Salvage Prostate Surgery

Werner · Guest

Dr. Leo

This is a wonderful project you have undertaken. Many patients and patients? families will benefit from it. It is especially encouraging that you, a professional medical doctor, intend to participate in the discussions.

I am 65 years old and was diagnosed with prostate cancer at age 62.

Between Dec 1999 and Dec 2000 my PSA hooked up from 2.1 to 4.1 ng/ml. In July 2001 a biopsy showed cancer of the prostate (Gleason 3+4=7). I finished 7800 Gy 3-D External Beam Radiation Treatment in April 2002. PSA had leveled off to about 0.5 until May 2004 when it rose to 1.0. In August 2004 PSA had risen to 2.1. Another biopsy showed recurrence of cancer. (Gleason 3+5=8).

After a series of scans (Prostascint, Abdominal/Pelvic Scan, Full Body Bone Scan) my Urologist suggested ?salvage surgery? to remove the prostate gland. Presumably the scans showed that the cancer is still contained in the prostate gland has not metastasized. He also put me on hormones (CASODEX pills and LUPRON shot).

Question:
Is surgery really a viable option after failure of external beam radiation treatment and if so, what can I expect? What are the statistics for such surgery and how much more traumatic is it to the patient than ?normal? prostate removal surgery? What institutions specialize in this procedure? Thanks, Werner

mycroft · Posted: Wed Oct 13, 2004 4:35 pm Post subject: Re: Salvage Prostate Surgery

[quote="Werner"]

Dr. Leo

(ka-snip)

Question:
Is surgery really a viable option after failure of external beam radiation treatment and if so, what can I expect? What are the statistics for such surgery and how much more traumatic is it to the patient than ?normal? prostate removal surgery? What institutions specialize in this procedure? Thanks, Werner[/quote]

*******

My 2¢:

Age: 68. General health: good.

I had cryosurgery in November, 2003 (Stage T2b, Gleason 9). PSA well down, then rose. Second biopsy 7/20/04. Result: another tumor, T2b, Gleason 8. No known metastases, but one cannot be sure for several years.

On October 14, tomorrow, will have last of 38 IMRT treatments. Also on Zoladex/Lupron.

I have been informed that salvage radical prostatectomy is NOT a viable treatment in the event that the RT fails to cure.

I'll be very interested in seeing Dr. Leo's response to Werner's inquiry.

Steve J

Guest · Posted: Wed Oct 13, 2004 10:21 pm Post subject: Re: Salvage Prostate Surgery

Note: this is really me (Leo), I forgot to log on to post Smile

Hello,

Thanks to both of you for posting and for the comments.

For the first poster, I researched and found a review article of December 2003 about salvage prostatectomy after failure of radiation therapy.

Here is the abstract:
[quote]Asymptomatic prostate-specific antigen (PSA) recurrence after radiation therapy for prostate carcinoma poses a diagnostic and therapeutic dilemma for clinicians. Patients with locally recurrent disease can consider treatment options of salvage surgery, cryotherapy, watchful waiting, or androgen deprivation. Of these options, only salvage surgery has been shown to result in long-term disease-free survival for selected patients. However, salvage surgery is associated with significant morbidity, including urinary incontinence and rectal injuries. Ideally, salvage surgery outcomes can be optimized with careful patient selection according to clinical stage, serum PSA levels before radiation and surgery, the medical condition of the patient, and clear expectations of the physician and patient. Among patients with locally recurrent disease, those with localized prostate carcinoma amenable to radical prostatectomy before radiation or cryotherapy would be the most suitable candidates for salvage surgery.[/quote]

And here's the conclusion of the article:
[quote]With vigilant PSA screening, recurrent disease after definitive local therapy for prostate cancer is commonly an asymptomatic increasing PSA level rather than clinically palpable disease. A growing subset of young healthy patients who were good candidates for primary prostatectomy will present for salvage therapy after radiation therapy with PSA-only recurrence. Careful patient selection and discussion of treatment options with suitable candidates can identify patients who would most benefit from salvage surgery. Compared with early reports of salvage surgery, contemporary salvage prostatectomy series have demonstrated excellent local control, good long-term disease-free survival, and acceptable complication rates and health-related quality of life. We believe that early identification and treatment of recurrent disease results in lower stage at diagnosis (optimally, clinical T1c disease), better biochemical and disease-free survival, and lower complication rates after salvage surgery.[/quote]

And here's the full reference with a link
1) Salvage prostatectomy in patients who have failed radiation therapy or cryotherapy as primary treatment for prostate cancer Urology, Volume 62, Supplement 1, 29 December 2003, Pages 69-78 Bert T. Chen and David P. Wood, Jr
http://www.sciencedirect.com/science?_ob=GatewayURL&_method=citationSearch&_uoikey=B6VJW-4BH98BN-9&_origin=SDEMFRASCII&_version=1&md5=6985ff7c4612dd4bc9e4bd7644d88007

Essentially this option appears to be of benefit only to selected candidates, who are otherwise in good health and are young. I think the ideal situation would be to discuss in more detail with your doctor. The big problem with having surgery in an area that has been irradiated is that the tissues become stiff and the surgery is much more technically difficult, and the complications are more frequent.

regards,
Leo

Guest · Guest

Dr. Leo

Thank you for your response with useful information as well as some mild advice.

I have an appointment at Mayo Clinic next Monday (18 Oct 2004) with a surgeon who has removed ?many? cancerous prostate glands after external beam radiation treatment has failed. This, according to a Urology Triage Nurse I spoke with by phone.

I realize that eligibility for surgery after external beam radiation has failed is very patient-specific and I may not qualify. The surgeon will make that decision based on my history, past test results, recent test results, additional test results and my input during the initial interview.

As things progress in my situation I will post again ? but it might be a couple of weeks.

Sincerely, Werner

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