Salvage surgery or salvage radiation?

Interesting option of salvage surgery. After having salvage radiation, the surgery was not mentioned, I might go with that option knowing I can get radiation later. Salvage radiation can cause long term problems which I am experiencing to add context to my answer.

@prettypass2000 I’ve been following your discussion with @jeffmarc and he’s really said it all in reference to your husband’s recurrence.
I would just add that surgery to remove a visibly affected lymph node is no guarantee that there aren’t invisible micrometastases present. The surgery ‘could’ be useless if that is the case.
However, targeted high dose radiation to the single node (SBRT) can be given in conjunction with multiple lower doses (IMRT) to the entire prostate bed and ALL the other nodes; this would get everything.
Also, you might want to discuss the addition of at least 6 months ADT - Orgovyx if you can be approved for it. Best,
Phil

@chippydoo another patient passed the information on salvage surgery, which the relapse is about 40% - 60% . I don't think it'll be approved by our insurance, knowing that their medical board who make the decision probably have the same statistic. There are not many studies about it, and whatever I've found don't seem to be very hopeful.

Interesting option of salvage surgery. After having salvage radiation, the surgery was not mentioned, I might go with that option knowing I can get radiation later. Salvage radiation can cause long term problems which I am experiencing to add context to my answer.

@prettypass2000
Didn’t realize you were in Europe. They do have their own regulations for prostate cancer treatment.

I think I mentioned I had never heard of anybody having that type of surgery, It could very well be something that is done in Europe.

@heavyphil Made some interesting points about the fact that doing the surgery would not necessarily get micro metastasis eliminated. Definitely something to consider. Doing Salvage radiation would radiate the prostate bed and lymph nodes, If the ones that are problematic are in the area of salvage radiation then that would take care of them. Otherwise, as mentioned, you could have SBRT radiation to them.

It would be interesting to know what is decided after you see an RO.

@chippydoo
Salvage Surgery would be done if you started off with radiation. Around 40% of the prostate is still there after Radiation. If you start off with surgery, there’s nothing to salvage with salvage surgery. That’s why you have salvage radiation.

@chippydoo another patient passed the information on salvage surgery, which the relapse is about 40% - 60% . I don't think it'll be approved by our insurance, knowing that their medical board who make the decision probably have the same statistic. There are not many studies about it, and whatever I've found don't seem to be very hopeful.

@prettypass2000 Honestly I hadn't heard of it before. I suspect insurance sop is radiation. Is proton an insurance option? EBRT tore me up.

@jeffmarc Yes, we live in Germany but using American private healthcare through my husband's employer. So, when we need a treatment approval, they use American approach to make a decision. When I submitted the documents for pre-approval, they requested my husband also see radiation oncologist before they make decision. It seems they want to compare notes between the two treatments. I do think they will favor radiation because there more "evident-based" studies. It seems lymph node dissection is one of the treatment for recurrence here, but it seems to be very limited studies.

You and @heavyphil are right about those microscopic metastasis. Upon discussion with another patient, he mentioned that sometimes the microscopic cells don't show up on scan because they're too tiny. It makes sense and makes me worried about doing surgery because it can miss those cells. I just don't want to put my husband through misery twice because the doctor said he highly recommended dissection and then do PSA test 6 weeks after. If it fails, he may need ADT or radiation or both. The limited studies I've found shows 40%-60% relapse after lymph node dissection.

@jeffmarc You're right. My husband had prostate surgery as his first treatment. When the chief urologist presented the option of salvage surgery to remove lymph nodes, I found it was odd. I feel that even with the best surgeons, they still can miss the microscopic cells that may not show up on the scan. We've had this experience from his first surgery, which all tests and scans showed no spread. However, they found 0.1 mm of cancer in one of the seminal vesicles during surgery, and it was confirmed in pathology report. That's why I'm very uneasy when surgery was offered again yesterday. I know very tiny trace of cancer can be missed even on PSMA scan. I don't get the idea of putting my husband through misery twice if the salvage surgery fails, and then he would need radiation.