Can Surgery Backup Radiation?

The prevailing opinion is that surgery is generally not a follow up to radiation.

I elected for surgery because my oncologist also said the same. Although I believed he meant nerve sparring surgery. His comment was the radiation turns the prostate into a raisin. Nerve sparring surgery is then impossible.

If radiation fails, it's almost always because the cancer has escaped the prostate, same as if prostatectomy fails, so it doesn't really matter much whether you have surgery or radiation as your primary treatment. Both are equally effective. The treatment for recurrence is generally the same in both cases--ADT and spot radiation and/or other non-surgical treatments.

I researched the stats on this:
When comparing radical prostatectomy (surgical removal) vs radiation therapy for localized prostate cancer, the risk of recurrence is often discussed in terms of biochemical recurrence, which is usually measured by rising PSA levels after treatment. Actual recurrence with detectable metastases is lower but related to the same risk trends.
Here’s a summary from studies and large reviews:
1. Radical Prostatectomy (RP)
For low- to intermediate-risk prostate cancer, 5–10 year biochemical recurrence rates are roughly 15–30%.
Risk increases with high-risk features (Gleason 8–10, positive margins, extraprostatic extension), where recurrence can be 30–50%.
Long-term (10–15 year) recurrence risk in high-risk patients can be up to 50%, especially without adjuvant therapy.
2. Radiation Therapy (External Beam or IMRT)
For low- to intermediate-risk disease, 5–10 year biochemical recurrence is generally 20–35%.
High-risk patients may see recurrence rates of 40–60% over 10 years.
Key Points
1. Direct comparison is tricky: Surgery often gives more precise PSA monitoring (undetectable PSA after surgery is easier to interpret). Radiation leaves the prostate in place, so PSA nadir can be higher and slower to reach.
2. High-risk patients benefit from combined therapy: Radiation + ADT or surgery + adjuvant therapy reduces.

Note: These numbers are general population statistics. Individual risk can vary widely depending on Gleason score, PSA, margins, lymph node involvement, and response to therapy.

Very few doctors will give you prostate surgery after radiation. It is possible there isn’t much tissue left however so it’s a very difficult operation. If you do have prostate surgery, make sure to ask the doctor about sparing the nerves and how likely it is.

Many people that have prostate cancer and have surgery find out that their Gleason score is much higher, and there are more issues than they thought after the prostate is examined following removal.

My father died of prostate cancer and I was diagnosed at 62, My brother at 75. I have BRCA2, which I got from my mother my brother did not get that that’s why he had it so much later.

Just so you know, you are a Gleason seven 3+4, The other numbers don’t matter.

I had surgery at 62 because my father had radiation and died from PC.

You need to get a genetic test. That affects how you will be treated. The fact that you got prostate cancer, so young could be because you have a genetic problem like I did. If you went to an oncologist, they almost definitely would’ve had you get one before doing radiation. You can get one free here, As long as you live in the United States, results come back in about three weeks and a geneticist will talk to you about the results.

Prostatecancerpromise.org

Make sure you do not select the option to have your doctor involved. Otherwise they will not send you the spit tube until your doctor has been contacted.

Wish you the best.

My doc gave me a similar answer to @jeffmarc

He explained that if the radiation comes first, the radiation causes enough damage to the tissue that reconstruct after the prostate removal becomes very difficult. It's a very specialized operation, fewer surgeons that do it.

If you have the operation first, then have a recurrence, the radiation doesn’t do as much damage to the reconstructed area (urethra), it's at a lower dose than if it was the primary treatment.

This fact was pretty much the deciding factor for me. “What’s my backup?” It’s just the way my brain works.

Best of luck to you!

Certainly you can do surgery after radiation but if that is done they are simply scooping out the mess that was created by the radiation which will lead to a high probability of both erectile disfunction and urinary issues. With a cancer that is expected to come back I would say surgery is your best option, but that is just my opinion.

Good point on the PSA after treatment. With surgery you theoretically should have a PSA at or near 0. With Radiation you will have a varying PSA level and it may never get at or near zero. Monitoring after surgery would be much easier in my opinion.

Yes, but very rarely done and with great difficulty. There is just a handful surgeons that do that.

Wishing you the best of luck with whatever path you choose 🍀

My understanding is that with intermediate risk PCa the disease free interval and survival with RT and a course of ADT is statistically identical
to the outcome of RARP. Both approaches have potential long term side effects, but newer radiation therapies have fewer long term issues than were reported even 5-10 years ago. There are therapeutic options for local recurrences after RT including surgery (though more difficult) as well as alternate ablation techniques. And, of course, recurrences after either surgery or radiation involving biochemical recurrence or distance metastases are treated with systemic therapies in either case. That being said, your young age certainly bears weight in the final treatment decision and I can see where your surgeon and oncologist are coming from when they lean toward RARP. Genetic testing of your tumor and your DNA certainly might be helpful in your decision making.

Wishing you the best of luck and a satisfying outcome whichever course you choose …