Phone: 512-238-0762

Fax: 512-341-7370

May 23, 2020

Three Docs Talk: Dr. Doug Rivera of Austin Cancer Centers joins the program to discuss treating prostate cancer with radiation

Speaker 1: 

Welcome back to the Armor Men’s Health Hour with Dr. Mistry and Donna Lee.

Dr. Mistry: 

Hello and welcome back to the Armor Men’s Health Hour. I’m Dr. Mistry, your host, here with my cohost Donna Lee. Hello, Donna.

Donna Lee: 

Hello, Dr. Mistry. I’m effervescent.

Dr. Mistry: 

Yes. Effervescent cohost. One of the newest partners here at NAU Urology Specialists, Dr. Lucas Jacomides. Welcome back, Lucas.

Dr. Jacomides: 

Thank you Dr. Mistry and Donna Lee. How are y’all today?

Donna Lee: 

Don’t forget, that’s his real name and your real name. Dr. Mistry and Dr. Jacomides.

Dr. Mistry: 

That’s right. Nobody doubts Dr. Jacomides.

Dr. Jacomides: 

Doctor is my first name.

Dr. Mistry: 

Doctor is my first name.

Dr. Jacomides: 

My parents had a feeling.

Dr. Mistry: 

You know there was a guy in Houston, I think he was a radiation oncologist in fact, and his name was Uday Doctor, so his name was Dr. Doctor.

Donna Lee: 

Stop it.

Dr. Jacomides: 

There’s that song in the sixties.

Dr. Mistry: 

Nobody’s going to believe that name. If they can’t believe Dr. Mistry, they’re not going to believe Dr. Doctor.

Donna Lee: 

We still are getting some people wondering about your name. It’s such a mystery.

Dr. Mistry: 

That’s right. That’s right. We’re joined here again with one of our wonderful referring physician partners, Dr. Doug Rivera from Austin Cancer Center. Welcome back.

Donna Lee: 

Welcome!

Dr. Rivera: 

Thank you. And the initials “Doug Rivera” is “DR.”

Dr. Mistry: 

Wow. Oh my God. Wow. It’s all…

Donna Lee: 

It’s all full circle.

Dr. Mistry: 

Donna Lee, you’re the only one with a stage name on this show.

Donna Lee: 

That’s right. But my maiden name was an R and I was also a DR.

Dr. Mistry: 

There you go.

Dr. Jacomides: 

And Dr. Mistry is S and M.

Dr. Rivera: 

Well there you go.

Dr. Jacomides: 

My god.

Dr. Mistry: 

…for another week. For another week.

Dr. Jacomides: 

We’ll have to edit this out. No we won’t.

Dr. Mistry: 

We come across radiation therapy frequently in urology when we’re treating patients, when it goes to prostate cancer treatment, but also when people may have had pelvic radiation for some other reason like anal cancer or cervical cancer and they may have some urologic issue as a result of that. Our paths cross quite a bit, right, Doug?

Dr. Rivera: 

That’s right.

Dr. Mistry: 

Lucas, you do a lot of prostate cancer, huh?

Dr. Jacomides: 

Yes. I mean, it’s something, it’s a conversation that I have at least once or twice a week. When we first get the diagnosis, I usually do it in the morning or in the day and just say, “Here’s what you have, here’s your Gleason score,” which we can talk about it, but this is a very short segment, so it’s hard to get the one hour conversation into an 11 minute soundbite. And a lot of times I have the spouse in the room and you say, “What do you think?” And usually she says, “I want it out yesterday.” And the guy’s like, “I don’t want you to touch me. So what else you got?” And I’m certainly, we discussed radiation treatments for prostate cancer. I’m curious, Doug, if you could elaborate, is there a certain patient that you think is ideal for different types of radiation in terms of grade of cancer, PSA, and what kind of conversations do you have with folks about, maybe you should think about this or maybe not? Maybe should think about surgery instead?

