Salvage Surgery

A few days back there was a post on this forum regarding salvage surgery after radiation.
It’s now been 12 months since I had salvage surgery in Dallas. The post operation pathology was not encouraging - positive margin with SV involvement.
Post-surgery my PSA at 4 weeks (September 28th 2014) was undetectable. I had my three month anxiety day otherwise known as a PSA test on September 17th 2015. Still undetectable.
As it been plain sailing? Not at all. I still have problems with stress incontinence which is slowly improving and ED is still a major issue.
How long will it remain undetectable? I have no idea. However, my thinking is that the longer it does then the chances of a longer term survivability period increases. I fully expect that one of these days I will have another encounter with HT.
My original treatment was nearly 13 years ago at MD Anderson, 42 days of radiation and two years of Lupron. I was 48 when diagnosed with a PSA of 4. Post treatment over 12 years it slowly increased. During this period I was under the watch of my RO at MD Anderson and when my PSA hit 2 then he decided that action was needed. Ordered a biopsy and 6 out of 12 cores were 4+3. My choices were straight to hormones or surgery. After a lot of discussions with Urologists and RO I opted for the latter.
I often think back to the days of my original diagnosis (2001). I had no access to a forum such as this. I was a Brit living in the USA. One Urologist told me that based on my first biopsy, surgery was a waste of time. An RO told me that BT was not a good option as it was difficult to keep the seeds in the right spot. Another surgeon said I was a definite candidate for RP but if I wanted nerve sparing it was an extra USD 5000.00. I eventually met with an RO at MDA who was able to explain things in a logical manner and came out with a phrase that as stuck with me through the years “there’s only one quarter back in this game and I am it”. He still is along with my Urologist in Dallas.
Back in the day, at 48, feeling sorry for myself I pitched up for my daily dose of radiation. For those of you who have been treated at MDA you know the drill - present your blue card to the wonderful ladies on reception and off you go with a full bladder, music and fun.
On this particular day in the reception area there was a mother of a very young girl who had just passed away from some form of cancer. Her mum came to deliver a cake, flowers and a thank you card to the receptionists. Some tears were shed. I vowed to myself then that whatever happens in the future I will never have another woe is me moment.
I already had 48 years on the planet. This young girl was maybe 4.
Now I am 61. Running every day, playing golf, working full time and enjoying my kids and a grandchild.
Whatever happens next I have been very lucky.
My best wishes to all.

Tim,
Thanks for the post. Your experience really puts things in perspective.

Timcebu,

Your philosophy really hits home with me. When I was diagnosed people would ask me how well I am getting through the treatments. I've always thought that I'm doing alright. Images of bald children in cancer wards would come to mind and I would think that if a child can do this, surely I can too.

Best of luck to you.

Tim-
Great post! I think it's important to have perspective about salvage surgery after radiation, and you are giving us that. Just like original surgery, the experience of the surgeon is everything. Just as most of us would never consider using a surgeon who had only done a few surgeries for original treatment, salvage surgery, being more difficult, requires, if anything, even more expertise. The problem then arises that because it is a relatively rare procedure, there are very few surgeons, maybe a handful in the US, who have much real experience in doing it, and they are all at the top institutions like MDA and MSKCC.

The other consideration is that all the salvage treatments after radiation failure - salvage surgery, salvage brachy, salvage SBRT, and salvage cryo - have similar rates of cancer control - about 50% - which is similar to the control rate seen in salvage radiation after surgery.

Side effects of salvage treatment - any salvage treatment, including SRT or salvage surgery - can be horrendous. While you got off lucky, not everyone does. It's a very serious decision. I'm glad it has turned out so well for you.

- Allen

Tim, thanks for sharing your story with us. I also note that your original treatment was 13 years ago, and things have come a long way since then. I hope your prognosis continues to improve and you get through this challenge.