salvage prostatectomy

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Wigs
Regular Member


Date Joined Mar 2009
Total Posts : 89
   Posted 3/25/2009 8:38 PM (GMT -6)   
How many on this forum have had a salvage prostatectomy?  My wife would appreciate talking to wives whose husbands have had the salvage prostatectomy.
Diagnosed @ age 47 - September 1997
PSA 5 / Gleason 3+3
Seed Implant - January 1998 @ Trident Hospital, SC
PSA 2.4 - July 2007
PSA 2.7 - July 2008
PSA 3.0 - November 2008
Diagnosed @ age 57 - December 2007
Gleason 4+3
Salvage Prostatectomy & Colostomy - March 2008 @ MSKCC, NY
Urethral-Rectal Fistula Repair - August 2008 @   Cleveland Clinic, OH
Colostomy Reversal - January 2009 @ Cleveland Clinic
Will have AUS implant - May 2009 @ Cleveland Clinic
 
 


divo
Veteran Member


Date Joined Jul 2008
Total Posts : 637
   Posted 3/26/2009 6:52 AM (GMT -6)   
Dear Wigs,

My husband has had salvage prostectomy... five years after radiation and brachy......I would never recommend it to anyone...The radiation damage that was done earlier, prohibited proper healing....plus, it didnt get the cancer anyway....it is rising again......Diane.
Husband Pete
dx Jan 2001 gleason 4 + 3 PSA 16.5
Seed implant and conformal radiation and Lupron from Jan 2001 to Jan2002
2005 Dec PSA began to rise from .5 to 8 within 6 months
Salvage surgery at MSK 9/06 Dr. Eastham
Fistula operation 2/07 MSK Dr. Wong
Many cystoscopies and ER visits with strictures
Catheter for one year....Catheter taken out Sept 07..
Total Incontinence since then....
PSA .52 3/08
AUS Operation at MSK Sept 8 2008 Dr. Sandhu
Activated Oct 28th Dr. Sandhu..MSK
Some difficulty with AUS arising Nov 10 2008
Meeting with Dr. Sandhu to discuss AUS problems and new PSA test Dec 11, 2008
PSA .6 12/08
AUS improving..only 2 pads a day and one at night
Complete hip replacement surgery Dr. Waters Gainesville, FL 1/9/09
Hip replacement total success..pain gone!!
PSA .7 2/10/09


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25364
   Posted 3/26/2009 8:05 AM (GMT -6)   
Hello Wigs and Diane,

Diane, you know my opinion on salvage surgery. Many urological surgeons won't perform them, including my own. The results are almost always a failure as far as erradicating any remaining cancer, the side affects of incontinence and ED often end up much worse or perm from it. The surgery is no longer clean so to speak, as the previous radiation has damaged much of the area and there will always be heavy scarring.

Without critising or judging anyone's decisions, not my place, but this is the main reason why radiation is not reccomended to be chosen over surgery first. If the rad doesnt get it, your viable option list has shortened greatly.

I hope Pete is still doing well, hadn't heard from you in a while.

Wigs, good luck to you in your situation.

David in SC
Age 56, 56 at DX, PSA 7/7 5.8, 7/8 12.3,9/8 14.5
3rd Biopsy Sept 08: Positive 7 of 7 cores, 40-90%, Gleason 7, 4+3
Open RP surgery 11/14/8, Right nerves spared, 4 days hospital, staples out 11/24/8, 5th cath out on 1/19/9
Post-surgery Pathlogy Report:Gleason 3+4=7, pT2c, 42 grm, tumor 20%, Contained in capsular, clear margins, clear lymph nodes 
First PSA Post Surgery   2/9 .05, 6 month on 5/9
 
 


Wigs
Regular Member


Date Joined Mar 2009
Total Posts : 89
   Posted 3/26/2009 9:18 AM (GMT -6)   
I will say that my urologist at MSKCC gave me the big picture, telling me that there would be no attempt at sparing during the surgery. Not in his words, but mine, it was going in and getting everything, prostate, nerves, etc. My pathology report was promising in that the cancer seemed to be well contained within the prostate.
Diagnosed @ age 47 - September 1997
PSA 5 / Gleason 3+3
Seed Implant - January 1998 @ Trident Hospital, SC
PSA 2.4 - July 2007
PSA 2.7 - July 2008
PSA 3.0 - November 2008
Diagnosed @ age 57 - December 2007
Gleason 4+3
Salvage Prostatectomy & Colostomy - March 2008 @ MSKCC, NY
Urethral-Rectal Fistula Repair - August 2008 @   Cleveland Clinic, OH
Colostomy Reversal - January 2009 @ Cleveland Clinic
Will have AUS implant - May 2009 @ Cleveland Clinic
 
