Radiation and Hormone Therapy | Prostate Cancer | Mark Scholz, MD | PCRI

In this video, PCRI's Alex asks Mark Scholz, MD, questions from our KZbin comments about radiation and hormone therapy for prostate cancer. Dr. Scholz is a medical oncologist specializing exclusively in prostate cancer.
0:07 What is the risk of developing secondary cancers after radiation for prostate cancer?
2:07 Is the use of SpaceOAR universal among radiation oncologists? What is the SpaceOAR process like?
3:34 Is taking testosterone safe after radiation and hormone therapy?
6:08 How does a man monitor if testosterone is safe? Can any physician order those kinds of blood tests?
6:31 If there is only one or two metastatic sites, should they be treated with radiation?
8:19 Is proton therapy cause fewer side effects (or have less risk of side effects) compared to other forms of radiation?
9:55 What is the optimal treatment for someone with a PSA of 13 and a Gleason 3+4?
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Who we are:
The Prostate Cancer Research Institute (PCRI) is a 501(c)(3) not-for-profit organization that is dedicated to helping you research your treatment options. We understand that you have many questions, and we can help you find the answers that are specific to your case. All of our resources are designed by a multidisciplinary team of advocates and expert physicians, for patients. We believe that by educating yourself about the disease, you will have more productive interactions with your medical professionals and receive better individualized care. Feel free to explore our website at pcri.org or contact our free helpline with any questions that you have at pcri.org/helpline. Our Federal Tax ID # is 95-4617875 and qualifies for maximum charitable gift deductions by individual donors.
The information on the Prostate Cancer Research Institute's KZbin channel is provided with the understanding that the Institute is not engaged in rendering medical advice or recommendation. The information provided in these videos should not replace consultations with qualified health care professionals to meet your individual medical needs.
#ProstateCancer #MarkScholzMD #PCRI

[@bahoonies]

I opted for hormone treatment (casodex for 6 months plus 2 triptorelin injections) with 39 radiation therapy sessions. Now almost 6 years post treatment my PSA is stable at 0.6 and the oncologist has signed into the care of my GP. Most of the side effects of treatment have gone or are manageable except for my strength which has never returned to pre-diagnosis levels. I wouldn't worry except I was a very active veteran racing cyclist used to winning races. Now I can't race as I'm just too weak. Even when cycling with friends who are several years older than me, I can't sustain their pace. I am 70 years old and they are between 5 to 9 years older than me. The oncologist's response was that I'm got older. Yes but so are those I raced against. Not being able to improve despite training and using weights has depressed me. Having seen this video I will ask my GP for a testosterone test and the possibility of testosterone treatment to see if it helps regain my strength. Many thanks for this information. The problem with cancer diagnosis is that it comes as a terrible shock and when the doctor asks if we have any questions, we just don't know exactly what questions we need to ask. Nobody told me I'd still be quite weak after 6 years. And until now I assumed there was nothing I could do about it. Perhaps now there is.

[@ronwise4380]

Plan is to put me on Orgovyx after radiation for 2 years. Really scared about muscle and bone density loss. Quality of life is my big concern. I love riding my bike and don't want to lose the ability. I'm just a casual rider.

[@bahoonies]

@ronwise4380 In the year since I wrote my comment, things have changed for the better. My doctor ran a bank of blood tests just after I commented. My iron level was fine, testosterone was slightly above normal and my thyroid function was normal but my vitamin D level was seriously low, putting me at risk of bone fractures. He put me on vitamin D3 (25000iu twice a week for 2 months and the 7000iu weekly after that). After those first 2 months the change in me was remarkable. My strength improved, my depression completely lifted, and my hair thickened. It had been thinning. Finally, my breathing under stress improved. He tested my vitamin D level 3 months ago. It went from 21 to 82. So I'm way up and no longer at risk. Also, my immune system is stronger and I haven't had as much as a sniffle since I started taking vitamin D3 and I ride my bike regularly. My advice is to get your bloods done. See where your vitamin D level is. If you live in the Northern hemisphere (I'm in Ireland), chances are you aren't getting sufficient vitamin D anyway. Let me know how you get on.