Dr. Rivera: 

You know, when I talk about the radiation options, the thing that differs a little bit about what we do is there are pretty clear pathways and how we do things and there’s a spectrum, you know, with prostate cancer, we say that very kind of openly as one thing, but y’all know there’s, you know, low risk and intermediate higher risk based on, you know, how aggressive the cancer is, how advanced it is. And so we do treat that slightly differently for folks that are very, very high risk. You know, we’re talking about radiation, which is going to include maybe the pelvis, prostate, maybe we’re doing that with hormone therapies. That would be the one extreme. All the way to the other side of the spectrum for those folks that have kind of the smallest kind of slowest growing cancers where it’s just radiation alone. And there’s everything in between, and that’s, you know, obviously a very long conversation. In regards to, you know, working with Dr. Jacomides, Dr. Mistry, you guys, you know, we do a good job of trying to give people all their options, right? Because it really is a couple of different options to approach prostate cancer pluses and minuses of each one. So I think going through, I try not to, I kind of lean on you guys a lot, very heavily to kind of talk about the surgical options. But as you know from those times where there are surgical options, there’s also radiation option as this kind of talking about the pluses and minuses of both.

Dr. Jacomides: 

Speak to that if you will for a little bit. Tell us, what are some of the options within radiation oncology in terms of what their choices are in terms of conventional external beam, IMRT?

Dr. Rivera: 

There’s really kind of two different options, right? There’s the external radiation we talk about, and that is radiation that kind of comes from the outside. So a lot of big words that people talk about is something called IMRT. It’s, it means a lot of different things. There’s protons now that people talk about. There’s things like CyberKnife. Those are all forms of delivering that radiation, kind of from the outside and focusing it to the prostate. And then there’s this internal radiation, what we call, you know, Brachytherapy or a lot of people affectionately call it Seeds essentially. So those are kind of the two different ones that they can be used in combination in some cases and in some cases kind of by themselves.

Dr. Jacomides: 

And is there a certain degree of cancer that you say, I don’t offer Seeds for this grade of tumor or this age of patient or this co-morbidity or whatnot? What do your, do you take them down that road? Just briefly talked about that if you can.

Dr. Rivera: 

Yeah. So let’s like, let’s lean on Seeds because that’s kind of one topic that’s easy to talk about. So not everyone is a great candidate for that. So there are some limitations to that. Prostate can’t be too large. If it’s very large, you’re going to put a lot more Seeds, a lot more trauma in putting that in. Also, their urinary symptoms are a little bit higher with that. So there are some folks that aren’t good candidates for that. I mean some of the things you guys might look at for folks that aren’t good for surgery, for example, maybe they have a bleeding disorder or some other risk factors like that, we probably wouldn’t do Seeds for it because there is some anesthesia required. Whereas you do external beam for these patients, it’s really, it’s noninvasive. They kind of come in every day, treatment’s about five minutes and they walk in and leave feeling the same.

Dr. Jacomides: 

What do you tell people in terms of complication rates, in terms of urinary symptoms, erectile dysfunction, just generally speaking in terms of, you know, quality of life kind of indices?

Dr. Rivera: 

As far as things that happen during the treatment, most of these things are going to be urinary. So we take these intakes in to kind of get their baseline and what goes up from there is their frequency of the urination. So they often will go a little bit more often. They’ll get the urge to go, their stream will kind of be reduced, that type of thing. Maybe we wake up more in the evenings. [Inaudible] has been reduced, and there’s a couple of reasons why that is, but you know, usually I tell folks, you know, if you’re a person that goes kind of once a day, likely is that you’re gonna probably go two or three times smaller stools. But in general, that’s about it. Pretty rare to have diarrhea these days. Those things typically go away post-treatment longterm. There are things that happened to have maybe some scar tissue on either the rectum or bladder, but it’s usually less than 10%. I think the big thing is the same thing, you know, even with the surgery that we all struggle with is what about erectile function? That’s a really important end point for a lot of folks. If you look at the modern studies at somewhere about 30%, you see somewhere between 20% and 40%. I kind of used the word, the number 30%. And a lot of those patients that they do have some erectile dysfunction, do respond to, you know, Viagras and those other medicines. But that’s kinda the rate that I talk about.

