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It's not that you "can't" do surgery following radiation; it's just that it's not routinely done that way. While surgery followed by pelvic radiation is itself a first-line treatment strategy (especially for men suspected of disease that might have escaped the capsule), surgery that follows radiation is typically called "salvage" surgery because it's usually done only if the initial course of radiotherapy has failed. In short, radiation plus surgery (in that order) is not a generally recognized first-line treatment strategy.
Moreover, surgery after radiation -- while not impossible -- is indeed more difficult to carry out and typically comes with greater complications and side effects. For ease of explanation, radiation "pickles" the prostate, making it harder to operate on than if radiation had never been administered. The surgical field is altered. Hence, I would entrust this type of a procedure to only a handful of highly-skilled surgeons in the U.S. with specific expertise in this space. If you're contemplating salvage surgery, I would absolutely avoid any surgeon but one that specializes in this complex procedure.
I'd back that up from R Scott and explain that radiation can change the structure of the tissues it encounters in "radiation scatter". It toughens them making them more fibrous and that makes sureery more complicated. Not impossible though. I had bladder cancer five years after radiation therapy (there is a small risk of this, by the way, in case the surgeon overlooked the fact). This meant removal of the prostate as well as my bladder five months ago. In fact the surgery went swimmingly and no problems were encountered, but they were expected. No one can say what will or won't happen in the future. It is all about risks, balancing them and taking a gamble.
The general advice is still: surgery is a good primary treatment in the right locally confined cases and can be backed up with later radiation of the prostate bed if necessary. The other way round is possible but harder and riskier and so not usually recommended.
Aloha Ralph,
I also had IMRT/EBRT (Sept-Oct 2007). In July 2012, it was necessary to remove the bladder & prostatic urethra as they were burned badly by radiation. It was a six hour open operation without complications. The surgeon who performed the operation had done this before, & I believe that he does it often as we were scheduled for 6 weeks, then one week when the patient could not make it. I found out later that he had a colorectal surgeon standing by to chisel the prostate off the rectum. I saw her later when she was looking at my rectal/anus problems. So, as stated above, this is not the way to go if at all possible. A friend of mine through church had warned me not to do the IMRT/EBRT as he, like Sir Ed, developed bladder cancer 8 yrs after radiation.
Joe