[@ronwise4380]

@@bahoonies Thank you so much for the quick reply. I have been taking D3 for years. Was told I could continue the D3 during radiation, but to stop all the other supplements. Hopefully I will be ahead on this.

[@bahoonies]

@ronwise4380 How much D3 are you taking daily or weekly? I'm now on 4000iu daily. I saw interviews with oncologists who noted that patients with controlled cancer who took the covid vaccine and boosters in some cases had an alarming resurgence of the cancer. They described it as explosive. One of the cancers is kidney cancer which I also had. So I stopped taking the boosters. One senior oncologist, Professor Angus Dalglish, in a long discussion on Dr. John Campbell's youtube channel said that for any patients of his who were taking D3 and caught covid, it was never fatal as their immune systems were very strong. Have a look at John Campbell's channel. Best wishes to you. And don't stop cycling.

[@ronwise4380]

@@bahoonies been taking 1000iu just doubled that. Haven't had covid as far as I know. Did the shot and first 2 boosters and decided not to take any more . Thanks again.

[@dannyjohnson4871]

Alex, I have a question for Dr. Scholz. Given the advancements in detection of prostate cancer outside the prostate, I am wondering if it would be reasonable to stop Lupron after 14 months and resume a reasonable diet, including eating some eggs and chicken in my diet. Logically, is there any harm in learning sooner than later that the cancer has survived treatments? With the PSMA Pet scans, why not learn the truth sooner than later? Here is a brief summary of my history: I was diagnosed with prostate cancer in December 2021 via both MRI in Arkansas and a 16 core biopsy at Cleveland Clinic. My PSA had jumped from 1.5 to 5+ in 12 months. Over the next two months it jumped 7+. When I received the biopsy results, Cleveland Clinic graded the biopsy a Gleason score 4+3=7 (grade group 3) with associated intraductal carcinoma. Being in Arkansas, I went to MD Anderson in Houston for treatment. MDA ordered the slides from Cleveland and graded it Gleason score 8 (4+4), grade group 4 with associated intraductal carcinoma. Meanwhile, based on the suggestions in Dr Scholz's books, I requested the slides be forwarded to Dr. Jonathan Epstien at Johns Hopkins. Dr Epstein graded the biopsy as follows: Prostatic adenocarcinoma, Gleason score 4+5=9 (Grade Group 5), involving 40% of one (1) core. Intraductal carcinoma of the prostate was identified. 5 of the 16 cores were positive. While in the Seattle area over Thanksgiving, I decided to visit Dr. Evan Yu at the Fred Hutchinson Cancer Center. Fred Hutchinson Cancer Center pathology graded my Gleason very similar to Cleveland Clinic, Gleason score 4+3=7 (grade group 3) with associated intraductal carcinoma. When I met initially met with the urologist and oncological radiologist at MD Anderson in January 2022, I specifically requested the tri-modality treatment option. Since then, I have received 11 months of Lupron. I just received an additional 3 month injection on December 1. I also requested Casodex for 9 months via my family physician. After the first three months of Lupron/Casodex, I received 22 external beam radiation treatments at MD Anderson. To date, noticeable side effects have been experienced, aside from the hot flashes associated with hormone treatments. Ten days after the external beam radiation, I received brachytherapy treatment. In November/December I returned to MDA for my 6 month followup. My PSA and testosterone levels were basically at 0. In addition to MDA treatments, I have followed a strict pescatarian diet for 9 months, lifted weights 2-3 days per week, and engaged in mountain biking 2-3 days per week. I'm happy to report I have gained significant strength and muscle mass during the past 6 months. I feel great, except for the hot flashes. Thanks for your two books. They have as a roadmap for my treatment plans. I have shared them with dozens of men who have found them beneficial. Because of you, the website, and the publications, I have felt empowered throughout the entire process. Thank God I read the books before I sought any treatment.

