Understanding & Treating Urinary Incontinence and Erectile Dysfunction After Prostate Cancer With Dr. Doyle, USC Urology In this informative session, Dr. Doyle—urologist and specialist in post-treatment quality of life—joins the Prostate Forum of Orange County to discuss the often-overlooked challenges men face after prostate cancer treatment. Rather than focusing on cancer treatment itself, Dr. Doyle addresses what happens after: urinary incontinence, erectile dysfunction, and other quality-of-life issues that can persist or even worsen years later. He explains why these problems occur, how common they are, and—most importantly—what can be done about them. Topics include pelvic floor therapy, surgical options such as the artificial urinary sphincter and male sling, and treatment pathways for erectile dysfunction. The session also includes an extended Q&A, where participants ask practical, real-world questions about recovery, radiation side effects, and treatment decision-making. ⸻ ⏱️ Chapters 00:00 Introduction & Dr. Doyle’s Background 03:15 Urinary Incontinence After Prostate Treatment 12:40 Treatment Options: Sling vs. Artificial Urinary Sphincter 20:30 Erectile Dysfunction Treatments & Options 28:00 Q&A: Real Patient Questions & Scenarios ⸻ 🔍 Key Takeaways * Most men regain urinary control within 6 months after prostatectomy—but not all * Pelvic floor (Kegel) exercises help many, but some require additional treatment * The artificial urinary sphincter (AUS) remains the gold standard for moderate-to-severe incontinence * Radiation therapy can increase long-term complications, sometimes appearing decades later * Effective treatments exist for both incontinence and erectile dysfunction—even years after treatment📌 About Prostate Forum of Orange County The Prostate Forum of Orange County (PFOC) is a nonprofit, volunteer-run support and education group for men and families affected by prostate cancer. We host online meetings on the 2nd and 4th Tuesdays monthly, with expert presentations on most 4th Thursdays. 💻 Connect With Us 🌐 prostateforum.org 📺 Subscribe for expert talks and community discussions 📧 Sign up for our newsletter at prostateforum.org ⚠️ Disclaimer This video is for educational purposes only and is not medical advice. Always consult your healthcare provider before making treatment decisions. 🙏 Support Our Mission If you find our programs helpful, please consider donating or sharing with others who may benefit.

Dr. Richard Szabo, MD, urologist at Kaiser Permanente North Orange County and Clinical Associate Professor of Urology at UC Irvine, discusses why transperineal prostate biopsy may offer important advantages over traditional transrectal biopsy. 00:00 Welcome and speaker introduction 05:00 Transperineal vs. transrectal biopsy: key differences 20:00 Safety and infection risk (sepsis, antibiotics, complications) 40:00 Accuracy and cancer detection (studies, evidence, guidelines) 1:00:00 Transition to Q&A In this presentation and Q&A, Dr. Szabo explains: • How transperineal biopsy differs from transrectal biopsy • Why avoiding the rectal wall may reduce infection and sepsis risk • The role of MRI-guided biopsy and targeted sampling • Why anterior and apical prostate cancers may be easier to detect with a transperineal approach • Current research, randomized trials, and meta-analyses comparing biopsy methods • Differences between European and American urology guideline recommendations • Practical issues: pain, anesthesia, antibiotics, cost, training, and availability • Questions from patients and physicians about biopsy safety, accuracy, MRI limitations, fiducial markers, active surveillance, and second opinions This program is intended for education and patient support. It is not medical advice. Men considering prostate biopsy should discuss their own situation, risks, and options with their urologist or cancer care team. 📌 About Prostate Forum of Orange County The Prostate Forum of Orange County (PFOC) is a nonprofit, volunteer-run support and education group for men and families affected by prostate cancer. We host online meetings on the 2nd and 4th Tuesdays monthly, with expert presentations on most 4th Thursdays. 💻 Connect With Us 🌐 prostateforum.org 📺 Subscribe for expert talks and community discussions 📧 Sign up for our newsletter at prostateforum.org ⚠️ Disclaimer This video is for educational purposes only and is not medical advice. Always consult your healthcare provider before making treatment decisions. 🙏 Support Our Mission If you find our programs helpful, please consider donating or sharing with others who may benefit.

