The b******s back

Hi Maggie,

Very upsetting news. There are some surgeons who will do a prostatectomy after RT but many will not do so because what is an intricate and major operation anyway, is made even more difficult after RT has caused severe damage to the prostate. Nevertheless, if your surgeon considers this would be beneficial in your husband's case it should receive careful consideration as he is fairly young. HT can hold the cancer back for a matter of months or years; even some of the best oncologists can't be sure for how long. There are of course drugs and chemo to help provide further defence possibly helped by a strict diet. (I believe Rob's the best person to speak about this here as he has researched and adopted a strict diet and I think had surgery after RT).

Edited by member 02 Nov 2014 at 23:31  | Reason: Not specified

Gerry, I can think of only one member here who has had salvage RP - generally speaking the medical position is that it is not possible and this is stated in the NHS leaflets, most books and the PCUK toolkit. There are two reasons for avoiding this way round - a) RT makes the prostate sticky and ill-defined which makes a clean surgical margin and total removal unlikely and b) the risk of life-changing and permanent side effects is much greater than for surgery followed by RT. Having said that, it is highly likely that the reason most surgeons avoid RP after RT is the fact that they have to publish their success rates and salvage RP has poor outcomes. If a surgeon is willing to give it a go, the thinking from countries where it is more common is that sometimes, it works :-)

* Amended to say that the idea of salvage RT after RP as a "second bite of the cherry" is flawed - the fact is that if RP fails and a second bite is needed, the statistical likelihood is that the outcome for that man will not be very good i.e. he is unlikely to get to or maintain a remission 

Edited by member 02 Nov 2014 at 23:31  | Reason: Not specified

Have made contact with MM Barry.

Just to add that salvage treatments include surgery; Cryotherapy, HIFU & HDR Brachytherapy as possibilities.

My surgery was no different to a standard robotic RP experience & I was home the next day. Rarely the prostate might be more difficult to remove & open surgery might ensue to help the surgeon. Newer scans give a better picture of the likelihood of problems prior to treatments.

The NHS is unlikely to offer salvage treatments unless  benefit is anticipated. This may only be extended survival but this can be important to some. For others the higher risks of side effects may put them off.  A personal decision.

In other cancers. it is common for one treatment to follow another immediately. e.g. surgery, then R/T , then chemo. Or,chemo, then surgery, then R/T.Or, surgery, chemo & then R/T . Recurrence is not waited for. Each treatment adds to survival chances/time.( See NHS Predict website for example for B.Ca. ). I doubt this is viewed as a second bite of the cherry by the medical world who follow such tried protocols. We are just way behind with P.Ca. on the best types & sequences of treatments for each case. We are often offered choices at diagnosis simply because the medics do not know which treatment will give the very best result .

R/T statistically still shows a higher recurrence percentage  than surgery cases  for P.Ca. Even if figures include less aggressive cases on the surgery side. So there is a place for salvage treatments post R/T and these are being evaluated for best results.