 


stxdave
Regular Member


Date Joined Nov 2008
Total Posts : 65
   Posted 3/26/2009 9:36 AM (GMT -6)   
I had salvage prostatectomy at M.D. Anderson in July of 2007. After intermittent Lupron therapy started failing, a prostate biopsy showed the rt. lobe with Gleason (5+4=9) cancer. The only other alternative was to start manipulating hormone therapies and/or chemotherapy. The surgery disclosed seminal vesicle inclusion but all lymph nodes tested were cancer free. There was a lot of cancer debulked.

I would not advise anyone having this surgery at anywhere with less stature than a center of excellence. The irradiated tissue is dissimilar from normal tissue and there are incising, suturing, and healing issues with which most local urologists are not experienced.

My salvage surgery would be considered a failure because after 15 months my PSA started to rise again from less than 0.1 to 0.4, then to 0.67. I am currently taking casodex and my last PSA in January declined to 0.4.

It is still possible for an individual to choose a treatment even though the odds of success are less than favorable. But, at some point you decide to ignore mathematical percentages and hope to beat the odds. It is human nature and, were it not so, they wouldn't sell lottery tickets and places like Las Vegas would have to close.

Dave
Dx'd 1999, Age 60, PSA 43, Gleason (3+4=7), T3c
42-3d EBRT w/Lupron/Casodex for 24 months and PSA remaining to be <0.1 for the entire 24 month period.
July 2001 - 2nd opinion required to go intermittent ADT.
MDAnderson biopsy revised Gleason (4+5=9).
Intermittent ADT, Lupron only, with PSA threshhold established at 1.0.
March 2007 - Diminishing returns with Lupron, conferred with MDA urologist for bilateral orchiectomy. Uro asked for biopsy of prostate again. Biopsy resulted in tumors found with Gleason (5+4=9).
August 2007 - RRP and bilateral orchiectomy. PSA <0.1
99% continent immediately
September 2008 - PSA 0.45
November 2008 - PSA 0.67
December 2008 - Resume Casodex
December 2008 - Stricture in bladder neck requiring surgical removal. 99% incontinent immediately.


Life is not waiting for the storm to pass, it's learning to dance in the rain.


Wigs
Regular Member


Date Joined Mar 2009
Total Posts : 89
   Posted 3/26/2009 10:04 AM (GMT -6)   
In my case, I came out of the surgery with a urethral/rectal fistula. The sutures did not hold due to the tissue damage from the seed implant 10 years earlier. My colorectal surgeon at MSKCC recommended Hyperbaric Oxygen Therapy to promote capillary growth in the damaged tissue. After 20 2 hour sessions, an examination showed that my rectal wound had closed by approximately 50%. My urologist saw improvement in the urethral fisutla, as well. I had 20 more 2 hour sessions before going to Cleveland Clinic for the surgery to repair the fistulas.
Diagnosed @ age 47 - September 1997
PSA 5 / Gleason 3+3
Seed Implant - January 1998 @ Trident Hospital, SC
PSA 2.4 - July 2007
PSA 2.7 - July 2008
PSA 3.0 - November 2008
Diagnosed @ age 57 - December 2007
Gleason 4+3
Salvage Prostatectomy & Colostomy - March 2008 @ MSKCC, NY
Urethral-Rectal Fistula Repair - August 2008 @   Cleveland Clinic, OH
Colostomy Reversal - January 2009 @ Cleveland Clinic
Will have AUS implant - May 2009 @ Cleveland Clinic
 
 


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25364
   Posted 3/27/2009 6:58 AM (GMT -6)   
Wigs,

From looking at your signature, are you from SC also? Trident Hospital is in Charleston I believe. I live in the other end of the state in the Greenville area.