A brief but important update from Joanne Weidhaas on advances in PROSTOX, a genetic test designed to predict the risk of urinary side effects from prostate cancer radiation therapy. 00:00 Introduction & Purpose of Update 01:00 Why Side Effects Matter in Prostate Cancer Treatment 03:00 What PROSTOX Does (Predicting Risk) 05:30 Two Tests: Fast vs. Standard Radiation 07:30 How Results Guide Treatment Choices 09:00 How to Get the Test (Process, Cost, Access) 10:30 Q&A: Real-World Use & Patient Scenarios 18:30 Closing In this Guest Update for Prostate Forum, Dr. Weidhaas explains how new versions of PROSTOX can now help guide treatment decisions between fast (SBRT) and standard radiation—using a simple cheek swab. With most patients showing low risk for at least one treatment option, this testing represents a meaningful step toward more personalized, safer care. She also discusses: • Why predicting radiation toxicity is increasingly important • Differences between fast (SBRT) and standard radiation approaches • How PROSTOX identifies patients at higher or lower risk • Real-world considerations, including insurance and access This short update highlights how genetics may help patients and physicians choose treatments that minimize long-term side effects while maintaining effectiveness. 📺 For Dr. Weidhaas’ full presentation, visit: prostateforum.org (Presentation #2507, July 2025) 📌 About Prostate Forum of Orange County The Prostate Forum of Orange County (PFOC) is a nonprofit, volunteer-run support and education group for men and families affected by prostate cancer. We host online meetings on the 2nd and 4th Tuesdays monthly, with expert presentations on most 4th Thursdays. 💻 Connect With Us 🌐 prostateforum.org 📺 Subscribe for expert talks and community discussions 📧 Sign up for our newsletter at prostateforum.org ⚠️ Disclaimer This video is for educational purposes only and is not medical advice. Always consult your healthcare provider before making treatment decisions. 🙏 Support Our Mission If you find our programs helpful, please consider donating or sharing with others who may benefit.

Focal Therapy for Prostate Cancer: Tulsa, IRE (NanoKnife), and HIFU — What Patients Should Know In this Prostate Forum of Orange County education session, Dr. Meng (UT Southwestern Medical Center) explains modern focal therapy options for localized prostate cancer, including TULSA-PRO (MRI-guided transurethral ultrasound ablation), irreversible electroporation (IRE / NanoKnife), and high-intensity focused ultrasound (HIFU). Dr. Meng discusses how focal therapy fits between active surveillance and definitive treatment (surgery or radiation), who may be a good candidate, expected outcomes, risks, and the importance of careful patient selection and follow-up. ⸻ Topics Covered • Prostate cancer risk groups and Gleason Grade Groups • Active surveillance: benefits and limitations • Side effects of surgery and radiation (urinary, sexual, bowel, hormonal) • What focal therapy aims to achieve • Candidate selection and follow-up requirements • TULSA-PRO procedure, outcomes, and retreatment rates • Irreversible electroporation (IRE / NanoKnife) — FDA approval and clinical results • High-intensity focused ultrasound (HIFU) evidence and outcomes • Micro-ultrasound imaging for prostate cancer detection and treatment guidance • How physicians choose among focal therapy options • Post-treatment monitoring and recurrence risk • Treatment regret and quality-of-life outcomes • Q&A on PSMA PET imaging, biomarkers, and emerging research Speaker: Dr. Meng, Assistant Professor, UT Southwestern Medical Center Host: Prostate Forum of Orange County ⸻ Chapters 00:00 Welcome and introduction 02:00 Prostate cancer risk groups and Gleason scoring 05:30 Active surveillance outcomes 11:30 Side effects of surgery and radiation 16:40 Goals of focal therapy 19:30 Patient selection for focal therapy 22:00 Overview of focal therapy technologies 24:30 TULSA-PRO procedure and outcomes 34:30 Irreversible electroporation (IRE / NanoKnife) 42:00 Micro-ultrasound imaging 49:30 HIFU evidence and outcomes 56:00 Choosing the right focal therapy approach 01:03:00 Post-treatment surveillance 01:06:30 Treatment regret research 01:11:30 Audience Q&A 01:22:30 Closing remarks ⸻ Prostate Forum of Orange County — Official YouTube Boilerplate (v1.0) About Prostate Forum of Orange County Prostate Forum of Orange County is a nonprofit, patient-focused prostate cancer support organization serving Southern California and beyond. We provide free prostate cancer education, treatment information, and patient support through live Zoom meetings on the 2nd and 4th Tuesday of each month at 5 PM Pacific, featuring leading urologists, oncologists, radiologists, and prostate cancer specialists. Watching on YouTube? Visit https://prostateforum.org to join our email list and receive meeting updates, program links, and trusted prostate cancer resources. Connect With Us 🌐 Website: https://prostateforum.org 📧 Newsletter signup: https://prostateforum.org 📺 Subscribe for expert talks and community discussions Disclaimer This video is for educational purposes only and is not medical advice. Always consult your healthcare provider before making treatment decisions. Support Prostate Cancer Education Prostate Forum relies on community support to provide free prostate cancer education and support programs. You can help through PayPal, personal donations (any amount helps), qualified charitable distributions (QCDs) from IRAs, or vehicle and property donations. Your support helps us continue delivering trusted, expert-led prostate cancer education at no cost to the community.

