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Does radiation preclude surgery due to scarring?

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Posted 2/22/2008 1:06 AM (GMT -8)
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.

Ken

Posted 2/22/2008 5:21 AM (GMT -8)

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.

Posted 2/22/2008 9:13 AM (GMT -8)

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.

Posted 2/22/2008 7:28 PM (GMT -8)
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.

Posted 2/23/2008 7:21 AM (GMT -8)
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).
Posted 2/23/2008 6:48 PM (GMT -8)

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.

Posted 2/24/2008 4:25 AM (GMT -8)
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.

Ken
Posted 2/25/2008 9:30 AM (GMT -8)
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!

Tony
Posted 2/25/2008 12:42 PM (GMT -8)
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.

Dave

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