Prostate Cancer Survivors

 

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Success of RP after Radiation

In an initial consultation with the surgeon I'm considering to preform a prostatectomy, he asserted that successful results of surgery were greatly lessened if one underwent any sort of radiation therapy and the cancer came back, no matter how long since the radiation therapy. Can someone share their experience with surgery AFTER radiation therapy?

Re: Success of RP after Radiation

Dave,

I'm not sure you'll find too many men who have undergone surgery after radiation. There are only a handful of surgeons who will even attempt this. The problem is that radiation creates scar tissue around the prostate. This makes it considerably more difficult for the surgeon to identify what he is cutting. The scar tissue covers the nerves making it very difficult to find them. I've talked to several surgeon's and radiation oncologists through my support group and they all confirm this.

Wendell

Re: Success of RP after Radiation

Surgery can be done, but it must be done only by an surgeon that is experienced in salvage operations. There are other salvage treatments for failed radiation. One can be reseeded if the source of the cancer is identified. Cryosurgery is a common and effective treatment for failed radiation. Recently HDR Brachytherapy has been used with results similar to salvage radiation after surgery.
With any salvage treatmentafter primary surgery or radiation the reoccurrance must be local in order to be effective.
I would concentrate on finding the best primary treatment for your individual cancer and not focus on backup treatments. The newer types of targeted radiation and seeding are far better than the older ERBT as a primarty treatment.

Re: Success of RP after Radiation

I agree with John about the problems associated with surgery after radiation. It can be done, but it is rarely successful.

I must say I have never understood why men concentrate so much on what salvage therapies might be available. If, for example radiation therapy is considered as a good salvage therapy for failed surgery, wouldn't it be better to have radiation initially rather than surgery. If radiation isn't considered a better option for primary therapy, why would it be good as a secondary?

Choose the one you believe is best for you and deal with salavge if and when it is neccessary.

I note that John has suggested that Brachytherapy or DHR (High Dosage Radiation) are also options for failed EBRT (External Beam Radiation Therapy). I have been under the impression until now that this is not possible simply because the initial EBRT procedure will have given the man the maximum 'safe' radiation dose.

Perhaps John could give some references to support his view?

All the best

Terry in Australia.

Re: Success of RP after Radiation

HDR Brachy as salvage after failed ERBT:
http://www.prostate-cancer.org/education/localdis/Song_SalvageHighDoseRate.html
Michael Dattoli in his book "Brachytherapy and IMRT" and on the Dattoli website also mentions reseeding with a different isotope as an option for salvage after failed Brachy.

Re: Success of RP after Radiation

Thank you John. That was very interesting indeed and challenges a couple of aspects of treatment that I had in my mind.

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