover a Gleason 6 lifestyle.

Get the inside scoop on prostate size. Learn about BPH diagnosis, treatments, and potential implications for prostate cancer. If your last PSA test come back elevated or you’re having symptoms such as frequent, urgent, urination一are you now convinced you have prostate cancer?

Before you get too worked up, listen to this episode. Join us and hear a few answers from Dr. Richard Lam this month on PROSTATE PROS.

Your problem may simply be a large prostate!

Liz: [00:00] We’re going to talk about what qualifies as a big prostate, the implications of big prostates and how they can be managed. Hey, Dr. Lam, what’s the biggest prostate size you’ve ever seen?

Dr. Scholz: [00:20] Welcome to the PROSTATE PROS podcast. We’re guiding you to treatment success and avoiding prostate cancer pitfalls. I’m your host, Dr. Mark Scholz here with my cohost Liz Graves.

Dr. Lam: [00:12] 300 cc’s, which is 10 fluid ounces.

Liz: [00:32] Okay, let’s expand a little more on the 300 cc prostate. Can you give me some insight onto why it was that big?

Dr. Lam: [00:40] Prostate size varies but everyone’s prostate grows as they age and some people just grow to these enormous sizes, whether or not we need to do anything about it depends on their symptoms and their ability to empty their bladder.

Liz: [01:00] So I’m assuming patients will come in with high PSA and maybe some urinary symptoms. What kind of tests do you conduct to figure out if they have big prostates?

Dr. Lam: [01:09] So one could get a good idea about the size of the prostate with a simple digital rectal prostate exam. If one wants to measure, get a better measurement of the true gland volume one could have the patient undergo a color Doppler ultrasound or a multiparametric MRI.

Liz: [01:28] I know it varies patient to patient, but what’s your typical approach or recommendation for men with BPH?

Dr. Lam: [01:35] There’s two approaches. One is to improve one’s urinary symptoms and that involves taking medications to help a patient empty his bladder better. The medications could include alpha blockers such as Flomax, Alfuzosin, or Rapaflo and also low dose, daily Cialis also helps people urinate better. Sometimes if despite these medications, the patient still has urinary problems, then we use medicines such as Proscar and Avodart to shrink the prostate.

Liz: [02:10] Thank you for the insight, Dr. Lam. Dr. Scholz, how big is a big prostate?

Dr. Scholz: [02:18] Prostates, as you know, are hiding down in the pelvis. And many men will go to their graves and never know what size prostate they have, but when problems occur, some men will go through an ultrasound procedure and they’ll measure the gland size and that’s described in cc’s, cubic centimeters, and that average for patients that come see me who are in their sixties is around 40 cubic centimeters. So a big prostate would be something 50 and a higher or as high as a 150 cc’s, quite, quite a bit larger than normal.

Liz: [02:57] So prostates grow with age. Do men need to be concerned if they have a large prostate?

Dr. Scholz: [03:04] Yeah, it seems like kind of a basic assumption that having a big prostate is a bad thing. And I think that prostates get maligned for every urinary problem that seems to develop with age. In my experience, only a minority of these urinary problems are actually due to the enlarged prostate. There’s other problems like hyperirritable bladders, prostatitis and other factors that we don’t really understand well that can cause men to have problems with getting up at night or running to the bathroom frequently, or a slow urinary stream. Well, a large prostate can contribute, it’s oftentimes not the main problem.

Liz: [03:44] So a lot of the urinary symptoms th

Radical prostatectomy is one of the most popular treatments for prostate cancer. Surgery is broadcasted all over the media as the gold standard of prostate cancer treatment. But does surgery really live up to the hype?

This episode of PROSTATE PROS covers the “Just Cut it Out!” mentality, the surgery versus radiation debate, and the side effects of the radical prostatectomy.

Dr. Scholz: Welcome to the PROSTATE PROS podcast. We’re guiding you to treatment success and avoiding prostate cancer pitfalls. I’m your host, Dr. Mark Scholz, here with my co-host Liz Graves.

Liz: Today on PROSTATE PROS, we’re addressing the desire to just cut the cancer out.

[Misc. Sound Clips]

Dr. Scholz: Why is surgery so popular for prostate cancer? The prostate cancer landscape is unusual because prostate cancer is the only cancer where surgeons are in the driver’s seat. ALl the other cancers: lung cancer, colon cancer, brain cancers, all these other types of cancers are supervised by cancer experts called medical oncologists. Why is prostate cancer such a backwards industry? 40, 50 years ago, surgeons were running all the cancers, but as the world became more complex and technology progressed, one by one the medical oncologists started taking over the management and only referring speciality cases for surgery. The prostate cancer world is the only exception to this procedure and to this day, urologists, who are surgeons are in the driver’s seat and controlling the prostate cancer decision making process.

