Surgery AFTER Radiation?

I will leave this for the more passionate people to carry on about so just some quick info....

You give it your best shot in primary treatment, surgery or RT methods, after consideration of all factors important to you. All methods will work for you with similar results but have different side effect potential so you will need to understand the differences after consulting with the appropriate doctors and getting any second opinions you desire.

If primary treatment fails, you move to secondary treatment. For surgery, it is commonly salvage radiation. For RT, it may be more RT or focal therapies and rarely salvage surgery unless something unique is going on. The biggest problem is understanding why primary treatment failed as many times the cancer has moved on from the local area which makes many secondary treatment schemes ineffective.

Make an appointment with at least one radiation oncologist (RO) and get their opinion on appropriate RT solutions for your situation. The urologist is great for what they do but this is one of those situations that can be treated effectively by multiple disciplines which most urologists will not be totally upfront about unless you ask and some may still be difficult about it.

I would be inclined to investigate SBRT (Stereotactic body radiotherapy) that can be done in approx. 5 sessions, every other day, which is not the weeks of conventional radiation but that is just me.

I'm going to weigh in as one of the more passionate players at that particular phrase.

This is a surgery sales tactic. It's saying that RT is less effective as a primary treatment, and is more likely to fail than surgery. (not true on both counts. if anything, primary radiation treats a wider area than surgery, so it is less likely to fail) It also is saying, truthfully, that salvage surgery is more difficult. Radiation damages the tissues in such a way that surgery afterwards is more complicated, with worse side effects, and so on. It is also saying that you've only got one shot at treatment if you do radiation first. Not true. There are numerous other treatments available if primary radiation fails. It's also assuming, even for someone who has a relatively uncomplicated situation that your primary treatment will fail. If it does, it puts you in a very low percentage group--like way less than 10%, probably less than 5%. Look on the positive side: you're cureable, if you treat promptly. Promptly with PC means in months, not days.

To me, this is a commonly made statement, by urologists trying to convince new patients to have surgery. It's right on the edge of unethical, in my view.

Please, go talk to one or more radiation oncologists at a quality cancer center. Have them review your case and explain the options. You owe it to yourself to do that.

Oh, if you look at my signature, I'm a surgery patient. I explored all the options, and chose surgery. I've had a great outcome: complete cancer control and barely any side effects for almost 10 years. When I was treated, SBRT was just coming online, and I would have done it if the location had more experience with it and PC at the time.

Surgery after radiation is difficult. And if someone wants to pursue this then they must seek out a good urologist that has a track record for performing this surgery. My oncology urologist has performed this surgery and he told me that there is a great risk of incontinence, impotence, and colon fistula.

I stand with halbert. The diagnosing uro, in my case, gave me an-almost used car salesman pitch about how his group could have me in within a few days, do the "carving" and get me back to everyday life, expeditiously. Given the virtual mental shock I was in after hearing I was 3+4 - - I almost bit. Hell, I just wanted the "invader" known as PcA out!

God Bless my wife. Being a breast cancer survivor, she had a cordial relationship with her oncologist. And that wonderful gent knew his stuff, you betcha! He suggested I consult with Dr. Sim at Monmouth Medical Center in NJ. Dr. Sim is radiation pioneer.

Dr. Sim was (no pun intended) just what the doctor ordered. He painstakingly explained radiation versus surgery. He was confident, based on review of slides, etc., that he could rid my geezerly carcass of PcA.

I underwent 45 sessions. Painless (physically). Emotionally, I prayed hard every time I went inside the "tunnel." I'm not a pious man. But as I did in Vietnam and on 9-11 (the causation of my malady), I asked The Almighty to hear my prayers.

Six months afterwards, my PSA was down from 8.7 to 2.3. Today, it's 0.2. Yes, He heard my prayer.

Making the decision between RT and surgery was tough. Arguments can be made pro and con for both. And medicine is not "one size fits all."

Sir, I wish you Godspeed.

Fred in Southern New Jersey

Post Edited (NJ Fred) : 11/23/2024 11:10:52 AM (GMT-5)

As in any situation, review your options, make your decision, stick to it. If you come back here and share, be prepared to hear that whatever choice you made, you were wrong in doing so.

Pratoman wrote:

Anyway, we can try to guide men to make educated decisions, but once that individual makes the decision, support is the best thing we could offer. JMHO

This is one of the basic rules of this forum. We likely all need to be reminded of it from time to time.

If I could predict the future, I would have the right answer for you.

Personally, I would not get RT as a treatment without Brachy, IMRT, and 6 ADT if you are 4/3 or greater,