Surgery -after- radiation?

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Regular Member

Date Joined Nov 2009
Total Posts : 212
   Posted 2/25/2010 12:27 PM (GMT -6)   
I know the normal way of thinking is that once you have radiation, surgery becomes very difficult, but I came accross this study:

Has anyone here had surgery after radiation?? Is there really any reason not to with an aggressive cancer (Gleason 9-10)?

On a related note, I see in a lot of peoples signatures that they are Stage 3, and they talk about their surgury, but I thought surgery was usually not done if it is stage 3 (ie. out of the prostate)??

James C.
Veteran Member

Date Joined Aug 2007
Total Posts : 4463
   Posted 2/25/2010 12:40 PM (GMT -6)   
One thing I noticed is the surgery followed 5 weeks of hormones and radiation. I suspect that 5 weeks aren't long enough periods that the typical guy who does have surgery after radiation and hrt does. Usually, brady and conventional radiation is months or even years before reoccurance of PCa, resulting in the gland being much more damaged, fused and such , which is the biggest problems with salvage surgery, I think. That said, I like their approach of throwing all of it at it at once.
James C. Age 62
Co-Moderator- Prostate Cancer Forum
4/07 PSA 7.6, referred to Urologist, recheck 6.7
7/07 Biopsy: 3 of 16 PCa, 5% involved, left lobe, GS 3/3=6
9/07 Nerve sparing open RRP 110gms.- Path Report: GS 3+3=6 Stg. pT2c, 110gms, margins clear
32 mts: PSA's: .04 each test since surgery, ED Continues-Bimix .3ml PRN or Trimix .15ml PRN

Regular Member

Date Joined Jun 2009
Total Posts : 292
   Posted 2/25/2010 12:50 PM (GMT -6)   
My uro said he did surgery one time after radiation and it was much more difficult than it would have been otherwise. I understood that to me greater chance for error and less chance for success.
Diagnosed at 54
PSA 8.7 Biopsy 1/7/09
4 of 6 cores positive, one at 90%
Gleason 3+4=7 Neg bone scan 1/15/09
One shot Lupron Depot 1/27/09 Tax Season
RP 4/29/09
Neg lymph nodes, postive seminal vesicle, 1 positive margin
Gleason 3+4=7 with tertiary 5
Catheter out at 2 weeks no nighttime incontinence Pad free week 5
PSA 6/6/09 <0.1 PSA 9/10/09 <0.1

Veteran Member

Date Joined Dec 2008
Total Posts : 3149
   Posted 2/25/2010 2:20 PM (GMT -6)   
Sometimes the theory is to remove prostate in any scenario of high risk patient (high stats)at any time, so as to 'debulk the tumor burden' on the patient. I have no idea how relevant that theory is in outcomes and prognosis's and so have no thoughts on it, other than neandrathal thinking of get rid of any garbage when you can....however in PCa...that is not easy to assess or guarantee that and because of micro mets, perinureal invasion and other unknows it can be done for might buy you more time is the plus side of this theory. (and I don't know if that is true...logically seems possible).
Youth is wasted on the Young-(W.C. Fields)

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Date Joined Jan 2010
Total Posts : 7082
   Posted 2/25/2010 3:36 PM (GMT -6)   
In my case, the pT3 rating did not come back until the post-op pathology report. I suspect a lot are like that - biopsy is borderline to start with, but there was no positive indication on Bone / CT scans. It was out after all, but they didn't know that.

I was also told that if the bone scan was positive, or there was gross EPE, that they didn't do or wouldn't proceed with the surgery. Guess I fell in the gray area.

Veteran Member

Date Joined Jun 2008
Total Posts : 1804
   Posted 2/25/2010 4:28 PM (GMT -6)   
Gibson, I understand your confusion over surgery with stage 3 situations. What you need to keep in mind is that, with surgical removal of the prostate, there are 2 stages assigned: the clinical (based on PSA, DRE, biopsy, etc.) and the pathological (based on detailed examination of the surgical specimen). Having the surgical pathology along with a more complete staging and Gleason score is one of the benefits of having a prostatecomy. Surgery is generally not recommended to treat clinical stage 3 prostate cancer.
Husband diagnosed in 2/2008 at age 57 with stage T1c. Robotic surgery performed 3/2008. Stage upgraded to T3a (single small EPE in posterior left). Perineural tumor infiltration present. Apex margin, bladder neck and SV negative. Final Gleason 3+4. PSA: 0.0 til July 2009. August 2009- 0.1, September 0.3, October back to 0.0, December 0.0. Thank you God!

Elite Member

Date Joined Oct 2008
Total Posts : 25393
   Posted 2/25/2010 5:11 PM (GMT -6)   
Two thoughts:

Often the Stage III designation is not known until after the surgical pathology report comes in. The biopsy is an estimate, the pathology after surgery is a fact.

I have repeated this story several times here at HW. My surgeon said as an intern, he had to assist in a couple of prostate removals after radiation, and that they were the most brutal surgeries he had ever seen or had a part in. He said he would not do another one under any circumstances, as the prostate bed becomes fused with everything else, and precise surgical lines are nearly impossible to maintain. And in all likelihood, the patient will end up with total and perm. incontinence at the least.

David in SC
Age: 57, 56 dx, PSA: 7/07 5.8, 7/08 12.3, 9/08 14.5, 10/08 16.3
3rd Biopsy: 9/08 - 7/7 Positive, 40-90% Cancer, Gleason 4+3
Open RP: 11/08, Rht nerves saved, 4 days in hospt, on catheters for 63 days, 5th one out 1/09
Path Rpt: Gleason 3+4, pT2c, 42g, 20% cancer, 1 pos margin
Incontinence:  1 Month     ED:  Non issue at any point post surgery
Post Surgery  PSA: 2/09 .05,5/09 .1, 6/09 .11. 8/09 .16
Post SRT PSA: 1/10 .12
Latest: 7/9 met 2 rad. oncl, 7/9 cath #6 - blockage, 8/9 2nd corr surgery, 8/9 cath #7 out 38 days, 9/9 - met 3rd rad. oncl., mapped  9/9, 10/1 - 3rd corr. surgery - SP cath/hard dialation, 10/5 - 11/27 IMRT SRT 39 sess/72 gys ,cath #8 33 days, Cath #9 35 days, 12/7 - Cath #10 43 days, 1/19 - Corr Surgery #4,  Caths #11 and #12 in at the same time, 2/8-Cath #11 out - 21 days

English Alf
Veteran Member

Date Joined Oct 2009
Total Posts : 2218
   Posted 2/26/2010 5:33 AM (GMT -6)   
Yes my staging is related to my post-op pathology too.

Aren't the stats something like 30% of Gleason scores get upgraded, so there must be a number of those whose staging goes up from 2 to 3 as well.

I also heard that it is very difficult (and therefore unwise) to remove the prostate after radiation as at the margins the "frazzled" tissue can get stuck to everything nearby, that can include nerves, bloodvessels, the underside of the bladder and the rectum, so it is thus a "nightmare" to try and remove just the prostate.

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