EP 605: Rethinking Radiation Oncology: What Every Man Should Know About Cutting-Edge Radiation Cancer Treatments

In this episode, Dr. Mistry and Donna Lee are joined by special guest Dr. Douglas Rivera of the Austin Cancer Center. Dr. Rivera is a radiation oncologist who uses modern and cutting-edge radiation therapy to treat a range of cancers in the body. Many people have misconceptions about radiation oncology and are afraid to consider this option. In reality, radiation treatments are incredibly precise and can be delivered in many effective, efficient forms depending on the type, severity, and even genetic markers of an individual patient's cancer. Tune in to learn what brachytherapy is and why these "radiation seeds" are a great choice for treating localized prostate cancer. Dr. Rivera also explains what every cancer patient should know before selecting a radiation oncologist and what to expect from different types of radiation therapies. Visit Austin Cancer Center online or call 512-531-5200 today!

Voted top Men's Health Podcast, Sex Therapy Podcast, and Prostate Cancer Podcast by FeedSpot

Dr. Mistry is a board-certified urologist and has been treating patients in the Austin and Greater Williamson County area since he started his private practice in 2007.

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Transcript

Speaker 1: 0:07

Welcome to the Armor Men's Health Show with Dr. Mystery and Donna Lee.

Speaker 2: 0:12

Hello and welcome to the Armor Men's Health Show. This is Dr. Mystery, your host. Heres always by my office manager, my partner in crime, and my sidekick. Mm-hmm.<affirmative> Donnel Lee. That's

Speaker 3: 0:23

Right. I'm a co-host and a board certified one at

Speaker 2: 0:25

That. You know what? I don't know, you know, like Batman and Robin, right? Mm-hmm.<affirmative>. But sometimes if Robin goes and does his own shows without Batman,

Speaker 3: 0:33

Batman gets jealous.

Speaker 2: 0:34

Does that mean that I'm the, that I'm the sidekick? Yes.

Speaker 3: 0:36

You're my[inaudible]<laugh>.

Speaker 2: 0:39

Great. Donna, I hope you get to have a lot of our other partners on, on the show at times. Oh, I will. And our and our wonderful new health coat, Lauren Hagan. That's right. We have a awesome new pelvic floor physical therapist named Mary. Mm-hmm<affirmative> and just practice continues to grow. This show is brought to you by the urology practice that I started in 2007. AAU Urology Specialist. Mm-hmm.<affirmative>, Donna, how do people get ahold of us? And we're our office. We

Speaker 3: 1:00

Are located in Round Rock, North Austin, South Austin, and Dripping Springs, Texas. Our website for this show is armor men's health.com and you can send questions there where we will answer them anonymously for Dr. Mystery for our guests. Like we have one today. And our phone number again, it's(512) 238-0762. Um, we have a lot of questions backed up, so after we have our guests on today, we'll have some questions

Speaker 2: 1:21

Answered. Well, thank you. And please send those questions. We love'em. Today we are honored to have, again, a really good friend of ours, Dr. Doug Rivera. Welcome back radiation oncologist. Doug, thank you for joining us again today. Well,

Speaker 4: 1:32

Thank you very much for having me. Mm-hmm.

Speaker 2: 1:33

<affirmative>, the urologist and the radiation oncologist are probably the two least favorite doctors a patient ever needs to, to go see. Would you agree?

Speaker 4: 1:42

Good point. I think that's fair.

Speaker 2: 1:43

I mean, I think there's a lot of plastic surgeons where the patient goes in there like really excited about the life that's about to happen and dermatologists or people are gonna finally fix up their acne, but rarely do they go to the radiation oncologist. Super happy to be there. That's

Speaker 4: 1:56

True. And most people I meet outside of work like, Well, nice to meet you and hope I never have to

Speaker 2: 2:00

Meet, never have to

Speaker 3: 2:00

Meet you again.