[@patriciareynolds2729]

ED here, my journey is similar. surgery, radiation with lupron- hellish drug. three years have passed, my PSA came off O last fall, doc said wait till Aug. and check again. wondering what is happening, prob. more lupron-praying its gone. I tell people cancer is a sneaky thing. hang in there.

[@newtexan1]

My husband was just diagnosed with prostate cancer early stage. However the VERY sample they took from him shows a high concentration of cancer. His urologist & surgeon (whom are excellent and known) both reject radiation. If he were to ave radiation and the cancer resurfaces (which it most likely will), he wouldn’t be able to have his prostate surgically removed, abs he’d be left with cancer and a death sentence.

[@ronwise4380]

Starting radiation next week. Was really surprised that my radiation oncologist was not a fan of SpaceOAR, neither was the RN that went over my treatment plans after my simulation.

[@robertrosanelli444]

I recently had radiation and no spacer was used. No problems resulted. Thanks for your videos, and the relatively new beard is a good move.

[@fredm5245]

My PSA was 26. After first 3 months of hormone treatment, it came down to 1.5. After the second three months and 20 radiation treatments, my final PSA was 0.09. I will do another PSA test early February followed by a phone call re the result. I cannot fault the treatment I was blessed to receive. There can be good news and I hope others can benefit also.

[@monster6968]

Sir when your Psa was down to 1.6.Was you prostate still growing and did you faced any other problems ?

[@paulford3951]

Hi, I have been diagnosed with prostate cancer and a Gleason score of 10. I am on hormone therapy (Bicalutamide) and I am currently scheduled to begin radiation in October. I am 78 years old and otherwise in good health. In your opinion, is the combination of hormone therapy plus radiation the best way to treat my cancer? Thanks for your thoughts!

[@iamric23]

What radiation treatment did you go with, thanks?

[@jean-claudelabbe7073]

@@paulford3951i

[@christined2495]

@@paulford3951 I hope your doing well, my husband was diagnosed yesterday Gleason 9 aggressive cancer he is going for a pet scan then the same treatment as you had, how did you do? I truly hope your doing well

[@Rockinrn]

Placement of SpaceOAR for me was relatively painless and quick.

[@donhart4460]

Dr. Scholz has been extremely helpful thru his videos. From start to finish, he has provided totally accurate answers, in a professional manner. What an outstanding contribution by an outstanding Doctor! God Bless Doctor SCHOLZ...... Don in New Braunfels, Texas.

[@JillRn]

Hello, my father (74 years old) was diagnosed feb 2023 with Gleason 10, stage four prostate cancer with Mets to femur, ribs and several spots along his spine. We have had two totally opposing opinions on whether to radiate the prostate. One doctor says absolutely no reason to radiate. The other one says yes we need to radiate it! Current treatment he is on: Nubeqa, Orgovyx and Taxotere chemotherapy. Any advice would help! Thank you! Also-Thank you PCRI for your support. It’s like having a personal sit down talk with a professional any time we want. We are so thankful for your positive outlook and abundance of knowledge. ❤

[@elijahghanbarnezad9909]

How’s he going?

[@tonyzayner-hp7sy]

You all are awesome....have learned so much from your informative videos....thanks so much...

[@John-the-Bass]

Thank you for the information. It is appreciated.

[@Kalense]

Thank you for an informative video, and than you Dr Scholz for the clear and simple explanations.

[@godwinizu7194]

Thank you for your information , I am in my early stage of my treatment . Your KZbin channel has been a great blessing to me and I hope more people will get to know of the wonderful work you are doing .

[@anilmehta6425]

Think of bones n take vit d n calcium ...n trace elements

[@agordonforme6797]

Thank you. Really interesting.