Dr. Jacomides: 

Yeah, that’s an interesting point. I don’t know [inaudible] had said that Sunny, as far as penile rehabilitation just to get people a better chance of improved erection. Certainly we do that with our surgery patients that getting a pills or a vacuum device to help facilitate erections afterwards because if you do a perfect nerve sparing surgery, and then things get trapped in the scar for a while and nothing happens. So it’s good to get things firing again and if it’s going to have a chance of working. And I’m curious if you have an experience with it with radiation, too.

Dr. Mistry: 

Well, I think that when it comes to the approach of virtually any disease process, and especially in cancer, people get really tunnel visioned on treating their cancer. And it’s one of the most disappointing things you see in a patient when you have not been able to make them understand that they’re going to have a life after the cancer and they really need to focus on preserving that function. So we make them jump through so many hoops right before surgery. They have to lose weight. They’ve got to get on a good immunologically nutritive diet. They’ve got to work on their erections. They’ve got to work on their pelvic floor. And we make them do this because we know that they have a life outside of the cancer and we’re going to fix their cancer. I mean that is what they came to us for, diagnose and treat their cancer. And so when we send a patient for radiation therapy, it’s no different. We want them to remember that they have a life outside of cancer. So we believe strongly in making sure that we help their erectile bodies and their pelvic floor and their gut health, all of which are kind of preserved, because you know, you have a job to do, Doug, to treat their cancer with radiation and then they’re going to live on, that’s what we’re, that’s what we’re actually going for. Right? That that’s not going to be the end of their functionality.

Dr. Rivera: 

Yeah. I think you guys do a good job with that. I think that’s really important as the, after the not only mentally, how you’re dealing with things, but also the rehab and being proactive, you know, with sexual rehab and that type of thing. You know, it’s very clear that, and this is true of almost anything that you do, the better people come into these things in terms of how functional they are and how active they are, the better they do afterwards. And that doesn’t matter if it’s radiation or surgery or any type of modality. So getting people, I think, you know, top shape going into things is really important.

Dr. Mistry: 

That’s a really great point. You know, I think that those patients that are sicker, older, overweight, when they go into radiation, I think they feel a little more fatigued, whether it be mentally or physically.

Dr. Jacomides: 

And that’s truly the kind of demographic that chooses radiation over surgery lot of times, right? So it’s very hard to do apples to apples comparison.

Dr. Mistry: 

And maybe Doug, you could just kind of briefly go over what, you know, when you’re going through radiation, what are you going to experience? You’re going to be on that table in this machine. Are you going to feel zapped?

Dr. Rivera: 

Yeah. No, you don’t really feel the radiation is you go in. There’s no question during the course of the few weeks that you go through it, you’ll get a little tiredness whether it’s coming every day for your part time job of getting radiation, right, or, probably that the radiation affects a little bit. It’s a little bit fatigued, but most of my guys continue to work throughout their thing. I encourage them to do so. I also encourage them to exercise throughout. There’s actually interesting trial looking at folks that exercise versus not during treatment and they had less side effects and overall did much better if they exercise throughout it and you can, you know, that’s the beauty of it. And that’s why, especially for older individuals kind of go down that road.

Dr. Mistry: 

Unless your gyms are closed from the Corona quarantine.

Dr. Jacomides: 

Hey Doug, can you let us know how to get ahold of you in your office website, phone number. How do people, if they want to go straight to you…?

Dr. Rivera: 

Yeah, we’re at Austin Cancer Centers, austincancercenters.com and our phone number is (512) 505-5500.

Donna Lee: 

Awesome. And we’ll have that podcast available so you can search for your podcast, too.

Dr. Mistry: 

And we’ll have that information on our Facebook.

Donna Lee: 

Oh yeah, the Facebook and the podcast. We’ll be right back.

Speaker 3: 

Dr. Mistry wants to hear from you. Email questions to armour men’s health@gmail.com we’ll be right back with the armor men’s help hour.

Austin Digital Marketing And Development By Fahrenheit Marketing