Speaker 2: 2:01

And they say that to me too. I was kinda insulted, you know, because of what we do<laugh>. So, uh, you know, as urologists we deal with a number of different kinds of cancer and a lot of those cancers, there's a component or a role for radiation the to play. So for us, even testis cancer, bladder cancer, there's no real role for kidney cancer. But prostate cancer for sure, oftentimes the radiation oncologist and the urologists play a, a really pivotal role to, to work

Speaker 4: 2:27

Together. That's right. Yeah. I think when you get prostate cancer, you really need to talk to urologists first, obviously, but also a radiation oncologist a lot of times.

Speaker 2: 2:34

So when it comes to radiation oncology, uh, I see a lot of patients that come to me and when you mention radiation, they just totally are like adamantly against any notion of it. Their dad had it or something happened. Maybe you could talk to me a little bit about what do you think drives patients kind of apprehension about concept of needing radiation therapy? Where do some of these myths come from and how have things changed over the years? Well,

Speaker 4: 2:57

I think this, the radi the word radiation's such a broad term, right? The first thing you think of is, you know, nuclear radiation exposure. And that's very, very different than what we use for medical purposes. So when we're talking about radiation that we use for lots of different things, actually quite useful. We use it for diagnostic x-rays, which we know has, uh, really helped significantly in medical care. But then when it comes to therapeutic radiation, what we're doing really is a more focused, targeted thing. It's not this full body exposure that think people think about with radiation. And there are so many different types. There are types that you implant radioactivity, and there's ones you take pills and the radioactivity goes throughout your body. And then what I primarily do with most of my patients, and particularly for prostate cancer, is using very focused radiation just to a small area.

Speaker 2: 3:41

So you have this notion or this myth that a lot of people have carried from, you know, the 1960s and radiation bombs and people losing their hair and becoming kac and having terrible secondary cancers. And they're kind of carrying that kind of thought process into what's gonna happen to them when they get treated with radiation.

Speaker 4: 3:57

That's right. Yeah. And it's because just the word radiation, right? People just think of all these different things. It is, but they don't, in particular think about what, how we really use it. And it's quite different.

Speaker 2: 4:05

It's quite different. And so you mentioned, uh, swallowing radiation, and that's for what? Thyroid cancer, That

Speaker 4: 4:11

Would be the most common type? Yes.

Speaker 2: 4:12

That's fascinating. So, you know, you have a, a solid organ in your body and that we've, we as in medicine, have created a way to deliver something that can kill this cancer that goes throughout the body and really focuses just on where that, that that chemical gets concentrated.

Speaker 4: 4:27

Right. And in particular, that would be for thyroid, be iodine type uptake, but, uh, even for other types of things we use for prostate cancer. Now, you know, there's a lot of, uh, studies and at least you'll see ads out there for, um, some medicines where you inject some, uh, radioactive material when it's specific for prostate cancer as well

Speaker 2: 4:42

Talked about this ligand therapy, psma ligand therapy that's coming out where it takes some radiation radioactive particle and puts it on a, on something that can find prostate cancer cells throughout the body. It seems like a, like this idea of targeted radiation is so opposite to people's view of what radiation is, which is just like this scatter thing where you just kind of sit in this box of light and get kind of soaked with radiation.

Speaker 4: 5:08

Yeah. Completely different.

Speaker 2: 5:09

So in prostate, you, you guys have been doing, uh, localized radiation therapy for many years, and I, I'm gonna talk about seed therapy now, a breaky therapy, which is also kind of radioactive sees what, what's happening, what, what, what type of patients are good candidates for seed therapy and, and, and is it, is it more or less common today than it was in the past?

Speaker 4: 5:33

Uh, I think if you look at the numbers, it's, it's less common these days because of some other things that we're doing. But, uh, it's basically this idea of having these radioactive, you know, seeds, we call them, um, implanted into the prostate and they very imminent just to emanate just a very few millimeters. And so the idea of, um, implanting it in there is you get high dose of radiation, which pretty much stays for the most part, confined in the, the prostate. And that's the idea behind it. So the ideal candidate would be someone who has a disease that we, you know, typically think is pretty limited to the prostate. Um, you wouldn't be using it as much in someone where, you know, there's disease outside the prostate or maybe, uh, if it's outside of the prostate, even as far as the lymph nodes, for example, you wouldn't just do brachytherapy.

