Salvage Surgery - Post Prostatectomy, Radiation and ADT

[MGBman]

PC diagnosed Nov 2014. PSA 35. Gleason 4 + 3. Have had "The Big Three" - Jan 2015 total prostatectomy. Thirty-one external beam radiation treatments. Two years of ADT (8 x Zoladex injections). PSA nadir 0.01 ends Oct 2017. Since then PSA rising slowly until last five months going from 2.51 to 6.01. Oncologist says back on ADT. Have had PSMA PETscan and two internal MRIs. All three ID a single tumour/lesion in area of removed seminal vesicle. Urologist and Oncologist say no surgery after radiation. Second surgeon opinion says yes surgery can do. Now confused and because of my rapidly rising PSA decision is somewhat urgent. Have been told that with the advent of PSMA Pet scanning, there will be more men like me. Any one else in a similar situation?

[Tall_Allen]

Do not have surgery, no matter what some hot dog surgeon says! Some surgeons think they can cure the common cold! You can hit the PSMA-avid area with HDR brachy or SBRT.

[MGBman in reply to Tall_Allen]

The hotdog surgeon is Dr Martin Gleave who you have said good things about on previous posts! This is why I am questioning!

[GP24 in reply to MGBman]

Dr. Gleave is offering salvage radical prostatectomy. Here is an overview: mdpi.com/1718-7729/28/4/252... I talked to one of the authors. He said, the risk of being incontinent after this surgery by him is 30 to 40 percent. But he can recommend a AMS 800 in that case. bostonscientific.com/en-US/...

Bottom line, the risk for side effects is high and therefore I prefer SBRT which I had without side effects.

[MGBman in reply to GP24]

Interesting information but I have already had a radical prostatectomy, external beam radiation (31 treatments) and ADT for 2 years. The recurrence is along one seminal vesicle remnant and possibly vas deferens. I am getting conflicting information about whether surgery to remove it is possible. Otherwise it is back to ADT.

[GP24 in reply to MGBman]

So in your case it is salvage RP after salvage RT. In any case, the risk of side effects is high, too high I think. Using SBRT you can re-irradiate in the previously radiated area. Only ROs offering SBRT radiation will agree with that though, not your urologist.

[Hidden in reply to MGBman]

No more surgery ! Adt is it ! Someday they’ll come out and say “ We we’re all wrong , adt is bs and testosterone isn’t the enemy “ . Until an onclogigal paradigm shifts occurs we are stuck on adt .. 🏋🏽‍♂️😳

[Tall_Allen in reply to MGBman]

Gleave is a much better oncologist than a salvage surgeon. IMO salvage surgery after radiation is always a bad gamble and should never be used. Radiation changes the tissue and makes it sticky and hard to remove.

[GP24]

I had a recurrence in my seminal vesicle radiated with SBRT. Needed fiducials placed in there before that.

[Magnus1964]

I would not recommend surgery in an area that has received radiation.

[Hidden]

I got a yellow MGB when i was 17 . I Didn’t keep it long due to the insane British electrical system . I sure did enjoy driving it however for a very short time . Youve been through the pc ringer already . Maybe chemo is called for ? We must be relentless living with his sob of a disease . Good luck! MGB

[MGBman in reply to Hidden]

Bought a brand new 1974 MGB. Must have been manufactured when the British car industry was in its death throes. Sadly, the car was the proverbial lemon. Bonus was that I sold it two yrs later for more than I paid for it. My PC enemy was dubbed “The Bastard”. I see my fight against The Bastard in military terms (served for 31 yrs). Initially, my troops counter attacked with prostatectomy, radiation and ADT but did not defeat him. We’ve been conducting surveillance since then and recently (rapidly rising PSA) we noted that The Bastard is marshalling more reinforcements. We need to launch another counter-attack, with current plan being ADT.

[Hidden in reply to MGBman]

The enemy within dear Sir! Living with no t in a depleted state of affairs is new for a macho man like me .I’m not a military man . Never fought or went to war . APC clipped me six years ago . They are surprised I’m still here . So am I . Once the pc is inside of us our fragility comes to the forefront .. Can I live life in second gear with no gasoline ? Yes . I’m not going to “ take that hill” but I’ll limp in the shadows as long as I can .. My MGB may have been a 73 or 74 ,but yes it was a mechanical nightmare . I quickly passed it on . I got a orange 72 240 z and thought I was king of 19 ! I commend you on your service to our nation . God bless you ! 🙏

[j-o-h-n in reply to MGBman]

Give those little bastards hell.......for me "a USO commando".......31 years? Holy shit you were a lifer...................

Good Luck, Good Health and Good Humor.

j-o-h-n Saturday 11/07/2021 12:10 AM DST

[MGBman in reply to j-o-h-n]

Ah yes…good humour. It’s a prerequisite for many things. After the initial shock of the Doc telling me that all eight biopsy cores of the old prostate were full of cancer, I figured I better gear up my sense of humour so I wrote a bunch of chapters poking fun at me, my wife, kids, grandkids, the doctors, nurses, technicians, janitors and basically everyone involved in my medical journey. When the Doc pronounced the final verdict, my wife and I sat in his office like two bobble headed dolls in the back of a 57 Chevy (you have to be of a certain age to appreciate that). Anyway, all of this was based on the highest respect for all of those folks who were part of ‘my journey’.

[j-o-h-n in reply to MGBman]

I would love to read those chapters....I'm into humor.....57 Chevy? what was that and what's a bobble head. I had less time than you serving our country....but it was tough being a USO commando....Burned my thumb on hot coffee.......Thank Goodness for sick call,,,,,,,

Good Luck, Good Health and Good Humor.

j-o-h-n Sunday 11/07/2021 6:10 PM EST

[Blackpatch]

The lesion showing up on PET is just the one big enough to show - it would be naive to assume it’s the only one. So chancing surgery on previously irradiated tissue just to treat the largest recurrence is not a sound bet.

You’re right that there are a lot of men showing up with PSMA PET-visible lesions after recurrence - the scans have been widely available in Australia for 5 - 6 years, and it’s a common event. There is a tendency to offer SBRT, on the clear understanding that it’s unlikely to be curative - the aim is to delay commencement of ADT.