There have been a lot of comments on this board that imply there are no good salvage treatments for failed radiation and a major reason for choosing surgery as a first line treatment is that you have a 2nd chance. Many urologists (surgeons) tell this to their patients on a regular basis.
The facts tell us that this is a misconception of uniformed doctors and patients.
The following article is devoted to salvage treatments available after a failed radiation:
To summarize the important points:
1. Only 26% of radiation failures are local. The vast majority are systemic failures. The same holds true for surgery.
2.. Salvage options:
c. low dose brachy
d. High dose brachy
e. radical surgery.
3. Results from High dose Brachy salvage:
Lee et al: 19 month follow up; 89% biochemical free.
Tharp et al: 58 month, 71% disease free
Gamie et al: 41% disease free at 41 months.
All of these results are better than the often quoted 30% disease free of salvage radiation after 1st line surgery.
The statements that there are no 2nd chances after failed 1st line radiation treatments are false.
Some of the salvage treatments, such as HDR Brachy, have better outcomes than SRT after a failed surgery.
The important thing to note that in all salvage treatment regardless of the 1st line treatment chosen, the reoccurrance must be local in order to be effective.
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.