Speaker 2: 6:18

So, uh, this type of brachytherapy is more appealing for some men over the standard therapy of going and getting the radiation from the outside. What are some benefits that somebody could expect from the seed therapy over the external beam

Speaker 4: 6:34

When it was a lot of the data looking at it, cuz you know, most of the stuff was done. Um, it's, it's been around for, you know, well over 30 years now. So, but if you compared a lot of the studies looking at brachytherapy versus external beam radiation treatments, uh, back in that area, also very different than it is now. Uh, but even surgery, a lot of the studies actually suggest that it had some of the best quality life outcomes in terms of, you know, erectile function preservation, um, urinary continents, those type of things. So there are, there is for the well selected patient, uh, slow, good role for using brachytherapy.

Speaker 2: 7:06

So, um, uh, I think that the time it takes is also a component too, because you put the seeds in, in one day where a prolonged course of external beam can take up to 45 days. Right.

Speaker 4: 7:18

That's a great point. Yeah. I, I think for, um, some individuals that makes a huge difference for them, especially if they're in communities outside where, you know, they can't get to a typical radiation center and go for several

Speaker 2: 7:29

Ways. Yeah. If you're driving an hour in, it's gonna be hard to come, come in, but yeah. But nowadays we have a solution where you can get the external beam radiation therapy done in a shorter time period. Maybe you could briefly talk about what that is and, and, uh, what are the tradeoffs

Speaker 4: 7:43

Of? Yeah, so the evolution of how we, you know, a lot of how we've changed this has been based on, you know, computers really, it, we didn't have computers and the ability to do these, all these calculations and kind of delivery methods of treatment imaging every day to kind of target the prostate. Um, you know, we couldn't do what we do today, for example. So that's where things have really evolved, where we are, you know, taking pictures every day of that prostate really being, you know, right on target. And so that's not as pushed the number of treatments down and, uh, so much to the point where now where you can even in, in some cases do it as little as five treatments. Uh, that's something called S B R T, uh, stereotactic body radiation. And so, um, you know, that's more what we call like breaky, like, in a sense, uh, is that it's a lot less treatments. We think it's highly focused more like the seeds, for example. Um, and, you know, not, not everyone's a candidate for that as, you know, for like anything else. But most people are, And in general, you know, it's been, we be able to migrate from nine weeks of treatment down to even little as five treatments

Speaker 2: 8:47

Because I think a lot of patients that I will talk to and recommend radiation therapy, this idea of being kind of tied up with your cancer care for nine weeks is pretty daunting. Yeah. And, uh, if to be able to offer something that's, uh, uh, more, uh, that's quicker and just as effective, maybe very, uh, appealing to some people.

Speaker 4: 9:06

Oh, definitely. Yeah. We've given people from, from all over the state, even, you know, electric people outside of the state as well. And it's easy to come for a week and a half. It's, it's almost impossible unless you have family or someone close by to come for eight or nine weeks, it's pretty hard to do that. Um, but, you know, not in addition to the convenience benefit, there are some theoretical advantages. It being more, um, efficacious as well. These, you know, better at curing the cancer in particular. So there are definitely a lot of benefits to it. Um, at the very least, most studies, you know, looking at this about 15 years out now suggests at the very least, they're at least equivalent.

Speaker 2: 9:42

Well, Doug, thank you so much. This is Dr. Douglas Rivera radiation oncologist talking to us about radiation therapy and uh, and urologic conditions. Uh, after a short break, we're gonna come back and talk about kind of side effects of radiation that people can expect. We can talk a little bit about hormone therapy and how that interacts with radiation therapy. And thank you so much for joining us today. How do people get ahold of you,

Speaker 4: 10:03

Doug? Call at(512) 531-5200. And uh, look me up at Austin Cancer Centers. Dr. Douglas Rivera.

