Surgery AFTER radiation

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New Member

Date Joined Sep 2010
Total Posts : 1
   Posted 9/3/2010 7:07 PM (GMT -6)   
I have heard and read conflicting reports about the possibility of prostatectomy surgery AFTER radiation. A surgeon, who does DaVinci type surgery, told me (in answer to my question), "Yes, I have done a number of "clean-up" surgeries after radiation failed." He did say it was more difficult after radiation.  One who asked the same question of other surgeons and urologists told me, "they described a post-radiated prostate as having indistinct margins from the surrounding tissue. In other words, it's not really a self-contained organ anymore.  And, radiation failed, which usually indicates the cancer cells have escaped the prostate.  So, you have a radiated prostate feeding cancerous cells into the surrounding area and the prostate itself is now difficult (some say impossible) to remove. "
I would be interested to know if anyone has had direct experience with surgery after radiation.
Many thanks in advance

Elite Member

Date Joined Oct 2008
Total Posts : 25393
   Posted 9/3/2010 8:22 PM (GMT -6)   

welcome here for starters.

my surgeon has almost 30 years experience as a uro/surgeon, and he said he had participated in to post radiation prostate removal surgery while he was a resident. he said they were very brutal surgeries, and he has never done once since, and would never do one again, period. for starters, the patient is almost guaranteed 100% total incontinence for life, and as you described above, the prostate and prostate bed are just one big mess of merged and melted margins. There are surgeons that will do it, but far and few between. As far as there being any curative hope on a salvage surgery, the chances would be slim to none from what i have been told.

david in sc
Age: 58, 56 dx, PSA: 7/07 5.8, 10/08 16.3
3rd Biopsy: 9/08 7 of 7 Positive, 40-90%, Gleason 4+3
open RP: 11/08, on catheters for 101 days
Path Rpt: Gleason 3+4, pT2c, 42g, 20% cancer, 1 pos marg
Incont & ED: None
Post Surgery PSA: 2/09 .05,5/09 .1, 6/09 .11. 8/09 .16
Post SRT PSA: 1/10 .12, 4/8 .04, 8/6 .06 11/10 ?
Latest: 6 Corr Surgeries to Bladder Neck, SP Catheter since 10/1/9, SRT 39 Sess/72 gy ended 11/09, on Catheter #21, will be having Ileal Conduit Surgery in Sept.

John T
Veteran Member

Date Joined Nov 2008
Total Posts : 4268
   Posted 9/3/2010 9:49 PM (GMT -6)   
There are a few specialized surgeons that perform this. It is not recommended. The primary treatment for failed radiation is cryosurgery, HIFU, or HDR Brachytherapy. In order for the treatment to be successful the cancer has to be confirmed to be contained. There is no local treatment that will cure PC if it is not local.

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.


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