Liz: Yes, we’ve talked about that before, how urologists have this leadership in the prostate cancer world and so a lot of men get surgery because that’s the only advice they are hearing.

Dr. Scholz: It’s not really apparent to patients when they’re thrown into a diagnosis, the urologist is the one that did the biopsy and he’s the one sharing the bad news that prostate cancer has been diagnosed. So it seems very natural and a smooth transition to assume he will continue in the leadership position. It’s obvious why surgery is so popular. Is there any problem with that? I mean, surgery seem like a natural solution for just about any type of cancer. The problem is the location of the prostate is in such a sensitive area in the body and it’s nearly impossible for the surgeon to finesse the prostate out without causing some collateral damage to urinary or sexual function. Historically, that’s what you were stuck with. The other options like radiation were very antiquated, caused a lot of side effects, had poor cure rates. But as technology has advanced over the last 15 years, radiation therapy, in my professional opinion, has become much better than surgery. I suppose we shouldn’t be surprised that the urologists have been a little slow to adopt this new policy because it involved referring their patients to a specialist, and they, therefore lose the opportunity to practice their own craft.

Liz: Yeah, to someone who isn’t in the medical profession, it makes sense to just cut the cancer out. It seems like a one time procedure: you go in, you get it done, and it’s gone.

Dr. Scholz: Yeah, and about one third of the men that have operations have a fairly good result. They’ll be able to get erections, they won’t be leaking urine, but those sorts of odds are terrible. Imagine that, two-thirds of men either have the cancer come back or they’re having a terrible problem with urinary leakage or they’ve lost their ability to get an erection. It’s not a satisfying outcome at all. I’m glad we’re having this conversation and raising awareness about the fact that other newer, better options such as many of the radiation therapy options are really far superior. Assuming of course, you go to a center of excellence where they have state of the art equipment.

Liz: Ok, so surgery hypothetically removes the cancer. But then you have to deal with all these problems that are in

PROSTATE PROS invites Alex Scholz, CEO of the Prostate Cancer Research Institute (PCRI), to discuss how the PCRI helps educate men and caregivers. Scholz gives us a look inside the PCRI’s annual and mid-year patient conferences, the PCRI helpline, and all the ways they provide free, expert-reviewed information on all aspects of prostate cancer.

ABOUT THE PCRI: The Prostate Cancer Research Institute’s mission is to improve the quality of prostate cancer patients’ and caregivers’ lives by supporting research and disseminating information that educates and empowers patients, families, and the medical community.

Register for the 2019 Patient Conference: pcri.org

Dr. Scholz: Welcome to PROSTATE PROS podcast we’re guiding you to treatment success and avoiding prostate cancer pitfalls. I’m your host, Dr. Mark Scholz, here with my co host, Liz and today’s guest, Alex Scholz.

Alex: Thank you it’s really great to be here.

Liz: Dr. Scholz, can we get some insight first into what the PCRI is, since you are one of the original co-founders?

Dr. Scholz: Yeah the PCRI was founded by Dr. Steven Strum and myself. Over 20 years ago to help patients learn about prostate cancer. As everyone has learned already, prostate cancer is very complex. And it’s a strange throwback, the world of prostate cancer, sort of a backwards industry because it is the only type of cancer where surgeons are operating in the primary care position. So, Dr. Strum and I, being medical oncologists, thought early on that it would be very helpful to provide education resources for patients as they are reflecting on all their many different treatment options. Our first employee was Harry Pinchot, called “Helpline Harry.” Harry would answer phone calls from all over the country from men who are interested in selecting their different treatment options.

[Misc. Sound Clip]

Liz: We’ve talked a little bit about the support men get at the PCRI conferences. I wanted to follow up on that with Alex Scholz who is the CEO of the PCRI. Welcome, Alex, we are glad to have you today.

Alex: Thank you so much for having me.

Liz: Alex, I’d love to hear a little bit more about the helpline, but the 2019 Patient conference is coming up fast, so can we talk a little bit about that first?

