I have a very close friend who was recently dx'd with PC and is trying to decide which type of PC treatment he should choose.

I've read other threads saying any kind of radiation treatment, as an initial treatment for PC, limits your options for future surgery and that many urologists are shy about doing any surgery once a PC patient has gone through Brachytherapy, HDR or IMRT treatments. I'm not sure if this is true.

Question: Does anybody have any first hand experience regarding the topic of surgery after radiation?:confused:

If radiation fails, salvage surgery is more complicated than normal surgery with higher incidence of complications. It should only be done by a top surgeon.

In choosing a treatment, this is just one consideration: treatment selection depends on overall factors of diagnosis, stage, general health, age etc.

Results from radiation and surgery are similar, so it often comes down to personal preference.

John

Does the biology of the prostate change after radiation? Does something change regarding the prostate structure or the prostate tissue after radiation? Is that why it's so touchy?

tony:

I was told by my Urologist that because damage is done to surrounding tissue (rectum, bladder, etc) when a PC patient has gone through Brachytherapy, HDR or IMRT treatments. That no "uro" in his right mind would want to touch it. As it is a mess to go iside to clean it all up. I was going to do the "Brachytherapy" at first until I was told that I would not be able to be around my 2 yo daughtr, so that was out. Then I thought about "HBRT"; however I would have to go to "Radiation" treatments for 5 days a week for
6-8 weeks. I took some time and went to Disney World for Xmas for daughters b-day and thought about it. And not having a prostate was more important than the abilty to have intercourse, or an erection. Being able to spendtime is more precious. So if your friend is worrying about this then he needs to REALLY think about it.

Thanks guys;

Really helpful. My friend is in his early 50's and is otherwise pretty darn healthy. He works out regularly at our local YMCA. Swims, does all the machines, dead weights and plays team basketball. He has no other risk factors like heart problems, diabetes, high BP, high colesterol, etc. His uro is "not" pushing him in any specific direction. I wish he were more internet savy so he could join this forum and read some of the posts. Because of his age and good general health, I want to suggest to him that surgery is his best option but I hesitate to offer advice because I really didn't want too many "experts" helping me make my decision. I sort of wish his uro would push him a little in the direction of surgery. I'll keep you posted about his decision.

tony:

I understand. My doctor told me that besides me having cancer, otherwisw my body was in great shape. I like your friend did not any no other risk factors like heart problems, diabetes, high BP, high colesterol, etc. My only problem was that and older brother told me about him having PC after I had a good bill of health from my doctor. Your friend may need to find another "Uro." Afterall it's his life.

Nathaniel

My urologist and a very good doctor friend firmly told me there is no such thing as surgery after radiation.

The exception was for removal of a large tumor and not the prostate gland.

I had surgery - radiation was the option after surgery.

One of the problems is that the ability to distinguish between aggressive and non-aggressive PC is not ideal. Many of us will have surgery that would not have been needed, though "needed" in the context of our personalities and personal aggressiveness. Though personalities differ, I cannot imagine anyone in their early 50's not opting for surgery if they are in good health. Recent studies of more than 20,000 cases strongly indicate that surgery prolongs life even among those who are older (65+). I suspect that some do not opt for surgery out of fear of impotence. Our culture expects us to be very sexual (reports are that the average number of sexual encounters per year is 103 among married adults), though reports of activity and actual occurrence may vary significantly. I will gladly, well not gladly, give up intercourse, if necessary, to be cancer free.
The options for further treatment if there is recurrence are greater with surgery, the follow-up is simple, pathology reports will definitively indicate the amount of cancer, and the risks are worth it for me. The greater number of treatments does indicate that there is no single treatment for everyone, though.

One of the problems is that the ability to distinguish between aggressive and non-aggressive PC is not ideal. Many of us will have surgery that would not have been needed, though "needed" in the context of our personalities and personal aggressiveness. Though personalities differ, I cannot imagine anyone in their early 50's not opting for surgery if they are in good health. Recent studies of more than 20,000 cases strongly indicate that surgery prolongs life even among those who are older (65+). I suspect that some do not opt for surgery out of fear of impotence. Our culture expects us to be very sexual (reports are that the average number of sexual encounters per year is 103 among married adults), though reports of activity and actual occurrence may vary significantly. I will gladly, well not gladly, give up intercourse, if necessary, to be cancer free.
The options for further treatment if there is recurrence are greater with surgery, the follow-up is simple, pathology reports will definitively indicate the amount of cancer, and the risks are worth it for me. The greater number of treatments does indicate that there is no single treatment for everyone, though.

Thanks guys,

Great information! I'll be sharing it with my buddy very soon. Hoping he begins to consider RP surgery much more carefully.