[@bradschwindt4582]

Prior to surgery I had Gleason 9 and PSA of only 4.6. PSA post surgery was 1.68 and Auxium PET scan revealed suspected 1 oligometastatic cancer in aorto-caval lymph node of 8mm. Began Hormone Deprivation Therapy with Lupron and Xtandi followed by SABRE radiation to the one sight and PSA has become undetectable,

[@roger1uk676]

Hello alex, thank you and thank dr scholz for answering my question( The first one.) 😊😊👍🙏

[@Truth_seeker743]

Hi Alex and Dr thank you it’s very informative like always you are doing g8 job God bless you

[@jeffpiper7430]

about 1/2 way though 39 treatments of radiation and 3 weeks way into hormone treatment which was lucrin i developed rashs over a lot of my body , around the waist and but they were lumps like hives and the rest of my body was like a normal ras , after 3 months on lucrin was put on a different drug / still a 3 month one but the rashes have persisted with most of the rash type one going away but the hive type one is still persisting and very ichey and sore , its mainly around the groin and butt area , specilist just says see your gp as rashs are not his field .. the gp says have no experience with this type of problem and being treated by him with stroids which helps but not a cure ... are these rashs / hives normal

[@daveh893]

Thank you. You are always very informative and helpful.

[@tedrick4713]

Excellent

[@tonysaid6184]

I am on hormone therapy after resection surgery of the prostate. How long should I continue with the hormone therapy before having hi tech radiation therapy?

[@bonscott3291]

I had 3+5 Gleason opted did external beam radiation. They put in the Spacer. Not a pleasant experience but worth it. The Doctor Also I wanted 2 years of Eligard therapy. 4 6 month shots. I did the first shot but decided to stop after that.

[@debross5881]

Where do you find the Centers of Excellence for radiation therapy?

[@jeffw8616]

Hi and thanks for your wonderful work. I’m just diagnosed and getting a second opinion, and will meet with doctors soon. After a lot of research, I haven’t seen a discussion about radiation treatment that fails at some point but can be followed by surgical removal. Thank you for any guidance on this.

[@MarkWilliams-rx6bl]

My Urologist says that after radiation, surgical removal is no longer a possibility. Anyone have any experience with that?

[@malcom59]

Mine said the same thing, that doing a RP after radiation would be difficult due to scarring.

[@peterdyes9724]

I was diagnosed wit Prostate cancer gleason 7 and gleason 8 plus oligometastatic bone lessions. Pelvis and backbone. I recieved 4 months of taxotare chemo, am on ADT for nearly one year. I had a psma scan a few months ago and the only active cancer that light up was in my prostate......my prostate has recieved sbrt for 6 weeks. My question is Can the schlerotic tissue left where the active bone mets were, be given sbrt radiation even though there was no active cancer shown on psma scan after chemo and adt..... my psa was 0.01 when I had the psma scan I worry it may have missed cancer in my bones......can any one please help?? can the area of where the cancer was in my pelvis and back bone {oligo metastatic areas] i have been told this is called schlorotic tissue cam these ares be radiated?? even though it appears the cancer cells are sleeping??

[@curtreese3089]

Great info

[@foodislifesouthafricacapet3716]

My husband has Gleason 9, he received hormone injections once and one course of tablets, then they removed his testicles. No other treatment was given. They first told him that his high risk after the MRI they said he's not high risk and doesn't have enough spread for chemotherapy, we going for a PSA test on the 30 January and for the results on the 6th February, we based in South Africa cape town . I'm very confused he has lymph node spread and one microscopic spread in the left hip , what should we be doing to prolong his life his only 52 years old and was diagnosed in December 2021. They doctors are confusing us and we have two young kids

[@user-wn6pf1ou8e]

No way i'm going for this treatment, SBRT 5 sessions and your done.

[@gary795]

How did your five sessions of SBRT (cyberknife) treatment go?

[@johnnyjohnson7642]

A lot of patients prefer non invasive procedures,like liquid biopsy MRI, ultrasound nuclear medicine bonescans ctscans prostate milking biofeedback

[@johnnyjohnson7642]

Good info every new radiology oncology drs.who just did a 5 yr. Resident in cypher, knife etc,all new procedures are updated but they still very inexperienced in reading MRI, ultrasound nuclear medicine bonescans ctscans prostate cancer biopsies but this is how we learned but 5 yrs.outta medical schools in a small town can be deadly

[@socarandy]

A question for Mr Scholz. Can someone have mixed beam radiation therapy, both Proton and Photon radiation as part of their treatment.

