Surgery verus other treatments

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Regular Member

Date Joined May 2009
Total Posts : 24
   Posted 3/10/2010 11:07 AM (GMT -6)   
My surgery is one year past at this time and other than minor drips things look well. However, during my pre-surgery time I was led to believe that any of the alternative treatments precludes surgery later. A good friend of mine is now in the same situtation and he is leaning toward a non-surgery treatment, i.e. proton therapy or seeds. Could someone comment on the likelihood of surgery after radiation, laser or other treatments.
70 year old male
PSA of 5.1

3/9/09 robotic surgery

non nerve sparing surgery

5/5/09 PSA Non detectable

5/24/09 slowly regaining bladder control.

6/8/09 graduated to thinner liners at night and most of the day. Pads when doing physical work, or going out of house for short trips.

8/18/09 PSA Non detectable at <.03

8/27/09 PSA redone by Mayo Clinic at my request - Non-detectable at <.0.01

11/20/09 PSA Non detectable using the super sensitive method.

Veteran Member

Date Joined Jul 2008
Total Posts : 966
   Posted 3/10/2010 11:47 AM (GMT -6)   
Charlie...I understand that surgery as a salvage for radiation is not the best scenerio...although there are some that have done it. I don't think a person should plan a primary treatment based on what secondary treatment is available. Primary treatment should be based on what the person feels is best for them ant then deal with salvage therapy if needed, not beforehand. But I will admit, salvage therapy was in the back of my mind and did influence my decision for surgery somewhat. And I will also admit that was wrong for me to think that way too.
You are beating back cancer, so hold your head up with dignity
Age 58 at Diagnosis
Oct 2006 - PSA 2.6 - DRE Normal
May 2008 - PSA 4.6 - DRE Normal / TRUS normal
July 2008 - Biopsy 4 of 12 Positive 5 - 30% Involved Bilateral w/PNI - Gleason (3+3)6 Stage T1C
Robotic Surgery Sept 18, 2008
Pathology October 1, 2008 - Gleason 7 (3+4) Staged pT2c NO MX - Gland 50 cc
Seminal Vesicles and Lymph Nodes clear
Positive Margins Right Posterior Lobe
PSA 5 week Oct 2008 <.05
                   3 month Jan 2009 .06
                   6 month Apr 2009 .06
                   9 month Jul  2009 .08
                 12 month Oct 2009 .09 

Regular Member

Date Joined Nov 2008
Total Posts : 65
   Posted 3/10/2010 11:48 AM (GMT -6)   
There are very few urologists that will perform surgery after a radiated prostate. The tissue is more rigid and heals differently.
Incontinence occurs in a large percentage of these patients. Since the success rate is so low, most post-radiation surgeries occur at major cancer centers or teaching hospitals where things are to be learned from the procedure.

As one of those patients, I was told at the outset that the surgery option was eliminated once radiation was selected. After a couple of years I became a patient at M D Anderson. When hormone therapy started failing, my prostate was biopsied, cancer found in the prostate, and was offered surgery. True to form I am now experiencing the world of incontinence and stricture surgeries.

Good luck to both you and your friend.

Dx'd 1999, Age 60, PSA 43, Gleason (3+4=7), T3c
42-3d EBRT w/Lupron/Casodex for 24 months.
July 2001 - Intermittent ADT. Lupron only, MDAnderson biopsy revised Gleason (4+5=9).
March 2007 - Diminishing returns with Lupron, Prostate biopsy (5+4=9) in unradiated lobe.
August 2007 - RRP and bilateral orchiectomy. PSA <0.1
99% continent immediately
Sept 2008 - PSA 0.45, Nov 2008 - PSA 0.67,
Dec 2008 - Resume Casodex, Stricture in bladder neck requiring surgical removal. 99% incontinent immediately.
Feb 2010 PSA 2.8 Added Avodart, More strictures requiring surgical removal. Artificial sphincter scheduled in April or May.

John T
Veteran Member

Date Joined Nov 2008
Total Posts : 4171
   Posted 3/10/2010 12:54 PM (GMT -6)   
Surgery can be performed after a local occurance of PC after radiation. It is a difficult surgery and only a few doctors in the US are capable of doing it without severe morbidity. Unless you go to one of these specialists it is not a good choice.
Better choices for failed radiation are cryosurgery, HIFU and HDR Brachytherapy. All of these have worked with the same cure rate as salvage radiation after surgery, which is about 30%. The reson for the low cure rate for any salvage therapy is that most reoccurrances are systemic and not local. If a reoccurrance is proven to be local then salvage treatments work well.
For failed Brachytherapy you can also be reseeded with a different isotope.

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.


Regular Member

Date Joined Jan 2010
Total Posts : 87
   Posted 3/10/2010 9:25 PM (GMT -6)   
It was a no brainer for surgery for me. But, as all of say on this forum, each of us has to call our own play. Obviously, age, gleason, biopsy results all play a part. I opted for surgery as mentioned previously: With surgery, you have post surgery options. With radiation, surgery is no longer an option. From radiation first, the prostate is too badly damaged and if if the cancer then has spread outside the margins, then there is a whole new playbook. The gleason/age correlation would be the most important call. At my age, with a gleason of 8, as I said, a simple decision. Da Vinci.
Age 54
PSA 8/2009 5.6 Gleason 8
DaVinci surgery 11/2009
Pathology - totally contained in margins -one bundle spared
PSA now undetectable at < .05
Continance: 1 pad and almost normal
Doing 3 P's and now using trimix

Veteran Member

Date Joined Aug 2007
Total Posts : 1015
   Posted 3/10/2010 10:21 PM (GMT -6)   
Charlie... Congratulations; it looks like you're on a nice path to good health!

Les... Very nice to "see" you again, brother.

Best to all!

Surgery: Da Vinci; July 31, 2007; 54 on surgery day;
Pathology: PSA: 4.3; Gleason: 3+3=6; T2a; Confined to Prostate;
Post RP PSAs: 09/07 <0.04; 12/07 <0.04; 03/08 <0.04;
06/08 <0.04; 12/08 <0.04; 06/09 =0.06; 09/09 <0.04;
Latest PSA 12/09 =0.05

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