Does radiation preclude surgery due to scarring?

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New Member

Date Joined Feb 2008
Total Posts : 8
   Posted 2/22/2008 4:06 AM (GMT -6)   
My urologist advised strongly that if I have radiation, specifically seed implantation, the scarring that will result will make surgery difficult if not impossible later on.  Anyone have first-hand knowledge of this?   Thanks.

Regular Member

Date Joined Jul 2007
Total Posts : 242
   Posted 2/22/2008 8:21 AM (GMT -6)   

My urologist/surgeon basically told me the same thing, and in fact, told me that he would not perform surgery on anybody with a recurring cancer who has had radiation. In layman’s terms he explained to me that the prostate becomes "sticky," after radiation, which makes removal difficult and risky.

Diagnosed: March 25, 2007. Age 49
Biopsy: Gleason 6. Five of twelve samples positive with <5% each. No perineural invasion seen.
Surgery: May 21, 2007
Post-op Pathology: Upgraded to Gleason 7 (3+4), negative margins, negative capsular penetration, negative seminal vesicles, lymph nodes left intact, multifocal perinural invasion, 15% of prosate involving cancer in both lobes. T2c
Continence: Out of pads at five weeks. Seven months post-op I'm fully continent.
Erections: Yes! With the assistance of Cialis.
Post Surgery PSA: Three tests, all <0.1
Family history: Great-great grandfather died from PC. My Father had his prostate removed at age 67 in 1997 and has had an undetectable PSA ever since. I was diagnosed at a much earlier age and had a more agressive cancer than my father. Go figure.

Regular Member

Date Joined Mar 2006
Total Posts : 355
   Posted 2/22/2008 12:13 PM (GMT -6)   

It is my understanding that surgery and Brachytherapy success rates are very close and surgery is not for everyone.  Please gather all the information you can and make an informed decision.  There are follow up procedures for those who have had radiation and new treatments are emerging very quickly.  I understand that HIFU can be performed post-radiation.

If you are not a surgery candidate please do not feel that "all is lost" - there are other treatments available which is why you have to reseach everything before making your decision.

My husband chose Brachytherapy - if you have any questions, I'd be happy to try and answer them.

Veteran Member

Date Joined Jul 2006
Total Posts : 686
   Posted 2/22/2008 10:28 PM (GMT -6)   
You are correct.  Many, maybe most seed therapy patients can not have salvage surgery.  But, there are many other radiation treatments that can be pursued. Maybe even other treatments that I am not aware of.

Biopsy 10/16/06
T2A,  PSA 4.7
Gleason 4+4=8 right side
adrenocarcinoma of prostate
DaVinci Surgery 01/16/07
Post op report,confirms Gleason4+4=8 , no extra extension or invasion
No continence problems
PSA results 90 day (-.01) 6 months (-.01) 9 months (+.02)
PSA one year (+.02)
Using Caverject/viagra for continuing ED problems (one year)

Michael's Wife
Regular Member

Date Joined Aug 2007
Total Posts : 150
   Posted 2/23/2008 10:21 AM (GMT -6)   
If you have essentially eliminated the prostate through radioactive seeding, I'm not sure why you would want to have surgery afterward to remove it. Your options for treatment afterward are essentially the same as your options had you eliminated the prostate via surgery in the first place (i.e., if there were cells missed on initial treatment). As it was explained to us by my husband's urologist, the prostate no longer exists as a prostate after seeding ... just as it no longer exists after surgery. Should cancer return/found to have spread in either case, you'd like want to target with broader based treatment.

As Julie says, the success rates of surgery and brachytherapy are equivalent, and surgery is not for everyone (including my husband).

Husband: Age 58
Stage: T1c
Gleason: 6 (3+3)
PSA: 4.4
Biopsy: 12 samples, Adenocarcinoma involving 3 cores, right side only (95%, 90%, 30%, discontinuously)

Pre-op prostate study - November 13
Brachytherapy - December 12, 2007
CT Scan - January 11, 2008

So far, so good!

Regular Member

Date Joined Sep 2006
Total Posts : 211
   Posted 2/23/2008 9:48 PM (GMT -6)   

Surgeons and others oten come up with this theory which is generally an academic argument.

You'll find few with first hand experience of surgery after radiation, mainly because it's not relevant to the situation.

With recurrence after ratiation, other available treatment options  are usually more applicable.

New Member

Date Joined Feb 2008
Total Posts : 8
   Posted 2/24/2008 7:25 AM (GMT -6)   
Thanks to all on the above responses. For the record, my psa was 3.6 in mid-2006, then rose to 4.6 in mid-2007. Biopsy in January 2008 indicated Gleason score of 3+4=7 with one of 10 needle biopsy indicating positive adenocarcinoma involving 40% of tissue in left apex. Not sure about all that but I'm told by urologists that my situation represents mid-level risk with several possible corrective measures to include: surgery, radiation, and hormone-bypass. Believe I am going to elect for radiation via Brachytherapy and hope that will take care of the issue. Many thanks again for all input and all the best to all of you.


Tony Crispino
Veteran Member

Date Joined Dec 2006
Total Posts : 8128
   Posted 2/25/2008 12:30 PM (GMT -6)   
Hi Ken,
You have certainly done your due diligence. Knowledge is very helpful when dealing with this disease. Good luck on your seed implants. They were not an option for me but I have done well from the surgery, hormone therapy, and the IMRT radiation. It is true that after brachytherapy surgery won't likely come up as an option for cure, but there is still too little information on that. For me and my age, PSA, and later found out advanced disease, brachytherapy would have been unsuccessful. And I would not have wanted that treatment given the age I was. If you can, you can list those numbers above in your signature by going back into the control panel and modifying your personal profile. It does help others help you, you to help others. Again, welcome and I'll have a prayer for your successful treatment. God Bless you and your loved ones!

Age 45 (44 when Dx)
Pre-op PSA was 19.8
Surgery on Feb 16, 2007
Post-Op Pathology: Gleason 4+3=7, positive margins, Stage pT3b (Stage III)
HT began in May, '07 with Lupron and Casodex 50mg
IMRT radiation for 38 Treatments ending August 3, '07
Current PSA (1/08): <0.1
I will continue HT until May '09. 
Visit my Journey at:
Prostate Cancer Forum Moderator

Regular Member

Date Joined Oct 2006
Total Posts : 444
   Posted 2/25/2008 3:42 PM (GMT -6)   
Hi Ken
From my previous research, I have found cases where surgery for recurring PCa may be possible after beam radiation treatments (i.e., IMRT photon or x-ray radiation and proton radiation which I had).  However, there are probably only a very small select group of surgeons who would be willing to perform such surgery and I have read that the side effects and complications after such surgery are much greater than having surgery as the first treatment.  Best of luck in your treatment decision.
-69 years young!
-29 core biopsy 9/27/06 at age 68
-PSA 7.1, Stage T1c, Gleason 7 (3+4) [less than 20% in one area], Gleason 6 [less than 5% in two other areas], Negative DRE, bone scan and Endorectal MRI. 
-Completed 39 Proton radiation treatments 2/22/07-4/18/07.   
-PSA History: 7.1 pre-treatment; post treatment: 2.1 (3 mo.), 2.4 (6 mo.), 1.7 (9 mo). Radiation oncologist said the 3-mo. drop of 70% exceeded expectations and the slight 6-mo. movement upwards was not a cause for concern now.
-The following is a link to My Journey With Prostate Cancer -- Proton RadiationTherapy.  

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