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