David in SC
Age 56, 56 at DX, PSA 7/7 5.8, 7/8 12.3,9/8 14.5
3rd Biopsy Sept 08: Positive 7 of 7 cores, 40-90%, Gleason 7, 4+3
Open RP surgery 11/14/8, Right nerves spared, 4 days hospital, staples out 11/24/8, 5th cath out on 1/19/9
Post-surgery Pathlogy Report:Gleason 3+4=7, pT2c, 42 grm, tumor 20%, Contained in capsular, clear margins, clear lymph nodes 
First PSA Post Surgery   2/9 .05, 6 month on 5/9
 
 


Wigs
Regular Member


Date Joined Mar 2009
Total Posts : 89
   Posted 3/27/2009 8:31 AM (GMT -6)   
Yes, I'm from SC. I live about 50 miles from Charleston, just up I-26, Holly Hill.
Diagnosed @ age 47 - September 1997
PSA 5 / Gleason 3+3
Seed Implant - January 1998 @ Trident Hospital, SC
PSA 2.4 - July 2007
PSA 2.7 - July 2008
PSA 3.0 - November 2008
Diagnosed @ age 57 - December 2007
Gleason 4+3
Salvage Prostatectomy & Colostomy - March 2008 @ MSKCC, NY
Urethral-Rectal Fistula Repair - August 2008 @   Cleveland Clinic, OH
Colostomy Reversal - January 2009 @ Cleveland Clinic
Will have AUS implant - May 2009 @ Cleveland Clinic
 
 


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25364
   Posted 3/27/2009 9:17 AM (GMT -6)   
Wow, I know Holly Hill. Lived in Manning for 4 years before moving to the Upstate.
Age 56, 56 at DX, PSA 7/7 5.8, 7/8 12.3,9/8 14.5
3rd Biopsy Sept 08: Positive 7 of 7 cores, 40-90%, Gleason 7, 4+3
Open RP surgery 11/14/8, Right nerves spared, 4 days hospital, staples out 11/24/8, 5th cath out on 1/19/9
Post-surgery Pathlogy Report:Gleason 3+4=7, pT2c, 42 grm, tumor 20%, Contained in capsular, clear margins, clear lymph nodes 
First PSA Post Surgery   2/9 .05, 6 month on 5/9
 
 


divo
Veteran Member


Date Joined Jul 2008
Total Posts : 637
   Posted 3/27/2009 12:51 PM (GMT -6)   
Hello David and Wiggs and also Stx,
The reason I was so adamant about the salvage prostectomy is just what wiggs said. Pete also had a fistula with another surgery to fix that. Also, the AUS , although not perfect, again because of the radiation damage, is working much better for Pete. Things are looking up now, although the next PSA is looming.

Di
Husband Pete
dx Jan 2001 gleason 4 + 3 PSA 16.5
Seed implant and conformal radiation and Lupron from Jan 2001 to Jan2002
2005 Dec PSA began to rise from .5 to 8 within 6 months
Salvage surgery at MSK 9/06 Dr. Eastham
Fistula operation 2/07 MSK Dr. Wong
Many cystoscopies and ER visits with strictures
Catheter for one year....Catheter taken out Sept 07..
Total Incontinence since then....
PSA .52 3/08
AUS Operation at MSK Sept 8 2008 Dr. Sandhu
Activated Oct 28th Dr. Sandhu..MSK
Some difficulty with AUS arising Nov 10 2008
Meeting with Dr. Sandhu to discuss AUS problems and new PSA test Dec 11, 2008
PSA .6 12/08
AUS improving..only 2 pads a day and one at night
Complete hip replacement surgery Dr. Waters Gainesville, FL 1/9/09
Hip replacement total success..pain gone!!
PSA .7 2/10/09


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25364
   Posted 3/27/2009 1:45 PM (GMT -6)   
Hello Di,
Nice to hear about your Pete again. Been thinking about the two of you lately. Yeah, I know what you mean about looming PSA tests. Even though I told myself not to get hung up about them after my surgery, I am already dreading and worrying about my six-month test in May. Still a ways off, but already on my mind. It's kind of funny, with the 3 bouts of previous cancer that involved radiation that ended 9 years ago, there was no other followup needed, so it was easy to put that far out of my mind, with PCa, it seems like we are forced to think about it all the time, or at least every few months, don't like that part, but seems to come with the turf.

David in SC
Age 56, 56 at DX, PSA 7/7 5.8, 7/8 12.3,9/8 14.5
3rd Biopsy Sept 08: Positive 7 of 7 cores, 40-90%, Gleason 7, 4+3
Open RP surgery 11/14/8, Right nerves spared, 4 days hospital, staples out 11/24/8, 5th cath out on 1/19/9
Post-surgery Pathlogy Report:Gleason 3+4=7, pT2c, 42 grm, tumor 20%, Contained in capsular, clear margins, clear lymph nodes 
First PSA Post Surgery   2/9 .05, 6 month on 5/9
 
 

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