[@chrissimpson3762]

Radiation therapy was completed in April 2022. I have been getting frequent and unpleasant outflows of blood from the rectum. Became concerned about possibilities of bowel cancer and risks of infectIon. A colonoscopy resulted in the removal of potentially harmful polyps, but revealed extensive burns and proktasis. While the aftercare process has reduced the concern, I have concerns about how this has come about, and what the coming weeks have in store.

[@gvet47]

I was not even talked to about any radiation. It had already spread to my lymph nodes. If I stop Lupron can I have something to stop terrible sweats. I'm 75 and want a better life. My PSA is now 0.75.

[@dougenglun4983]

I have had 25 Sessons of radiation plus 3 hormone injection for prostate cancer. every thing went great. but now i am having major problems with out control stool rectum discharge. my question is can i get back to normal with this problem. i have to stay at home not knowing when this problem is going to come up, i am taking 2 imodium 2mg a day. how long does this problem last.

[@atefifa7769]

my father had metastatic prostate cancer to the bone he did only one session of hyperfractionated radiotherapy is it enough please advice?

[@glamup2013]

How is ur father now

[@elshamie075]

The radiologist treating my father refuses to start treatment after 6 months of hormone therapy. Any advice?

[@robwells230]

Get a second opinion or a different doctor

[@soniamanuel4917]

Side effects thigh ache is very painful what medicene can cure?

[@robwells230]

I can never get a straight answer regarding the benefit of adding chemical castration to radiation alone, or to the added benefit of 24 months of chemical castration after RT compared to just six months??? I have refused further Eligard toxic injections after the first 6 month shot expired because Eligard has destroyed my quality of life, and it appears redundant as my T remains below castrate level at 9. I am concerned that even after 8 months off the Eligard, my T level remains well below castrate level. I am in a rage that no one informed me about the devastating and deadly side effects of Eligard or that I might well end up castrated for life. How can patients make informed decisions and give consent to CASTRATION without the real information necessary to do a reasoned QOL COST -! BENEFIT analysis????

[@KDean22]

THIS IS SO CRAZY. YOU ARE BEING DESTROYED

[@KDean22]

DOCTORS CARE ABOUT MONEY. NOT YOU

[@iamric23]

Not sure if the Dr. can pick one radiation treatment over the other. But I don't recall hearing the radiation treatment called cyberknife spoken, is there a reason for leaving it out?

[@bencamicia103]

I am a 70 year old male just diagnosed with Prostate cancer, with a Gleason score of 3+3. My Urologist is indicating that my options are limited because my prostate is very enlarged. Is that true?

[@wolfgang9570]

Space Oar is part of the cutting edge of radiation treatment. I would not consider any clinic that does not utilize it prior to treatment.

[@jeffdavis4898]

I watch all of your videos. Prostatectomy 8 yrs ago had svi. But psa has only up to 0.04 now im surprised doc wants me to do radiation...is it time?

[@anjalitrakru3115]

You should get the radiation done to wipe out any remaining cells left . We did otherwise in my father's case and are suffering badly.

[@richardbennington323]

My question is PSA for men normal is 4.0 so on recurrent prostate cancer. Why is 0.24 more critical than 4.0 seems to me I hope I'm wording this right

[@clintcarter]

Yeah exactly. I see quite a few people getting all uptight over .3 - .4 psa. I had a 75 psa and got it down to .3 as of my last test. Thought I was in the clear but then see some of these guys freaking out over .3 and I’m like uhhh am I missing something? 😮

[@patriciareynolds2729]

Ed here, don't know if its beneficial, but the surgery was hell. the radiation wasn't bad, but lupron is tough also. thankful though to be doing well after 3 years. don't see how surgeon can tell what they're doing with robiotic surgery as cancer is so sneaky. still don't know why PSA easing back off O, do i still have cancer? if so it appears it was outside the prostate and then the radiation missed it also. i consider Lupron as chemotherapy even if it only contros male hormones.

