Salvage Prostatectomy

Hey fellas anyone here ever had surgery to remove the prostate after failed radiation treatment?

When I was considering it after a biochemical relapse with node involvement 3 years ago, I was told by several Drs things like ''very few surgeons will attempt it, there will be horrendous side effects, your Pca has metatastized what's the point? etc,etc.''

However a new Medical Oncologist i'm under the care of said that surgical techniques have vastly improved since then and if a PSMA scan shows only a few mets, than he believes SP is a good option for me.

It makes sense to me to get rid of the bulk of the cancer. Even though it still won't be a cure,surely it will prolong my life at least in some small way.

Any thoughts?

Thanks,

Mark

15 Replies

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  • Mark,

    Seems like a risk/reward proposition that only you can decide on. I would think your med oncologist knows what he is talking about, and so you now need to consult with a few surgeons to gain confirmation. And if you go ahead, make sure the surgeon you choose is top notch and has a track record of doing such a procedure.

    Best wishes

  • There are two questions that need to be answered before you undergo surgery, effectiveness and ease of operation.

    Recent studies have shown that there is a benefit to removing the primary source of cancer even if it has spread locally. (No benefit if has spread to the bones or distant organs). That was my case 15 months ago when I had to argue (beg) for them to operate even though the cancer was in my lymph nodes. In your case it looks like there may be benefits for surgery.

    The second question may be harder to answer. As radiation turns your insides into "melted mush", most surgeons will not operate. It is just to hard and dangerous. That is why the most people have surgery before radiation (I had 38 rounds four months after surgery). Please discuss this point in detail with your surgeon. Have him explain what technique he/she will use to cut through all of the scar tissue. Then, if you do not mind, share the answer with us.

  • Deano,

    I agree with Hank and Dr. Who.

    I seem to recall that there was a clinical trial many years ago of salvage prostatectomy that found that the disadvantages outweighed any advantages. If you are tempted to try it, I would at least do as much research as you can. I'd also ask the doctor questions like:

    How many salvage prostatectomies have you done?

    What are the differences between operating on a radiated vs. a non-radiated prostate?

    Can you tell me about the results of the salvage prostatectomies you've performed?

    Are there patients I can talk to about it?

    Best of luck.

    Alan

  • There are few around the country who can . One in Mayo minn. Dr.karnes I think. Was presented by Dr kwon in many syosiums. Ask what the side effects might be. They can be drasti. Good luck. Rocco

  • Debulking the primary PCa by surgery even after the cancer has spread out is a modern approach some oncologists ( a minority ) prefer to pursue. All types of dangerous cancer cells remain mostly in the prostate gland and on the face of the idea it could be beneficial since the residual cancer is going to be of low burden once the main source is eliminated. But prostatectomy after radiation could be a very complex issue and I fully agree with Dr.WHO and Alan. Certainly you need to think seriously.

    Wish you the best.

    Sisira

  • I wonder if HIFU would be a better alternative to conventional surgery. I opted for HIFU as my first treatment option for non-metastasized Gleason 8 PC. It was approved last year by the FDA for ' prostate tissue ablation'. Here's a link (not endorsing this practice, I went to the SF area for my treatment): greaterbostonurology.com/hi...

  • Correction -- it was approved 2 years ago. How time flies when dealing with PC.

  • Was PC detected my MRI or other means? I would guess that the PC had metastasized prior to radiation but was undetectable by scans. What was your PSA history?

  • The reoccurred PCa was detected by MRI. Two bone scans 6 months apart were both interpreted differently. The first one showed several "suspicious areas",the second one was clear.

    PSA 5.1 on dx Sept 2006. Back then Bone scan and pelvic ct clear. G 4+3 2 cores.

    Psa was around 1.0 for about 5 years after EBRT. Then it started to rise, 1.2 to 2.5 in 10 months, 3.7 in June 2014 when relapse was dx. Started ADT at PSA of 15.0 in Sept. 2015. Went intermittant June 2016 with PSA of 0.03. Resumed ADT March 2017 when PSA went to 15.8.

  • Just as a footnote I changed DRs in March 2017 because my treating Dr,who is a Radiation Oncologist,and who was involved in my initial treatment back in 2006, wanted to wait until my PSA was 20 to resume ADT. Even then his approach was stay on Lucrin until that stops working, and then go on to something else.

    I'm now seeing a Medical Oncologist who specializes in PCa, after some good advise I've received from this and another site. This Dr said he would never have let me go on IADT in the first place.

    Since my biochemical relapse, and I know that you can't look back with regret on decisions you've made in the past, I'm convinced that I was given the wrong advise to have the Radiation instead of surgery.

    Anyway thanks for letting me vent!

    Thanks for your help fellas,

    Cheers

    Mark

  • I had a significant recurrence 5 years after radiation with a Gleason 9. I had surgery at MD Anderson by Dr. Louis Pisters. Although it didn't cure me, the doctors there hold to the principle that removing the source of the cancer is advantageous. The side effects consistent of impotence and incontinence. The latter did not resolve, so after a year, I has a artificial urinary sphincter installed, which has worked.,. MDA is a great place to be treated, and I strongly recommend it.

  • So would you say the side effects were pretty much the same as one would expect with a normal Radical Prostatectomy? Why would that be, because of the skill of the surgeon?

  • No. Much worse. First, there was no nerve sparing, so the impotence was total. Likewise for the incontinence; due to the difficulty of the surgery, it caused total incontinence. For a normal RP, this is often a temporary condition that resolves over time. However, Dr. Pisters' advanced skill allowed this difficult surgery to be done at all. Despite the impacts, I have no regrets.

  • Thanks jal1954 . I really appreciate your input.

    Mark

  • Thank you all for your replies and advise. Will keep you posted.

    Mark

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