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
Written by
deano58
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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.
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.
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?
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...
in reply to
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.
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.
I decided to reply even though this is an old post in the event someone else is contemplating having a salvage prostatectomy. DON'T DO IT. I had EBRT in 2011/12 after Gleason 8, cancer in 8 of 10 cores. All went well until 2015 when cancer returned and I was told that some hotshot surgeon at DanaFarber Medical Ctr has been doing about one monthly with 80% or greater success. I agreed to have it done and life has been hell since I had it and my cancer is now metastatic (not his fault). They thought they had all the cancer, they took nodes which were all negative, but urologically: I got out of the hospital with the typical foley catheter, which was pulled out after a week and I did fine, being able to urinate more or less normally. DONT DO IT
DONT DO IT About 5 weeks later I had urinary retention, and I had to be have an emergency foley to keep my bladder from rupturing. That led to 6 months of self catheterization (fun for you and your whole family). Eventually, I became incontinent...more fun: diapers, pads, wet pants. Those who remember what it's like to go out with diaper bags for their kids can relate. Then I had urinary retention again but they couldn't get a foley through the sphincter due to the scar tissue, so now I have a suprapubic catheter that drains into a bag and I'm incontinent to boot, so I still need pads
(more fun for the whole family...damn bags leak from time to time or get disconnected) I cant count the UTIs I have on a regular basis, I can't go away for more than 2 weeks without a bag of antibiotics. DONT DO IT
I connected with a guy who lives near me who had the procedure done at the same hospital with a different doc during the same week. His story is worse, he ended up with a foley and tubes into his kidneys for 6 months, a lacerated ureter later. He hardly goes out anymore, it ruined his life he says (he's cancer free though) DONT DO IT
They may have improved the procedure in 2 years but in my opinion I would have taken my chances with medical options if I know then what I know now. PS, I haven't heard from anyone at that hospital on the final outcome in over 22 months, so when they tell people their success stories they must be for 3 weeks post op. Sorry for rambling, if someone has a better story I would love to hear it.
I'm doing ok i suppose. Still on ADT which is still doing it's job after 2 1/2 years on and off.
That PSMA scan I had back in Nov last year showed a met on the 3rd right rib.
So I decided against the Salvage Operation. The risks far outweigh any benefits.
I do worry about things like the cancerous Prostate closing off the urethra further down the track,which the MO said is common as the disease progresses.
But i have to live in the moment and not worry about something which may not happen.
All the best to you my friend and thank you for your reply.
I still think you might have done the right thing. There are so many medical options available to you right now, and while many of these drugs also have unpleasant side effects, I think 2 of the most critical to always consider for men are incontinence and impotence. If the drugs are controlling your PSA and your scans arent getting worse, then again, my advice: DONT DO IT.
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