Prostate cancer treatment and sexual recovery — what men should know after surgery, radiation, or hormone therapy In this Prostate Forum of Orange County educational session, Dr. Raj Jayadevan (“Dr. Raj”), urologist at the UCLA Men’s Clinic, explains why sexual side effects — especially erectile dysfunction — commonly occur after prostate cancer treatment and what treatment options are available to help men recover sexual function and quality of life. This prostate cancer support discussion focuses on sexual health after treatment, including recovery timelines, rehabilitation strategies, and medical and surgical solutions. Dr. Raj specializes in male sexual function and works with patients before and after prostate cancer treatment to support recovery and restore intimacy. Topics covered include: • Why erectile dysfunction occurs after prostate cancer treatment • Effects of radical prostatectomy, radiation therapy, and focal therapy • How prostate cancer treatments affect nerves and nitric oxide signaling • Recovery timelines for sexual function after prostate surgery and radiation • Penile rehabilitation and improving blood flow after treatment • Erectile dysfunction medications (Viagra®, Cialis®, vardenafil, and others) • Vacuum erection devices and penile length preservation • Injection therapy when medications are not effective • Penile implant surgery and long-term treatment options • Treatment options for men on hormone therapy (ADT / Lupron) • Testosterone replacement therapy (TRT) after radiation and ADT • Stepwise treatment planning and improving quality of life for prostate cancer survivors Dr. Raj emphasizes that men are not alone — millions of prostate cancer survivors experience treatment-related side effects — and that many effective treatment options exist. Early evaluation and ongoing care can significantly improve outcomes. This program is part of Prostate Forum’s ongoing prostate cancer education and patient support series featuring expert-led discussions for men and families navigating diagnosis, treatment, recovery, and survivorship. --- About Prostate Forum of Orange County Prostate Forum of Orange County is a patient-focused nonprofit prostate cancer support organization serving Southern California and beyond. We provide free prostate cancer education, treatment information, and patient support through live Zoom meetings on the 2nd and 4th Tuesday of each month at 5 PM Pacific. Programs feature leading urologists, oncologists, radiologists, and prostate cancer specialists. Watching on YouTube? Visit ProstateForum.org to join our email list and receive updates, meeting links, and prostate cancer resources. 💻 Connect With Us 🌐 prostateforum.org 📺 Subscribe for expert talks and community discussions 📧 Sign up for our newsletter at prostateforum.org ⚠️ Disclaimer This video is for educational purposes only and is not medical advice. Always consult your healthcare provider before making treatment decisions. 🙏 Support Our MissionSupport Prostate Cancer Education Prostate Forum relies on community support to provide free prostate cancer education and support programs. You can help through PayPal, personal donations (any amount helps), qualified charitable distributions from IRAs, or vehicle and property donations. Your support helps us continue delivering trusted prostate cancer information and expert-led patient education.

