There is a common misconception that there are no salvage techniques for failed brachy or failed external radiation. 1st the reoccurrance has to be local and not systemic for any salvage therapy to work.
There are salvage therapies available for localized radiation failure and their cure rate is exactly the same as salvage radiation after surgery.
Surgery is a poor option as a salvage therapy, but in the hand of a very experienced surgeon it can be done, but not recommended.
For failed Bracytherapy a patient can be reseeded with a different isotope than the original treatment. (Datttoli Cancer Center)
HDR Brachytherapy is established as a very good option for failed radiation.(PCRI website, search HDR Brachytherapy)
Cryosurgery is also an effective option as is HIFU.
All of the above salvage therapies are better options than salvage surgery.
The main reason that most patients choose Brachy or IMRT or Proton as a 1st line treatment rather than surgery is that the cure rates are similar or better than surgery (Prostate Cancer Study Group 2008) and the temporary and permanent side affects are much lower. This seems like a very resonable decision for many patients.
64 years old.
PSA rising for 10 years to 40, free psa 10-15. Had 5 urologists, 12 biopsies and MRIS all neg. Doctors DXed BPH and continue to get biopsies yearly. 13th biopsy positive in 10-08, 2 cores of 25, G6 less than 5%. Scheduled for surgery as recommended by Urological Oncologist.
2nd Opinion from Dr Sholtz, a Prostate Oncologist, said DX wrong, pathology shows indolant cancer, but psa history indicates large cancer or metastasis. Futher tests and Color Doppler confirmed large transition zone tumor that 13 biopsies and MRIS missed. G7, 4+3, approx 16mmX18mm.
Combidex MRI in Holland eliminated lymphnode mets. Casodex and Proscar reduced psa to 0.6 and prostate from 60mm to 32mm. Changed diet, no meat and dairy. All staging tests indicate that tumor is local and non agressive. (PAP, PCA3, MRIS, Color Doppler, Combidex, tumor reaction to diet and Casodex, and tumor location in transition zone). Surgery a poor option because tumor is located next to the urethea and positive margin is very likely; permanent incontenance is also high probability with surgery.
Seed implants on 5-19-09, 3 hours door to door, no pain, minor side affects are frequency and urgency; very controlable with Flowmax and lasted 4 weeks. Daily activities resumed day after implants with no restrictions. Gold markers implanted with seeds to guide IMRT.
25 treatments of IMRT 6 weeks after seed implants. No side affects at all.
PSA at end of treatment 0.02 mostly the result of Casodex. When I stop Casodex next week expect PSA to rise. Next PSA in November. Treatments and side affects have greatly exceeded my expectations. Glad to have this 11 year journey finally conclude.