[@petegodfrey5735]

I'm 72, in good health, stopped drinking cow milk/dairy, take many herbs & recommended supplements. My last PSA was 15, nor do I know why it jumped up like that. I see the urologist on Jan. 3rd to find out what's going on. Any ideas why the PSA would jump so dramatically, from 5 to 15??

[@frankmoen4666]

Have you checked prostate by MRI?

[@simmomantua8910]

If his PSA jump like that sorry to say most likely has prostate cancer I would see a doctor as soon as possible

[@edg531]

I recently completed my 6th of 28 radiation treatments. I haven’t seen anyone else comment on this, but I wanted to say that although I am happy to be getting life-saving radiation, the process of keeping my bladder full and my bowels empty on a pinpoint schedule has been rather grueling... in fact, far more grueling than the radiation, itself. Has anyone else struggled with this?

[@christined2495]

edg531 my husband staring the same journey as you this month, and this is something he has been concerned with as well, going to see radiologist next week hope to get an answer to this

[@edg531]

@@christined2495 You can adjust a few things which may help slightly, but truly, there is no answer. He just needs to gut it out for his own sake and the sake of his loved ones. Godspeed to you and him! (I have now completed 11 of 28 sessions and it hasn’t gotten any easier. I’m thankful tomorrow is Saturday, so I get a day off!)

[@pmh1nic]

I'll be dealing with this starting next week. I've never been a person that can have a bowel movement on command.

[@edg531]

@@pmh1nic You may not have an issue, God willing. For me it’s been hard. See what the doctors say. I’ve used Gas-X to reduce gas, stool softeners just before I go to bed, and LOTS of water in the morning to coax a bowel movement. I don’t mean to scare you. Just do what you have to do and get your treatment done. Best wishes! I’ve completed 14 of 28 sessions.

[@pmh1nic]

@@edg531 Appreciate the advice and encouragement.

[@carolgrilleto9872]

What about HIFU radiation treatment?

[@richardbennington323]

Why can't space or be used reoccurring prostate cancer

[@russelljohn5258]

I had prostatectomy 9.5 years ago, PSA stayed undetectable till a year ago when it showed up at 0.18. PSMA Pet 6 months ago was negative. PSA now up to 0.35. Radiation Oncologist wants to do prostate bed radiation plus hormone therapy. I am 78 years old recovering from shoulder joint replacement surgery with more joint surgery on the horizon. I do not want to go on Hormone therapy, my muscle loss is already bothersome. I have requested another PSMA Pet scan. Any thoughts/suggestions? Thanks!

[@frankmoen4666]

what is the status now? new PSMA PET?

[@russelljohn5258]

@@frankmoen4666 psa up to 0.41 a month ago so oncologist put me on Casodex. Will start lupron today will schedule radiation sometime after July. Oncologist and I agreed psa doubling time a concern. Current psa on Casodex undetectable. Not looking forward to this adt but want to get this pc killed while it is small.

[@cindyulrich4788]

Hello did you start Casodex before Lupron for a more immediate drop in your Testosterone?

[@russelljohn5258]

@@cindyulrich4788 yes I took casodex for 1 month before starting lupron. Started radiation about 6 weeks after starting lupron.

[@clintcarter]

Yikes. All this concern over a .3-.4 psa? And here I thought was doing well coming down from a 75 psa to after radiation and 14 months Lupron got it down to .3. Thought I was I in the clear but apparently not. Meh

[@johnnyjohnson7642]

By listening to your format I learned that only 5 pct.of urologist are board certified in internal medicine,a lot of these drs.dont like educated consumer,& if you are a m.d.,they feel you should shut up and listen 👂 to there methodology protocols,& pay your bills, always?? These Drs.

[@KDean22]

DOCTORS ARE DISHONEST. THEY WANT YOU TO BE SICK AND FRIGHTENED

[@hankaul6256]

Aloha n mahalo n U R very very pretty! Thank you