UCLA urologist Dr. Wayne Brisbane explains how micro-ultrasound compares with MRI for detecting prostate cancer, based on the Optimum Clinical Trial published in JAMA. This talk is ideal for men with rising PSA, newly diagnosed prostate cancer, or those considering biopsy, MRI, or active surveillance. Learn how micro-ultrasound works, what the research shows, and what it means for real-world decision making. ⸻ Chapters 00:00 Welcome & introductions 01:25 Why UCLA pursued micro-ultrasound 04:46 How micro-ultrasound works (high-resolution imaging) 08:20 PRI-MUS vs PI-RADS: scoring systems 11:30 Optimum Trial: design and purpose 21:25 Clinical implications and future uses 22:09 Q&A: training, variability & AI 25:08 Q&A: PSMA PET with micro-ultrasound 31:30 Q&A: biopsy safety, tract seeding & implants 36:40 Closing comments and community updates ⸻ Summary Micro-Ultrasound Overview Dr. Brisbane explains UCLA’s work with high-resolution micro-ultrasound, which images the prostate at ~70 microns—far more detailed than conventional ultrasound. This allows clinicians to visualize abnormal duct patterns associated with prostate cancer, offering MRI-like detail in real time and without the limitations caused by metal hip implants or MRI scheduling delays. How Micro-Ultrasound Compares With MRI Micro-ultrasound can reveal structural changes in prostate tissue that correlate with Gleason patterns. Dr. Brisbane compares micro-ultrasound and MRI images of the same gland, demonstrating how higher resolution can help identify suspicious lesions. Unlike MRI, micro-ultrasound is performed directly in the clinic, with no claustrophobia and no ferromagnetic interference. PRI-MUS vs PI-RADS The PRI-MUS scoring system parallels PI-RADS for MRI. Using acoustic features—duct patterns, density, and shadowing—it helps categorize lesions from low risk to highly suspicious. UCLA continues to refine PRI-MUS to improve accuracy, including AI-assisted interpretation. Correlation With Pathology UCLA developed a specialized process to align micro-ultrasound, MRI, and whole-mount pathology from prostatectomy specimens. These comparisons validated how well micro-ultrasound can map tumor location and characteristics, forming the foundation for the Optimum Trial. Optimum Trial Findings The randomized Optimum Clinical Trial compared three approaches: micro-ultrasound alone, micro-ultrasound with MRI, and standard MRI-fusion biopsy. Results showed that micro-ultrasound was non-inferior to MRI for detecting clinically significant prostate cancer—and even trended slightly in its favor. Grade Group 2 and higher-grade cancers were detected at similar rates in all arms. Cost & Practical Benefits Replacing MRI-guided biopsy with micro-ultrasound can save roughly $445 per patient, reduce radiologist workload, and streamline scheduling. Micro-ultrasound may be especially valuable when MRI is not possible or not definitive. Clinical Applications Potential uses include: • Combining MRI + micro-ultrasound for improved targeting • Reducing the number of biopsy cores when both modalities identify the same lesion • Supporting active surveillance by tracking lesion changes • Improving diagnostic accuracy for men with rising PSA but negative MRI Audience Q&A Highlights Dr. Brisbane addresses: • Training challenges and the role of AI • How PSMA PET compares with MRI and micro-ultrasound within the prostate • The extremely rare risk of biopsy tract seeding • Advantages for men with hip replacements • Where micro-ultrasound is available in Southern California ⸻ About Prostate Forum of Orange County Prostate Forum is a patient-focused nonprofit serving Southern California and beyond. We meet online via Zoom on the 2nd and 4th Tuesday of each month at 5 PM Pacific, including during the holidays. Meetings feature presentations from leading urologists, oncologists, radiologists, and prostate cancer experts. If you’re watching this on YouTube, visit ProstateForum.org to sign up for our email list and receive links to upcoming programs. ⸻ Support Our Work Prostate Forum relies on community support to keep these educational programs free. You can contribute via: • PayPal • Personal donations (even $5 helps) • Qualified charitable distributions from IRAs • Vehicle or property donations through our partner program Your support helps us continue providing trusted, expert-led prostate cancer education.