Speaker 3: 10:09

You feel like that was his mobile phone number?

Speaker 2: 10:10

Yes,<laugh> just hit, just hit text me. Just hit me up on my Snapchat.<laugh>

Speaker 3: 10:16

Not on Tinder. Uh, awesome. You can reach us at 5 1 2 2 3 8 0 7 6 2 and our website's, armor men's health.com. And, um, you can check out our podcasts wherever you listen to free

Speaker 2: 10:26

Podcasts. I'm Dr. Mystery, your host. Today I'm a board certified urologist, a men's health expert and founder of N AAU Urology Specialist. It's a comprehensive men's wellness and urologic care facility. I'm joined by the person really responsible for making this show a success and helping our practice grow so greatly. Ms. Donna Lee.

Speaker 3: 10:45

That's right. Welcome back to our show everybody. I am Dr. Donna

Speaker 2: 10:48

The Hector. Donna is not what she is<laugh> she is certifiable. She's a standup comedian. She just recently did a show. We can't wait to see her back on stage. That's right. I maybe one of these days I will do a standup comedy routine. You

Speaker 3: 11:00

Should, we'll do a little show together. That'll be fun. I think the listeners would

Speaker 2: 11:03

Enjoy that. That woman in the back cowering is my wife. Everybody<laugh>. Thank you. We are joined once again by Dr. Doug Rivera, Austin Cancer Center. He is our preferred radiation oncologist for our practice. So if you are a prostate cancer, bladder cancer, or a testis cancer patient in our practice, you're more than likely gonna be referred to Dr. Rivera if we think that you need radiation. Thank you so much for joining us today, Doug. Thank you very much. You're our favorite because you are incredibly thorough, calm, well demeanor and you don't try to take the limelight from me and I really appreciate that

Speaker 4: 11:33

<laugh>. Oh wow. I'm blushing right now. I can't see it.<laugh>.

Speaker 2: 11:37

He'll give you, he'll give you his phone number to text later. That's right. He's very personable when people are looking at getting radiation therapy. We, in our previous segment we talked about different forms of radiation therapy specifically for prostate cancer. An area that I come up to kind of butt heads, not butt heads, but kind of have a a difference of opinion is the role that hormone ablation therapy in patients that are gonna go through radiation and, and how those play together. Because, because we give so much testosterone in our clinic, we know the benefits to muscle mass, energy, mood, sexual function, sexual libido. And then when we're about to send a patient with prostate cancer to a radiation oncologist, oftentimes the first thing they want to do is give'em a drug to take away all their testosterone so that the radiation works better. Maybe you can speak to kind of where did that thinking come into play and how big of a role does hormone ablation therapy play in, uh, making radiation better? Yeah, it's

Speaker 4: 12:26

An awful conversation. You know, you say, I'm gonna give you a medicine that's gonna take away your test all your

Speaker 2: 12:29

Testosterone.

Speaker 4: 12:30

Good luck. Yeah, you're gonna love it. It's gonna be great. A lot of that stuff comes from the fact that we know when people have advanced prostate cancer, when I say advanced, I meaning it's gone outside, you know, to the bones and other parts of the body, which unfortunately does happen. The first thing we do is we put'em on that medicine and we know that, you know, many decades ago we would cut someone's test testic. Awesome. That sounds terrible. Yeah. That's what you would do. And you would decrease her testosterone and their prostate cancer would kind of shrink and go away with knowing that we use it and with radiation for lots of folks. And the idea in particular primarily is actually to reduce the fact that the chance of it taking up shop elsewhere outside the prostate, we think there's some synergy in the prostate, but we think it also, most of it probably works for letting it take up shop elsewhere. That's why we've done that. The, the trials have been done showing there's a benefit to it. But I'll tell you though, in my practice, um, what I do is that that's an old way of thinking about things. You know, you do lots of stuff we do in medicine, you'll see it put'em on because we know that 10 people out of a hundred are gonna benefit from it. The other way to look at that is that it means there's a lot of people we treat that don't

