The primary treatment for failed radiation is cryosurgery. Low Dose Brachy, High Dose Brachy and HIFU are also used as salvage treatments. There are a few surgeons that specialize in salvage surgery and it is not recommended unless you use one of these highly specialized surgeons.
I am of the opinion that one picks the primary treatment that does the best job of eliminating that person's individual cancer and not use a salvage treatment as part of thier decision. Persons who have a large prostate, difficulty in urinary funcions, a large volume, high grade cancer that is contained may be better served by surgery.
Small tumors of any grade, tumors that are close to the edge or a nodule felt by DRE, or tumors that have nerve involvement, seminal vessicle involvement, transition zone tumors and tumor close to the Apex margin are probably better served by radiation. Indications of any extracapsular extensions by MRIS or color doppler are much better suited to radiation.
As Strum often says, "the biology of your individual cancer should dictate the treatment" and not the availability of a salvage treatment.
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.