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why surgery after radiation?

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Posted 12/28/2006 6:09 PM (GMT -8)
hello all,
many people on this forum have commented that surgery after radiation is difficult or impossible. could someone explain why surgery might be necessary after brachytherapy? does anyone know of cases where the brachytherapy didn't kill all the cancer and then the prostate needed to be removed (or some other scenario)??

thank you!
Posted 12/28/2006 6:18 PM (GMT -8)
that is a good question.

we just met with the radiologist yesterday and I didn't think to ask that.  I guess I assumed because radiation therapy might not kill all the cancer cells in the prostate?

Posted 12/29/2006 1:09 PM (GMT -8)

Usually Brachytherapy is regarded as an appropriate treatment for low risk patients, not for those with agressive cancers or any  high risk elements.

Like any treatment it can have failures.  Salvage surgery can be done, but it is more difficult than usual surgery.

John

Posted 12/29/2006 2:43 PM (GMT -8)

Hi gralestel,

The radiation thearapy (brachytherapy) in this case statisticly is every bit as sucessful as any of the surgical techniques. The difference is even if there is a very small chance that a surgical procedure was unsucessful there would always be radiation, or hormone therapy to have as back-up treatments. This may not be possible if a radiation technique is the first treatment. Although it would not entirerly exclude surgery as a fall back option; many surgeons believe that the tissue in and around the treated area would have been too greatly compromised. Then hormone therapy would be the remaining option.

I know swimom has done extensive research in this matter, and I'm sure will soon explain in greater detail what I have left out or missed. 

Glen

Posted 12/29/2006 4:37 PM (GMT -8)
Gralestel,

My surgeon told me that he does 4 or 5 surgeries a year on men that have had radiation first. I guess it depends on the circumstances whether or not he would do it and I am not knowledgable enough to know what those may be. He did say that the complications are considerably worse in those cases.
So to say that surgery after radiation is not an option is not absolutely true but it is a very rare occurance.

Tamu
Posted 12/29/2006 4:52 PM (GMT -8)
Gralestel,

I'm not sure whether you mean a prostatectomy following brachy for cancer or for another reason. The one major reason I can see the as cause for a prostatectomy following successful seeds/radiation would be in the event of severe urinary complications. The prostate is so large or damaged for whatever reason that a man has his prostate removed to relieve symptoms.

Tamu is right...second attempts at a cure for PCa using a prostatectomy is possible. The incontinence risk is about 50% and the impotence rate is 80+. Each man weighs his options and what is most valuable to him in that case.

Swim
Posted 12/29/2006 8:55 PM (GMT -8)
ahhhhh, that makes sense, swim.
Posted 12/29/2006 8:55 PM (GMT -8)
ahhhhh, that makes sense, swim.
Posted 12/29/2006 8:55 PM (GMT -8)
ahhhhh, that makes sense, swim.
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