If you have radiation you cannot ever have surgery

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Ger42
Regular Member


Date Joined Apr 2010
Total Posts : 189
   Posted 5/24/2010 1:11 PM (GMT -6)   
Someone on another board wrote that if you have any type of radiation therapy on your prostate you can never opt to have your prostate removed. Is this true?
I go tomorrow for a nuclear stress test to see if my heart could withstand a DiVinci operation. If not I'll have some thinking to do. Removal is my current choice.
Age 68 on 4/30/2010
weight 185
height 6'
Samples taken 4/19/2010
3 out of 12 samples cancer
1) gleason score 3+3 involving 65%
2) gleason score 3+3 involving 65%
3) gleason score 3+3 involving 10%

PSA 3.5 Mar 19
PSA 2.5 Apr 4


Paul1959
Veteran Member


Date Joined Nov 2007
Total Posts : 598
   Posted 5/24/2010 1:23 PM (GMT -6)   
That statement is a bit extreme. I think it is safe to say that Radiation can make it difficult and perhaps more challenging to perform surgery. How's that for a vague promise! You can't say never. New techniques are being developed every day to cope with things like this. Many doctors will not do surgery post radiation, but some will. It depends on how much, what kind, how burned the parts are, etc. But, in general, it is safe to say that at the very least, it truly compromises the possibility of surgery.
Paul
www.franktalk.org ED website for PCa guys

46 at Diagnosis.
Father died of Pca 4/07 at 86.
10/07 PSA 5.06 (Biopsy 11/07 1 of 12 with 8% involvment) (1mm)
Da Vinci surgery Jan 5, '08 at Mt. Sinai Hosp. NYC www.roboticoncology.com
Saved both nerve bundles.
Path Report: Stage T2cNxMx
-Gleason (3+3)6
Pad free on March 14 - (10 weeks.) Never a problem since.
ED - at one year, ED is fine with viagra.
Two year PSA - undetectable!


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25380
   Posted 5/24/2010 1:29 PM (GMT -6)   
As a general rule, most surgeons will not do a prostate removal surgery after radiation has been used as a primary treatment. There are exceptions to that rule, and there are few remote cases where it went well. Often, its an overly complicated and messy surgery, with a lot of risk of bleeding, and the radiation damaged areas make it hard to make surgical lines accurately. My own surgeon refuses to do them, said he had to assist in a couple of salvage surgeries when he was in medical school, and that they were the most brutal surgeries he had ever seen. Often, the surgeries are blotched, and its almost a guaranty that there will be 100% incontinence and ED after the surgical attempt. If a person really, had to have one, then they would have to find the rare surgeon with some first hand sucess experience in doing one, something I believe would be hard to find.
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, no problem post SRT
Post Surgery  PSA: 2/09 .05,5/09 .1, 6/09 .11. 8/09 .16
Post SRT PSA: 1/10 .12, 4/8 .04, next one:  July
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  same time, 2/8-Cath #11 out - 21 days, 3/2- Cath #12 out - 41 days, 3/2- Corr Surgery #5, 3/6 Cath #13 out - 4 days, Cath #14- 27 days, Cath #15 - 26 days, Cath #16 - 31 days, 5/24 put in Cath #17


Tudpock18
Forum Moderator


Date Joined Sep 2008
Total Posts : 4156
   Posted 5/24/2010 1:58 PM (GMT -6)   
Ger, "never" is a strong word and I probably would not use it in this case.  However, as the others have said, post radiation surgery is a risky propostion and should only be done by a highly experienced surgeon.  Having said that I can tel you that as a brachytherapy patient myself, I would not personally opt for surgery if my radiation treatment fails.
 
However, there is some good news for you.  If surgery is you choice and you cannot have it and must have radiation, there are still several very good options for salvage treatment if your radiation treatment fails.  They include reseeding, cyrotherapy, HIFU and HT.  The salvage success for those treatments is equal to the post surgical salvage success with radiation.
 
I hope this helps and good luck to you.
 
Tudpock (Jim)
Age 62, Gleason 3 + 4 = 7, T1C, PSA 4.2, 2 of 16 cores cancerous, 27cc
Brachytherapy December 9, 2008.  73 Iodine-125 seeds.  Procedure went great, catheter out before I went home, only minor discomfort.  Regular activities resumed, everything continues to function normally as of 4/10/10.  6 month PSA 1.4 and now 1 year PSA at 1.0.  My docs are "delighted"!

142
Forum Moderator


Date Joined Jan 2010
Total Posts : 6949
   Posted 5/24/2010 2:22 PM (GMT -6)   
My DaVinci surgeon said basically the same thing as everyone else is repeating above - the surgery on a "cooked" prostate is extremely difficult. He was not willing to consider radiation first in my case.

