Hi Tony 1951,
I am not sure what your experience was with surgery but I will say that the only time you know what is going on is after it is over. I had open heart surgery and the last thing I remember prior to the surgery was joking with the nurse about needles. Next thing was waking up in the ICU with a tube in my throat. Nurse took care of that in seconds. After that it was just a matter of time for the sternum to heal. Never had any pain or serious discomfort. Also had a hernia repair done laproscopically a few years before the heart. Again no problems and done on an out patient basis. I was sore for about two weeks and walked a bit stooped over.
There is salvage surgery available for previously radiated patients. It is hard to find a surgeon willing to do it from my research but they are out there. Cryotherapy is done as a salvage operation and apparently has been successful but comes with side effects. (So what 's new about that?)
I chose IMRT for my case based on the fact that I would have required radiation anyway due to spread and my research indicated no statistically significant difference in results for surgery vs. radiation. There was one point made in a research paper that surgery was slightly better than radiation in terms of reoccurence of the cancer. The difference was not statistically significant but you want any edge you can get. Seems that if the cancer reocurrs it is at the original site of the prostate in over 50% of the cases. Either the gland or the bed after removal of the gland. Mayo Clinic has published a number of papers regarding the relative value of the options and suggest that, in some cases, surgery and radiation combined is the best alternative to treatment of advanced PCa. In those cases there is usually a good chance that hormone therapy will be given as well.
As I understand it in radiation the gland is not completely destroyed and there is always some viable tissue. The cancer cells are completely destroyed after a time. Any where from 18 months to 36 months.
If you would like more input from IMRT types try prostatepointers.org and go to the EBRT group. I got a lot of good input there prior to making my decision.
Best of luck to you.
PSA 21.5 (first and only test resulted from follow up visit to emergency room for kidney stone. first time for kidney stone too)
Gleason 4 + 3
DRE palpable tumor on left side
100% of 12 cores positive for PCa range 35% to 85%
Bone scan clear
Chest x ray clear
CT scan shows potential lymph node involvement in pelvic region
Started Casodex on May 2 and stopped on June 1, 2008
Lupron injection on May 15 and every four months for next two years
PSA test on July 14, 08 after 8 weeks hormone .82
Started IMRT/IGRT on July 10, 2008. 45 treatments scheduled
First 25 to be full pelvic for a total dose of 45 Gray to lymph nodes.
Last 20 to prostate only. Total dose to prostate 81 Gray.
Completed IMRT/IGRT 09/11/08.
Second Lupron shot 09/11/08
Next PSA test by oncologist 03/09