Alex: Absolutely. September 6th, 7th, and 8th we have the prostate cancer patient conference and there’s a lot of conferences out there on prostate cancer but what sets this conference apart is that it is absolutely, 100% designed with the patient and the caregiver in mind. Our job is to make sure their questions get answered and there is a lot of information in prostate cancer around lifestyle, side effects, and treatment and we want to make sure that they get to have their questions answered by experts. So from all over the world we have experts coming in those types of treatments, in those types of situations to guide these patients to the right choices for themselves.

Liz: So, I went to the mid-year conference in March and it was my first experience with PCRI and I got to sit in on a couple of talks. I was getting the answers to questions I didn’t really know I had. And a lot of those I didn’t know a lot about where I didn’t know a lot about testosterone and hormone therapy. So, I’m curious in the annual conference if there will be more on that or what topics are you covering?

Alex: Yes, there will. So, our job at the September conference, you mentioned the mid-year that’s in March. So, we have two conferences every year, one in the spring and one in the fall. And the fall conference is really designed to cover all topics of prostate cancer, so we will be covering testosterone, hormone therapy side effects, we’ll be covering advanced treatments, you know active surveillance with Gleason 6, there is no aspect of prostate cancer that isn’t covered. And how that is designed is through our staging system. The audien

Whether you’ve just found out you have prostate cancer, or have been managing your prostate cancer for years, it can be a frightening, confusing experience. Who to turn to – which type of doctor should you see? How do you share with loved ones? Where can you find support and get unbiased information?

On this episode of PROSTATE PROS Dr. Scholz answers these common questions and guides listeners through what to consider when choosing a treatment team. The doctors, family, and support you have in your circle are major players in your prostate cancer journey. Set yourself up for treatment success by assembling a team that has your best interest at heart.

Dr. Scholz: Welcome to the PROSTATE PROS podcast, I’m Dr. Mark Scholz, here with my co host, Liz. We want to help guide men to treatment success so that they can become their own expert.

[Misc. Sound Clips]

Liz: OK, Dr. Scholz, this is a big topic.

Dr. Scholz: The idea of assembling an optimal treatment team.

Liz: Can we start with which kind of doctors should help?

Dr. Scholz: Yeah, that’s the easiest part. We only have a limited number of players. Everyone knows the urologist, of course, the surgeon who’s been managing this field now for 100 years. And then, in addition, just to summarize this quickly, we have radiation therapists, we have radiologists, those are the people that take the pictures, we have pathologists, the ones that look at biopsies. But that’s not the whole team. We also have family members, support groups, we have people that think they’ve been through this and they have all the answers. There’s a lot of people who get involved in this process.

Liz: Okay, so how should a new patient approach weeding out which opinions they should listen to?

Dr. Scholz: I think that’s a wonderful question because many times they don’t have all the choices you think they should. Prostate cancer is sort of a backwards industry. It’s the only type of cancer that surgeons are still in the primary care position. People say “How can this be?” All the other hundred cancers out there: breast cancer, colon cancer, lung cancer, brain cancer. They are all managed by medical oncologists, specially trained doctors that only do cancer. Urology is sort of a throwback and this is a result of a time, 40 years ago, when all cancers were managed by surgeons. There was no other treatment back then. But technology has evolved so quickly now that as we see it in 2019, prostate cancer is the only one where the surgeons are still in control. Does that mean that you have to go to a surgeon for your care? No, not necessarily. The reason that surgeons take over care is because they are the ones that do the initial biopsy. After doing the biopsy, they’re the one who have to tell the patient whether they have cancer or not. People should be aware that centers are springing up all over the country that use targeted MRI biopsies. It is possible to be evaluated now, in this modern era, for a biopsy without seeing a urologist. Who’s going to take care of you in that scenario? Anybody that you choose. You can choose a medical oncologist, a radiation therapist, or a urologist. And of course a bottom line issue will be how much experience do they have treating prostate cancer.

Liz: So, in choosing a doctor, is it important that patients get second opinions to avoid bias?

Dr. Scholz: Absolutely. The issue of course, is that most patients are going to be diagnosed by a urologist. They’ll have undergone a random biopsy and they are going to be told in many cases that surgery is the best option. Urologists are surgeons. Patients need to be bold. And they need to be willing to ruffle feathers. Doctors and patients build very intimate relationships with one another. Now, no one wants to hurt anyone’s feelings. And I’ll have to confess as a doctor that some of us have a little bit more ego than they shou

Avoid those prostate cancer pitfalls. We want you to join us – learn from Dr. Scholz and explore with guests about prostate cancer treatment options, what’s new in prostate cancer, and how to be your own prostate cancer expert!