Treatment of Inguinal hernia after RP and Axumin scan?

[happycamperguy]

I just discovered a likely RIGHT inguinal hernia (IH) on July 6, which comes after my March 17, 2020, laparoscopic da Vinci radical prostatectomy (RARP) and a follow-on July 2 Axumin Scan. I’m awaiting Axumin scan results from my Urology surgeon Dr. Ray Lance in Spokane, no later than a July 20 telehealth appointment. Plus likely start of Firmagon ADT about that time. Plus likely Varian Edge targeted radiology about that time an hour away in Kennewick WA, but we need to see Axumin results first.

Per surgery pathology, I’m Gleason 9 with some positive margin in removed prostate, but zero cancer in 21 removed lymph nodes. Axumin scan should tell if cancer is still localized or metastatic.

I see my local Walla Walla non-surgeon Urologist tomorrow to further diagnose my hernia. Note I had traditional mesh repair of LEFT IH in 2017.

I understand IH can occur post-RARP. Seems to me related to RARP follow-on. Maybe I lifted something too heavy too soon.

Questions:

—Will my Axumin Scan show this hernia? Or do I go get more imaging specific for hernia?

—What “special” IH surgery approach is needed? Due to recent RARP surgery in that area, I understand it may involve no IH mesh, but some sort of suture for the IH “hole.” Possible posterior-entry surgery?

—What type of surgeon is likely needed for this IH surgery? General surgeon? Urology surgeon? Any suggestions?

—Could I do IH surgery first and defer likely radiation, using Firmagon only to control cancer? Or prioritize radiation while delaying IH surgery?

Lots of variables here. Really need my Axumin scan results, firm IH diagnosis, and IH surgery options.

[Hidden]

Your post RALP PSA is?

If it is less than 0.1 you can delay Firmagon and RT to give healing time to your body.

You are aware, I asume, that your urinary continence will deteriorate (at best will remain the same) as of the start of RT. My personal experience is that the latter gets improved even after 13 months post RALP.

[happycamperguy in reply to Hidden]

I went from PSA 74 pre-RARP oct. 2019 to post-surgery 3.12 PSA April 29, 2020. Then to PSA Ultrasensitive 5.37 on June 5, 2020. Thus the Axumin scan. So my PSA isn’t near-zero yet. Thanks.

[Hidden in reply to happycamperguy]

Under these PSA counts starting Fimagon seems compulsory. The question is whether irradiation will be of any benefit or a harder ADT would be preferable. This is what the Axumin scan will, hopefully, reveal. It would be a tad better if you had a PSMA PET/CT, but at these PSA levels the detection improvement is not worth the hassle, especially if you are in the US where this scan is still "experimental".

[GoBucks]

I have a post RALP hernia. It causes no pain and is small. I am doing nothing to it on advice of 3 Docs(surgeon, MO, family Doc). Your PSA should be zero without a prostate. So yes you are in for ADT and maybe radiation. If mets are found in your bones then no need for radiation.

[Tall_Allen]

Good idea to get an Axumin PET/CT to eliminate the possibility of distant metastases before going through salvage radiation. The PET scan itself won't show your hernia, but the CT scan given with it may.

As you've learned, inguinal hernias are a known side effect of RP. It weakens the pelvic wall. You have to find a hernia surgeon with experience at stitching them up. I agree with your concern about healing with radiation. If you get a 6-month shot of Lupron, that will stop any progression and give time for the stitches to heal. Monthly Firmagon shots are not a good idea during the pandemic.

[MateoBeach]

The hernia is not the priority unless there is protrusion of bowel through it and risk of entrapment (incarceration) which is a surgical emergency. Have a surgeon check it out but if it is not causing pain or other problems then focus on the priority of cancer treatment based upon your Auxumen scan. Good luck. We are with you.

[j-o-h-n]

I had the old "open" RPD and two hernias repaired at the same time..... NO problem. In on a Friday afternoon out on Monday morning.

Good Luck, Good Health and Good Humor.

j-o-h-n Thursday 07/09/2020 2:06 PM DST