As said, it is "possible", as are most things given the appropriate skill, time, and money. Which means for the average guy with average insurance, not a chance -

Ziggy9
Veteran Member


Date Joined Jul 2008
Total Posts : 981
   Posted 5/24/2010 4:06 PM (GMT -6)   
I know that this many times is the reason many opt for surgery as a primary treatment. Not often mentioned is that salvage radiation after radical surgery has only a 30% success rate.
Diagnosed 11/08/07 - Age: 58 - 3 of 12 @5%
Psa: 2.3 - 3+3=6 - Size: 34g -T-2-A
 
2/22/08 - 3D Mapping Saturation Biopsy - 1 of 45 @2% - Psa:2.1 - 3+3=6 - 28g after taking Avodart - Catheter for 1 day -Good Candidate for TFT(Targeted Focal Therapy) Cryosurgery(Ice Balls) - Clinical Research Study
 
4/22/08 - TFT performed at University of Colorado Medical Center - Catheter for 4 days - Slight soreness for 2 weeks but afterward life returns as normal
 
7/30/08 - Psa: .32
11/10/08 - Psa.62 -
April 2009 12 of 12 Negative Biopsy
 
2/16/10 12 of 12 Negative Biopsy 
 
 
 


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25380
   Posted 5/24/2010 4:28 PM (GMT -6)   
That is quite true, Realziggy, but for those of us that opt for salvage radiation, you can only hope you are in the 30% group as your last curative attempt to stop the cancer. In my case, due to rapid PSA velocity pre-surgery, my odds of the salvage working were reduced to the 20% group. But again, at age 57, I wanted to use whatever curative means I had, despite the lower odds.
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, no problem post SRT
Post Surgery  PSA: 2/09 .05,5/09 .1, 6/09 .11. 8/09 .16
Post SRT PSA: 1/10 .12, 4/8 .04, next one:  July
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  same time, 2/8-Cath #11 out - 21 days, 3/2- Cath #12 out - 41 days, 3/2- Corr Surgery #5, 3/6 Cath #13 out - 4 days, Cath #14- 27 days, Cath #15 - 26 days, Cath #16 - 31 days, 5/24 put in Cath #17


Ziggy9
Veteran Member


Date Joined Jul 2008
Total Posts : 981
   Posted 5/24/2010 5:02 PM (GMT -6)   
I understand what you are saying Dave. My post was more directed to some who I think choose surgery based on an expected much higher cure rate for salvage than it is.

John T
Veteran Member


Date Joined Nov 2008
Total Posts : 4227
   Posted 5/24/2010 5:47 PM (GMT -6)   
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.

JohnT

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.

JohnT


Casey59
Veteran Member


Date Joined Sep 2009
Total Posts : 3172
   Posted 5/24/2010 5:55 PM (GMT -6)   
realziggy said...
...Not often mentioned is that salvage radiation after radical surgery has only a 30% success rate.

It is not meaningful to generalize in this way.  There are far too many variables...what was PSA before surgery, what was Gleason, were surgical margins positive, was there EPE, how many months before biochemical recurrence, what was PSADT?
 
For the most commonly occurring cases, the success rate is much higher.  The best thing to do is to use the free online Sloan-Kettering nomogram to calculate the probability based on a statistical distribution of cases similar to one's individual case characteristics.
 
 
 
That being said, John's quote from Strum should be repeated over and over to all newcomers:  "the biology of your individual cancer should dictate the treatment."

Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25380
   Posted 5/24/2010 6:49 PM (GMT -6)   
real ziggy: i do understand your point, i think that salvage radiation is over sold to with some people, and for those that never have experienced any radiation treatments before, they be totally clueless of what it can mean, and what happens when things go wrong.

johnt: i still agree with the heart of what you are saying, i don't think you should choose a primary treatment based on what secondary treatment is available, but i think that you should be made well aware of what your options will be if your primary fails. choosing a surgical solution just because you can have salvage radiation is not a good enough reason to choose surgery and its impact if that is a persons only reason.

the primary treatment should be what best suits the true situation of the cancer at that point, and the general health of the patient
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, no problem post SRT
Post Surgery  PSA: 2/09 .05,5/09 .1, 6/09 .11. 8/09 .16
Post SRT PSA: 1/10 .12, 4/8 .04, next one:  July
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  same time, 2/8-Cath #11 out - 21 days, 3/2- Cath #12 out - 41 days, 3/2- Corr Surgery #5, 3/6 Cath #13 out - 4 days, Cath #14- 27 days, Cath #15 - 26 days, Cath #16 - 31 days, 5/24 put in Cath #17


James C.
Veteran Member


Date Joined Aug 2007
Total Posts : 4462
   Posted 5/25/2010 8:51 AM (GMT -6)   
David, speaking of things going wrong, here's a question for your Radiation doctor. I think we both are in the same category here, so it might apply to you. We both had open surgery. A year later, I had a lower back xray and the doctor was startled to see probably 50 metal clips that the surgeon had used during my surgery, clamping off stuff. They looked like used staples, you know the ones that have been thru a stapler, spread all over my abdomen. We speculated as to why so many, but it just occurred to me that metal scatters radiation, and this may be why yours went so wrong, if your surgeon did in fact use metal clips, as mine did. It also gives me pause as to what I would do if I should need future radiation treatment. How about asking your radiation spec. about this, the next time you speak to them?
James C. Age 63
Gonna Make Myself A Better Man www.youtube.com/watch?v=a6cX61oNsRQ&feature=channel
4/07: PSA 7.6, Recheck after 4 weeks Cipro-6.7
7/07 Biopsy: 3 of 16 PCa, 5% invloved, left lobe, GS3+3=6
9/07: Nerve Sparing open RRP, 110gms, Path Report- Stg. pT2c, 110 gms., margins clear
3 Years: PSA's .04 each test since surgery, ED continues: Bimix- .3ml PRN, Trimix- .15ml PRN