**Daniel Park from USC Keck Medical Center presents a comprehensive overview of prostate cancer diagnosis, treatment options, and cutting-edge surgical techniques.** 00:00 Introduction and Welcome 02:11 USC Urology Program Overview 07:10 Prostate Cancer Overview & Statistics 16:54 Risk Factors and Diagnosis 21:17 Biopsies 26:17 The Treatment Trifecta 31:00 Robotic Surgery 32:50 Video: da Vinci SP Robotic System (https://www.youtube.com/watch?v=TGjnb86HndU) 46:00 HIFU 58:15 Q&A **KEY TOPICS COVERED:** **Diagnosis & Detection:** - PSA testing limitations and the continued importance of digital rectal exams - The game-changing role of MRI in prostate cancer detection - MRI fusion biopsies vs. traditional random biopsies - how many cancers are missed - Gleason scoring (Grade Groups 1-5) and what the numbers mean - Why traditional biopsies are imperfect and often miss aggressive cancers **Treatment Options:** Dr. Park reviews the full spectrum of treatments including surgery, radiation, active surveillance, hormone therapy, and focal therapy. He emphasizes the treatment "trifecta" goals: cancer control, urinary continence, and erectile function preservation. **Active Surveillance:** - Appropriate for low-risk Gleason 6 (Grade Group 1) disease - Not "watchful waiting" - requires regular PSA, MRI, and biopsy monitoring - When to convert to active treatment **Robotic Surgery Revolution:** Extensive discussion of USC's single-port robotic surgery platform: - Evolution from open surgery to minimally invasive techniques - Single-port advantages: ~3cm incision, faster recovery, improved precision - Superior visualization and triangulation compared to traditional laparoscopy - Minimal scarring and quicker return to normal activities - USC's investment in cutting-edge surgical technology **Focal Therapy - HIFU (High-Intensity Focused Ultrasound):** Detailed explanation of this prostate-sparing treatment option: - How HIFU works: focused ultrasound energy heats tissue to ~194°F with millimeter precision - Two machines at USC: Sonicare and Ablotherm - Procedure takes 2-3 hours with real-time monitoring - Success rate: 80-85% based on USC's published research - Patient selection criteria: localized disease (T1-T2), Gleason 6-7, appropriate prostate size - Who should NOT have HIFU: advanced disease, high-grade cancer, certain medical conditions - Critical importance of post-treatment surveillance (annual MRIs, periodic biopsies) **Emerging Technologies:** - AI applications in surgical training and cancer detection - PSMA PET scans as next-generation imaging - Clinical trials: aquablation, nanopac injections, vaccine research - Future of robotic and AI-assisted surgery **Q&A HIGHLIGHTS:** Viewers ask about: - HIFU success rates and patient selection (honest discussion about 15-20% recurrence rates) - Managing PSA recurrence after prostatectomy (salvage radiation options, PSMA PET imaging) - AI's role in prostate cancer diagnosis and treatment - Post-HIFU follow-up protocols and aquablation for BPH symptoms - Active surveillance for newly diagnosed patients with pre-existing bladder issues - USC's focal therapy specialists: Dr. Andre Brew and Dr. Amir Lebashti - Insurance considerations and choosing high-volume treatment centers - Advanced treatments for metastatic disease showing improved survival rates **KEY TAKEAWAYS:** - MRI is essential for accurate diagnosis and treatment planning - Not all prostate cancers require immediate aggressive treatment - Multiple effective treatment options exist - choose based on individual circumstances - High-volume centers like USC offer latest technologies and expertise - Post-treatment surveillance is critical regardless of treatment choice - Support groups and patient education are vital - men need to talk about their health This presentation offers invaluable insights for newly diagnosed patients, those considering treatment options, and anyone interested in the latest advances in prostate cancer care. Dr. Park combines deep technical expertise with an approachable, patient-centered perspective. 📌 About Prostate Forum of Orange County The Prostate Forum of Orange County (PFOC) is a nonprofit, volunteer-run support and education group for men and families affected by prostate cancer. We host online meetings on the 2nd and 4th Tuesdays monthly, with expert presentations on most 4th Thursdays. 💻 Connect With Us 🌐 prostateforum.org 📺 Subscribe for expert talks and community discussions 📧 Sign up for our newsletter at prostateforum.org ⚠️ Disclaimer This video is for educational purposes only and is not medical advice. Always consult your healthcare provider before making treatment decisions. 🙏 Support Our Mission If you find our programs helpful, please consider donating or sharing with others who may benefit.

