Can Surgery Backup Radiation?

Posted by 4rbest @4rbest, Sep 23 7:06am

I have prostate cancer, am 60 and in good health. My father had it at age 65. In the past 18 months my PSA jumped from 3.38 to 5.1. Multiple tests in past few months with two at 5.1 then down to 4.8 and 4.0. MRI showed PI-RADS 3 lesion. MRI guided biopsy had 6 cores out of 16 with cancer. Gleason scores of 3+3=6, 3+3=6, 3+4=7, 3+4=7, 3+4=7 and 3+4=7. Urologist surgeon said, "Don't be worried, catching early. Very manageable, early stage, localized to prostate, with medium aggressiveness." He recommended prostate removal within 6 months. In that conversation he said “if you do surgery you can always back it up with radiation but you can’t back up radiation with surgery”. I have had radiation oncologists dispute that saying surgery can come after radiation. I have had multiple opinions and was thinking radiation. My Primary set me up with an oncologist for their recommendation. The oncologist is recommending surgery due to containment and my young age. He said the same as surgeon in that there is no backup option with surgery after radiation. Has anybody had personal experience with this?

Interested in more discussions like this? Go to the Prostate Cancer Support Group.

The idea that “if you choose radiation first, you cannot have surgery later” has some truth to it, but is old-school and doesn’t consider modern treatment techniques.

If there is local recurrence after initial radiation, choice of treatment would depend on the nature of the recurrence; there are other options - focal therapy (e.g., cryo), brachytherapy, SBRT, and yes even re-radiation in some cases. (I personally know two guys who had their prostate recurrence re-treated with SBRT, because the recurrence was a single spot.). For me, surgery would be a last choice for salvage treatment just tax it was for my initial treatment.

So, I wouldn’t let the old “no options if recurrence” philosophy change my initial treatment decision.

(At 65y, I had localized prostate cancer, PSA of 7.976, PIRADS 5, Gleason 7(4+3), and chose 28 sessions of proton beam radiation + 6 months of Eligard.)

REPLY

@4rbest
This has come up a lot on MCC. What you heard was what most are told.

My experience with this comes from my Mayo urologist, UFHPTI R/O, Mayo R/O, and my Mayp PCP not my personal opinion as not a medical professional.

You can have surgery after radiation has been done. Most urologist do not offer it as it takes a highly skilled and experience surgeon to do surgery on a prostate that has gone through radiation and the damage that is done to prostate. The medical experts that I mentioned above said surgeons are out there that will agree to do it but very few will risk doing it as again very speicalized surgery that most don't want to do.

I was told the prostate after radiaion could look and feel like the tecture of a football. Have not idea that is accurate but know that mine really went through WWIII and is in no mood for surgery.

REPLY
Please sign in or register to post a reply.