RickyD
Regular Member


Date Joined Dec 2009
Total Posts : 163
   Posted 5/25/2010 6:26 PM (GMT -6)   
medved posted this a few days ago:    http://www.jnccn.org/content/8/2/228.full.pdf

This report indicates much better than 30% success rate for salvage radiation.
This is from Feb 2010 and I believe is that latest information on adjunct and salvage radiation after prostatectomy.


Age 55,  PSA = 4.97 on 11/17/09, DRE negative,
Biopsy 12/2/09:  1 of 12 cores positive with less than 5% volume, Gleason 3 + 3 = 6
RALP performed on 4/7/10 at Vanderbilt University MC with Dr. Joseph Smith
Final Pathology on removed prostate:
Prostatic Adenocarcinoma present bilaterally from apex to base and extending to inked margin at right apex. 
Gleason 3 + 3 = 6, stage pT2c
Prostate Size  = 59 grams, Tumor 5% of total prostate volume.
SV negative, EPE negative, PNI present. Lymph nodes - not checked
5/24/10 PSA < 0.10  (undetectable)
 
 
 

Post Edited (RickyD) : 5/25/2010 6:33:05 PM (GMT-6)


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25380
   Posted 5/25/2010 6:47 PM (GMT -6)   
james, thanks for the tip, I have since emailed you about this point. Will definitely bring it up with my uro next time we meet.
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, no problem post SRT
Post Surgery  PSA: 2/09 .05,5/09 .1, 6/09 .11. 8/09 .16
Post SRT PSA: 1/10 .12, 4/8 .04, next one:  July
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  same time, 2/8-Cath #11 out - 21 days, 3/2- Cath #12 out - 41 days, 3/2- Corr Surgery #5, 3/6 Cath #13 out - 4 days, Cath #14- 27 days, Cath #15 - 26 days, Cath #16 - 31 days, 5/24 put in Cath #17


goodlife
Veteran Member


Date Joined May 2009
Total Posts : 2691
   Posted 5/26/2010 7:04 AM (GMT -6)   

Ricky D/medved,

That was a very interesting study.  The other nugget in there was that 1 in 3 men will experience BCR after RP.  This number does not correlate at least in principal to the nomograms that would indicate closer to a 90 % curative rate.

It certainly speaks strongly for adjuvant therapy as well, but only from a clinical pount of view.   If you take side effects into account, the possiblility of permament incontinence is a big consideration for quality of life issues.

As a Gleason 9 patient, I was encouraged to do adjuvant, but did the wait and see based on PSA and continence issues.

Thanks for the link.


Goodlife
 
Age 58, PSA 4.47 Biopsy - 2/12 cores , Gleason 4 + 5 = 9
Da Vinci, Cleveland Clinic  4/14/09   Nerves spared, but carved up a little.
0/23 lymph nodes involved  pT3a NO MX
Catheter and 2 stints in ureters for 2 weeks .
Neg Margins, bladder neck negative
Living the Good Life, cancer free  6 week PSA  <.03
3 month PSA <.01 (different lab)
5 month PSA <.03 (undetectable)
6 Month PSA <.01
1 pad a day, no progress on ED.  Trimix injection
No pads, 1/1/10,  9 month PSA < .01
1 year psa (364 days) .01


STW
Regular Member


Date Joined Jun 2009
Total Posts : 292
   Posted 5/26/2010 11:47 AM (GMT -6)   
My Uro said he's done over 2000 RPs. Only two of those were after radiation treatment. He said they were much more difficult than they would have been otherwise. I got the impression he'd just as soon not do it again.
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 T3b
Catheter out at 2 weeks no nighttime incontinence Pad free week 5
PSA 6/6/09 <0.1; 9/10/09 <0.1; 3/11/10 <0.1


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25380
   Posted 5/26/2010 2:52 PM (GMT -6)   
I agree with your conclusion, STW. If your surgeon has only done 2 salvage, that would be equal to just 1/10 of 1% of his total surgeries or less. After participating in 2 himself when he was still in medical college, my own surgeon has refused to do any in his long career.
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, no problem post SRT
Post Surgery  PSA: 2/09 .05,5/09 .1, 6/09 .11. 8/09 .16
Post SRT PSA: 1/10 .12, 4/8 .04, next one:  July
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  same time, 2/8-Cath #11 out - 21 days, 3/2- Cath #12 out - 41 days, 3/2- Corr Surgery #5, 3/6 Cath #13 out - 4 days, Cath #14- 27 days, Cath #15 - 26 days, Cath #16 - 31 days, 5/24 put in Cath #17

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