224: Beyond the Shotgun: Dr. Eve Tiong on the New Era of Prostate Radiotherapy

In this episode of The Penis Project Podcast, Melissa is joined by Dr Eve Tiong, a radiation oncologist with Icon Cancer Centre in Western Australia, for a deep dive into how prostate radiotherapy has changed and why many of the horror stories people associate with radiation no longer reflect modern practice.  Dr Tiong walks through the shift from older, broad-field radiation techniques to today's highly targeted approach, explaining how image guidance and modulated delivery now concentrate dose on the prostate while sharply reducing exposure to the bladder and bowel. She and Melissa unpack what this means in practical terms for urinary, bowel and sexual side effects, and discuss how rectal spacer gel is helping to protect bowel function during treatment.  The conversation also covers how patients and their clinicians weigh up surgery versus radiation, the role of hormone therapy for higher-risk cancers, the difference between external beam radiotherapy and brachytherapy, and the emergence of focal therapy as a less invasive option for carefully selected men. Throughout, Dr Tiong returns to a consistent theme: informed decision-making, honest counselling about trade-offs, and the importance of taking sexual health and quality of life seriously at every stage of the prostate cancer journey.  In This Episode, We Cover  Men on active surveillance who want to understand what triggers a move to treatment  Modern radiotherapy is far more targeted than the broad “four-field box” approach used decades ago, sharply reducing dose to the bladder and bowel  Severe long-term side effects from contemporary radiotherapy now sit below 5%  Rectal spacer gel can further protect the bowel during treatment and dissolves naturally within four to six months  Cure rates for surgery and radiation are equivalent for low-grade and favourable intermediate-risk prostate cancer  Focal therapy, treating only the affected area of the prostate, is now emerging as an option in WA  Sexual health and continence should be part of every prostate cancer conversation, regardless of treatment type  higher-risk cancers  PSA monitoring after treatment, the significance of the 0.2 threshold, and emerging PSMA PET tracers  Reframing relapsed or advanced prostate cancer as a manageable, often chronic condition rather than an immediate death sentence  Key Message from Eve  A cancer diagnosis, including relapse, is not automatically a worst-case outcome. With the range of treatments now available, many men go on to live full, active lives for many years, and ongoing advances continue to expand what is possible.  Resources & Links  https://iconcancercentre.com.au/doctors/eve-tiong/  Steve’s YouTube channel – personal stories and practical experience from a prostate cancer survivor: Everyday Prostate Cancer Warrior on YouTube  Book a telehealth appointment with our sexual health nurse practitioners at Restorative Health Clinic  For more information check out our websites www.rshealth.com.au , www.makehardeasy.com.au and www.melissahadleybarrett.com.au   Steve Fisher YouTube link to his Everyday Prostate Cancer Warrior. https://youtu.be/APLm1W8uPBA?si=SfaA9A74GqMNcvUq  Click here to shop the Sompatherapy Pumps: The Touch II Automatic Pump, and the Response II Manual Pump  Click here to watch Melissa’s YouTube video: Most Men Use the SOMA VED Wrong | Here’s the Correct Way    Book a telehealth consultation with our sexual health nurse practitioners:  Restorative Health Clinic    For more information visit our websites:  www.rshealth.com.au  www.makehardeasy.com.au  www.melissahadleybarrett.com    Need Support?  At Restorative Health Clinic, we support men and their partners with:  Penile rehabilitation after prostate cancer treatment  Erectile dysfunction  Vacuum pump and constriction ring education and prescription  Penile injection therapy  Intimacy and sexual recovery  Partner-inclusive support where appro