I am recurrent following radiation, who is the best Doctor performing salvage radical prostatectomy ? Any recommendations and experiences ?

[kmack57]

had proton and cryo, looking for third salvage attempt

[Tall_Allen]

Have you had a PSMA scan to confirm that the cancer is only in your prostate and nowhere else?

Peter Scardino at MSKCC is possibly the most experienced salvage surgeon. If he doesn't take patients, James Eastham would be good too.

[kmack57 in reply to Tall_Allen]

I just had an MRI and that looked good, having an Axumin scan Monday. The scans are being done at the University of MD. I talked to one surgeon there that wouldn't try it. I am working with a MedOnc at Johns Hopkins. I am near the DC Baltimore metro area but would travel anywhere for the best doctor.

Another Doc recommended salvage brachy as a possibility too.

[Tall_Allen in reply to kmack57]

You seem to be getting ahead of yourself. What makes you think that the recurrence is only local? If it isn't, salvage surgery can leave you incontinent, not to mention impotent, with risk of fistula too.

[kmack57 in reply to Tall_Allen]

True, however if it is local I would like to have some names to contact. Any treatment I choose has those risks you mentioned, some I already experience. If given the chance to obtain a cure, even with the risks of side effects, I would choose to go that route.

[Tall_Allen in reply to kmack57]

It would have to be ONLY local, and not at all distant. Your Axumin scan should tell you more. If it is only local, I think you would be better off with salvage focal HDR brachy:

pcnrv.blogspot.com/2017/09/...

[kmack57]

Thanks for that link, good information

Kevin

[Hidden]

You might consider HIFU as a salvage treatment if it really is local and contained.

[garyg0616]

I had a robotic salvage prostatectomy in 2012 performed by Dr. Louis Pisters at MDA in Houston following Proton Beam therapy in 2008. I have had no detectable PSA since the operation and all subsequent bone scans have been clear. I have 100% urinary incontinence and partial bowel incontinence. A summary of my condition just prior to prostatectomy follow.

Mr. Gary Goodwin was a 74-year-old male who was initially diagnosed with clinical stage T2b, Gleason 7 adenocarcinoma of the prostate with a pretreatment PSA of 6.9. He underwent proton beam radiation therapy in 09/2008. The patient developed a rising PSA profile, and his most recent PSA was 9 on 07/23/2012. The patient had repeat prostate biopsies, which demonstrated a Gleason combined score of 9 (4 + 5) adenocarcinoma involving multiple cores, including a very large in the right prostate. The patient, after an extensive discussion with Dr. Louis Pisters, opted to undergo a robotic-assisted radical prostatectomy for salvage therapy. This was performed on 10/11/2012.

Good luck with your future procedure.

Gary G

[matt2001]

Re salvage options :

Post external beam treatment My psa went up to 2.2 in 4 years, I Got a PSMA pet scan (BC, trial in Vancouver) , then a MRi with a "coil", both will help define where your cancer is. if required a biopsy to confirm actual cancer, Mine was confirmed as best as possibile to be confined to top of prostate a small tumour and also into seminal duct , I found a clinic that is offering focal "HDR" Brachytherapy. Seems like a focal treatment (they only treated the tumour and the seminal ducts) that had very little or no affect on other organs. my 2nd treatment I have a sore arse (needles under full anesthetic) and thats it so far. not much seminal fluid but no impotence (no change from external beam 4 years ago).

fingers crossed the cancer is gone, I also went vegan after I discovered the cancers return, especially focussed on zero eggs and dairy. (Choline in foods gets converted to TMAO and has a clear link to aggressive prostate cancer), hope it all helps, anyway after 6 months on near vegan diet and once a week resistnatce gym work on top of good exercise life style I feel 10 years younger and lost 10Ib's.