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Surgery after unsuccessful radiotherapy? - Surgery (prostatectomy / RP),radiotherapy

User
Posted 27 Dec 2015 at 12:46

Hello, 

My father has prostate cancer, still localized in the prostate. Our first doctor didn't recommend surgery, but radiotherapy. After it, we found out that the amount of radiation was small, around 40, when it is possible to go as high as 72. It didn't really work and now it is getting worse. They say that surgery after radiotherapy is not possible, but another doctor said that it can be done now as it was to little. And the scans look good and we may take the risk. We don't know what to do. Did someone have a similar experience and can advice me?

Thank you in advance.

Elena

User
Posted 27 Dec 2015 at 14:10

Hello Elena and welcome to the site.

I believe that in general it is accepted that if you've had RT then surgery is no longer an option but as you say, your father has been advised it is still possible due to the relative amount of radiation.

My husband was certainly advised that it wasn't possible to do RT first when we were looking for treatment options.

I hope that somebody else will be able to reassure you having already had the experience.

You have come to the right place here. We are all doing our best to help each other, although the fact that you live in another country may make a difference to any advice.

Best Wishes

Sandra

 

I've edited to ask if you know what his latest PSA and Gleason scores are?

Edited by member 27 Dec 2015 at 14:11  | Reason: Not specified

We can't control the winds - but we can adjust our sails
User
Posted 27 Dec 2015 at 16:00

Elena, there isn't enough information for us to be able to help you properly - for example, was your dad treated in Moldova or another country? Not all countries might use the same measurements for giving radiotherapy (RT).

Here are some things that might help you while we wait for you to give more details:

- how do you know it hasn't worked? Can you tell us some proper scores? Was he given any hormone treatment with the RT?
- the 40 isn't necessarily 'less' than the 72 - it isn't that straightforward as he might have had bigger doses over fewer sessions but the cumulative effect is greater
- it is sometimes possible to have surgery after RT but because the prostate will be gloopy, it is very hard to remove it all so there is more risk of leaving some cancer behind
- it is also much more likely that dad would have long term side effects like incontinence and impotence
- in your circumstances, I would be worried about the motives of the person who says the operation is possible - who will be paying for the operation? Do you have a free health service or insurance or do patients have to pay cash for their treatments?

"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

User
Posted 27 Dec 2015 at 21:36

Elena,

My first thought follows the first question Lyn raised. What was your Dads PSA when first Diagnosed? What was it just prior to treatment and when the RT was administered and when was that? Has it now increased (perhaps after the lowest point after treatment called 'nadir') to a level or in a way that indicates that the RT was not successful? It has to be remembered that RT goes on working for something like two years but if Hormone Treatment was also given, this would usually help drop the PSA for the period it was given and for a relatively short time afterwards, after which the RT would be acting on it's own.

If indeed he was given inadequate RT (and not just the alternative of fewer fractions of a higher dose), has he asked whether further RT could be given now, perhaps together with HT? Maybe he would not wish to go this route after his previous experience even if offered? A relatively small number of men have surgery after RT due to only few surgeons being prepared to do this and the increased risk of more severe side effects.

There are other treatments for where the cancer is contained within the Prostate. Two of these are HIFU (High Intensity Focal Ultrasound) and Cryotherapy and they can be given where RT has failed. However, these are only available in a few countries and mostly would have to be paid for by the patient or his insurers where not provided as a state service.

Barry
 
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