Prostate removal after radiation treatment?

why would you want to remove your prostate after radiation?

Jack64:
I know of one person who I follow on another forum who had this done. So far so good; his initial PSA after surgery was excellent.

More in general, whereas removal after radiation is possible, it should be done by a doc who has experience doing this kind of prostatectomy. I imagine there are (many?) urologists who have not been trained to do this.

Sr Sailor said...

F8 said...
why would you want to remove your prostate after radiation?

It's an option after the cancer has returned.

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my guess is that recurrence confined to prostate after radiation as a primary treatment is pretty rare these days. i've been on the forum going on 15 years and if it's been reported, and confirmed, here i don't remember a case.

i do remember botched brachy cases from back in the day but those were cases of incompetence. i know i happens but i think it's rare these days

35% of surgeries fail and require radiation. The failure rate for locally confined PCa after radiation is nearly non-existent. So much so that there are no studies or statistical reports. I have been on this board for 14 years and remember only one radiation failure of a local disease and that was a G6 that used permanent seeds. Several years after treatment a tumor was found attached to the bowel. This was clearly outside the radiation area of permanent seeds and to me shows that EBRT should have also been used.

In the rare case that local PCa recurs after primary radiotherapy, then several other salvage methods are available including SBRT, HDR brachytherapy, HIFU, NanoKnife and cryotherapy. There is no need for surgery and that is why so few salvage surgeries are performed. They simply aren’t needed. Any surgeon that isn’t knowledgeable enough to understand what so many lay persons do should not be trusted with patient care, in my opinion.

The “radiation after surgery works, but surgery after radiation doesn’t” is simply a red herring argument promulgated by surgeons that want to operate and steer patients away from any other treatment. Medical malpractice in my opinion.

And any doctor that suggests surgery and says you will also need radiation to salvage the failed surgery is just wrong, in my opinion. Why subject the patient to a double dose of treatment side effects? If the surgeon is counting on radiation to bail out the failed surgery then why cut the person up in the first place? Simply do as so many others, and I, and just use radiation to begin with. Surgery is absolutely not necessary to successfully treat PCa.

I had a second opinion with a urologist that had done over 4000 procedures and actually asked about surgery after radiation. He said he had done a few and that they were very difficult and time consuming but it can be done. My guess is that it was not his idea to do the surgery but came from the oncologists who had a smoldering prostate on their hands causing trouble so they went to a top surgeon to do it.

I agree that it is probably pretty rare today but there are a lot of men around that did not have modern RT so it may still happen on occasion. I think PSMA scans can identify if the prostate remains a source of trouble so maybe there is some data now?

halbert, I barely tolerated the 8 mile drive after my treatments and I only had 28. 40 treatments and 200 miles daily? You made a wise choice. Thanks for all the replies.
Jack

F8, I'm one of them. I was not well informed when I had the surgery, but chose it simply because radiation could be used later should it recur.

Six years last month NED.

I am heavily invested in Depends though.

Yes, I remember many guys coming here and almost proudly stating that they were having surgery because salvage radiation, if needed, was their ace in the hole secret weapon. It’s such a beautiful selling point for Uros to get extra business. Guys love having plans — and having a plan with a backup rings a man’s bell like nothing else. When advised by the Forum that RP followed by RT may not be as shiny as it sounds, I recall that few guys left and didn’t come back.

Sadly, as F8 noted, over time and after repeating it enough, plenty of Uros probably believe this nonsense, so they actually think they are doing the right thing for their patients.

I would note that there are situations where surgery could be a better choice, such as preexisting urinary flow problems.

It's hard for me to believe that all of the urologists who say this are using it as a sales pitch. I really think most of them are perhaps 'trying' to make a truthful statement: If you choose radiation as primary treatment, it more or less closes the door on future surgical intervention.

Now, there is nuance in there and we are focusing on the nuance, and assuming unethical or 'sales' behavior on the part of the urologists. To me, the unethical next step would be to refuse to refer the patient to a RO, or otherwise discourage the patient for trying to learn as much as they can about their options.

Duck2 said...

F8 said...

Sr Sailor said...

F8 said...
why would you want to remove your prostate after radiation?

It's an option after the cancer has returned.

#############

my guess is that recurrence confined to prostate after radiation as a primary treatment is pretty rare these days. i've been on the forum going on 15 years and if it's been reported, and confirmed, here i don't remember a case.

i do remember botched brachy cases from back in the day but those were cases of incompetence. i know i happens but i think it's rare these days

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Mayo Climic have two urologists that specialize is post RT prostatectomy. The procedure is much more common than many believe and RT failure is not uncommon.

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and why aren't these guys on this forum? maybe they will show up tho i doubt it