Speaker 2: 13:23

Really need. That means there's 90 people that had like a worse, worse afternoon because of something that we were doing for the 10. And because we're doctors, we're overly conservative and we want to give everybody the greatest chance to survive their cancer that we can. And so sometimes we may recommend things that, that, that cause people to not benefit as, as fully. So an individualized treatment, I think we would both agree is so important and a conversation with those patients is so

Speaker 4: 13:46

Important. Yeah, that's right. And then, and now there's a few different, these, you know, what we call genomic profiling tests, Your genomic classing fire tests, they call'em. What those are is we take your, uh, tumor that you've had from a biopsy that the urologist gets that you would get Dr. Mystery. Right. And we send it off to a lab and then you look at the genes in there and they try to match based on patients with known outcomes before, um, if they have the same type of genes. And that kind of helps me figure out the people I truly feel like are gonna benefit from the hormone therapy. You'd be surprised. Like I've seen tests where, um, they were supposed to be, you know, have a somewhat aggressive cancer, but boy their genetics are saying they have a very aggressive cancer. And that way I really, that I feel more comfortable saying, Hey, you do need to be on that medicine. And then others were, um, it may say the opposite where it's like your risk is actually pretty low, even though under the microscope it looks like this genetically not very aggressive. And so those type of people, I don't give hormone therapy too.

Speaker 2: 14:37

It, it's such a great like notion that we talk about a lot on this show is this idea that if you go to a doctor that treats you like you're just a piece of cookie dough and uses the same cookie cutter on you every time, you may not be getting the kind of care that you need. And we are in a new era of medicine when it comes to personalized, digitized molecularized medicine and it's gonna get better and better and better and better. And if you were going to someone who did the same thing for your dad and here, uncle and your brother, every time you're gonna get the same type of templated therapy, then I think that you might be selling yourself short. And the same is true of radiation therapy, but that can be hard with cancer, right? Because people are so emotional, the the wife is crying that she wants you to do everything to save him. The guy's like, please don't take away my erections. I mean it's, yeah, it can be a really emotional time.

Speaker 4: 15:23

It definitely can. And I think you touched on a lot of points and I think that's what, you know, you and I like really focus on, right? Is that's the idea we're going to, um, really look at the whole person, figure out, you know, how to do it the right way because you don't always do everything the same way. Now some things you do, I mean there's a lot of benefit to repetition as you know, as a surgeon. Um, but that's just those other things. You're tailing for the individual patient because not everyone's prostate cancer, you know, is the same. There's gonna be some that are caught much more earlier, others that are gonna be far, far more advanced and some folks that have much more aggressive cancer and those that don't have very aggressive cancer at all.

Speaker 2: 15:56

We have a lot of our patients that focus on the Gleason score and that's how it looks under the microscope. That's what you're saying? Yeah. And the, the worse it looks under the microscope usually the worse that it's gonna act in, in, in, in, in true life. And, but what we're saying is that now we can even do more advanced molecular tests. We can look beyond just what somebody's eyes see on the microscope down to the real genes that are turned on and turned off inside that cancer to give you better advice. So when somebody ultimately does go through radiation therapy, um, does it burn, does it hurt? Like do they lose their hair? These are the, these are the things I hear all the time. What are the common things that people can usually expect to feel through, uh, either external beam radiation or SBR t for prostate cancer? And then what are some of the things that you really worry about happening?