Dr. Elizabeth Zhang from Keck Medicine USC explores the "alphabet soup" of radiation oncology treatments for prostate cancer—including advances from 3D-CRT through IMRT, VMAT, SBRT, and the role of proton and internal therapies. Chapters and timestamps are included for ease of navigation. Chapters & Timestamps 00:00 – Introduction & About Dr. Zhang-Venten Brief welcome and overview of Dr. Zhang’s background. Keck Medicine’s expansion into Orange County and the motivation for demystifying radiation oncology acronyms. 02:43 – What is Radiation Therapy? Explanation of external vs. internal radiation, with a focus on External Beam Radiation Therapy (EBRT)—how LINACs work and the goal of precise targeting. 06:34 – External Beam: Machines, Beams, and 3D-CRT How a linear accelerator delivers EBRT, the evolution from 3D conformal radiation therapy, and historical context of “box” approaches and challenges for surrounding organs. 10:10 – Advances: IMRT & Inverse Planning Shift from “forward planning” to “inverse planning” using computers; describing IMRT and how modern machines allow fine dose modulation and better protection for healthy tissue. 15:48 – VMAT: Speed and Precision Introduction of Volumetric Modulated Arc Therapy (VMAT). Illustrates how VMAT enables rapid delivery using rotating machines that dynamically block and shape radiation in real time. 19:40 – Shorter & Safer: SBRT and Sessions Transition to modern fractionation schedules: From 44 to as few as 5 sessions with SBRT. Discussion of appropriate selection, role of rectal spacers, and patient-specific factors like prostate size and urinary symptoms. 24:10 – Proton Therapy Explained Comparing photon and proton radiation. Using patient-friendly metaphors, explores why protons offer a different dose profile, but highlights trial results showing similar quality of life outcomes for prostate cancer between modern photon (VMAT/IMRT) and proton therapy. 31:16 – Brachytherapy: Internal Radiation Explanation of internal radiation, using metaphors such as flashlights and glow sticks. Differentiates Low Dose Rate (LDR) “radiation to go” (permanent seeds) and High Dose Rate (HDR) “radiation for here” (temporary needles)—plus the risks, benefits, and technical notes on placement and migration. 33:50 – Modern Practice & Clinical Decision-Making How current advances shape patient decision-making—surgery vs. radiation for enlarged prostates, impact of hormone suppression, and quality of life factors. Dr. Liz shares recent studies, experience, and collaborations that guide patient care. 39:28 – Q&A & Live Discussion Open Q&A session addressing personalized patient questions: recurrence, oligometastatic disease, clinical guidance technologies, AI and imaging, risks with spacers, and the importance of expert placement. Dr. Liz offers advice on choosing centers of excellence and the significance of collaborative team care. 1:12:41 – Facility & Technology Overview Highlights of newest technologies in Orange County facilities, including TrueBeam machines and unique PET-guided linear accelerators at USC Newport Beach, plus the value of imaging integration for individualized care. Key Topics Covered EBRT: How external beam radiation is delivered and shaped for optimal safety Treatment advances: From “box” 3D-CRT to IMRT, VMAT, and SBRT Deciding on number of treatment sessions based on new techniques and patient factors Role and evidence for proton therapy in prostate cancer Brachytherapy (internal): LDR vs HDR methods, advantages, and practical risks Interpreting imaging, using integrated technology, and enhancing safety Q&A recap: Decision-making, recurrence management, technical guidance, and facility highlights Explore the chapters to learn about the latest prostate cancer therapies, hear patient-friendly explanations, and discover what advanced radiation oncology can offer today!. 📌 About the Prostate Forum of Orange County The Prostate Forum of Orange County (PFOC) is a nonprofit, volunteer-run support and education group for men and their families affected by prostate cancer. We host online support groups on the 2nd and 4th Tuesdays of each month, and feature presentations from medical experts on the 4th Thursday of most months. Our goal is to provide reliable information, expert insight, and a welcoming community where patients, survivors, and caregivers can share experiences and learn together. 💻 Learn More & Join Us 🌐 prostateforum.org 📺 Subscribe to our YouTube channel for monthly expert talks and fireside chats. 📧 Sign up for our free newsletter via our website to receive meeting updates. ⚠️ Disclaimer The information presented in this video is for educational purposes only. It is not medical advice. Always consult your healthcare provider before making treatment decisions. 🙏 Support Our Mission If you find our programs helpful, please consider supporting the Forum through donations or by spreading the word to others who may benefit.