Speaker 4: 16:46

Yeah, I think some of the, you know, questions that I get, you know, often is am I gonna lose my hair? Am I gonna have skin burning on the outside? Um, am I gonna be able to be around my family? Right? So all those things, um, don't apply for prostate radiation typically, you know, you don't lose your hair at all. Um, we're focusing in the pelvic area, you don't have any skin burns on the outside and unless you're doing the thing we talked about before, breaky therapy, which is a seas, um, you don't have any radio activity in your body whatsoever. So you don't have any exposure to anybody that'll risk to anybody. Um, in general, what I say for most of the radiations we're doing, we're treating the prostate. You know, the way that radiation works in part is to kind of invoke the immune system and, and it does kill some cancer cells cause they're rapidly dividing and that's how, how it, it kills them. Um, but people can expect simp something similar to mild prostate inflammation. You know, not, not in infection cause there's no bacteria in there necessarily, but basically

Speaker 2: 17:41

So a little swollen prostate.

Speaker 4: 17:42

Yeah, yeah, that's typically what it is, right? So they're, uh, initially you, you don't feel anything and kind of builds up and then, you know, you get some of those symptoms where you maybe peel more often, maybe get kind of the urge to go, maybe you're waking up more at night, but in general, once you're done those that inflammatory kind of process goes away.

Speaker 2: 17:58

And that's a good point. So in our clinic, uh, when we are sending a patient for radiation therapy, we wanna make sure that they don't have any existing BPH or an enlarged prostate symptoms. So frequently as you're, uh, undoubtedly aware, you'll see me do surgery to get rid of their enlarged prostate before they go through radiation so that the radiation doesn't, doesn't lead to it. So it's really a very collaborative approach between the urologist and the radiation oncologist. It's not like if I say the patient's gonna get radiation, just throw'em to you and they're gone for me forever.

Speaker 4: 18:29

Yeah, that's right. I mean there, there are so many things that we need to consider bef, you know, before treatment after treatment. And it really is a collaborative approach to kind of follow, uh, the patients to make sure not only are they cured, number one, but number two, um, to minimize any potential side effects for them.

Speaker 2: 18:43

So if you're gonna advise a patient that was recently diagnosed with prostate cancer, um, what kinds of things should they have heard about from their radiation oncologist? How did they judge whether they got good advice? What, what are some like key high points that you think that everybody should leave an appointment with you?

Speaker 4: 18:59

Well, I think they should know where they are on the, the spectrum of prostate cancer in terms of how advanced it is, right? That's gonna deem, um, what their prognosis is. They need to know like what their chances of it coming back are, what the chances are there, this could affect their overall life expectancy. Um, number two, um, you wanna see someone that has, uh, experience with all the different modalities of treatment, whether that's brachytherapy, whether that's, um, S B R T or we use something called s CyberKnife, whether that's external radiation because if you only have one tool, that's all you can

Speaker 2: 19:31

Ever use. That's right. Everybody looks like a nail.

Speaker 4: 19:33

Yeah. Um, and then also, um, knowing that there are other options, you know, we, you, you, a lot of the things you do surgery, high food, things like that, um, radiation oncologists be well versed enough to know that those that are also acceptable treatments.

Speaker 2: 19:47

I think that's really great. You know, making sure that your radiation oncologist and your surgeon can do multiple different things and that you're not just one more kind of, uh, uh, that they, they only have one tool that they can use and then everybody's gonna feel like they fit right into that, that, uh, in, into that, uh, that algorithm. Uh, Dr. Rivera, thank you so much for joining us. Uh, I'm just an incredible service that we're doing to our patients and we really appreciate you servicing our patients. How do people get ahold of you?

Speaker 4: 20:17

Uh, look at me up to Austin Cancer Centers. Uh, our number is 5 1 2 5 3 1 5 2 0 0.

Speaker 2: 20:23

And we really appreciate you taking care of our patients. Donna, how do people send us questions or get ahold of Dr. Rivera through us?

Speaker 3: 20:28

That's right. You can reach out to us at armor men's health.com where there's a little button you can submit a question. You can call us during the week at 5 1 2 2 3 8 0 7 6 2 and check out our podcast wherever you listen to free

Speaker 1: 20:38

Podcasts. The Armor Men's Health Show is brought to you by NAU Urology Specialist. For questions or to schedule an appointment, please call 5 1 2 2 3 8 0 7 6 2 or online at armour men's health.com.