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Retzius-sparing Surgery after Failed R.T.

User
Posted 30 Jun 2021 at 04:25

Professor Whocannotbenamedhere has been involved in a limited trial of the Retzius-sparing prostatectomy for men whose radiotherapy treatment has failed.

Many surgeons are reluctant to attempt such surgery, because as one said, following RT the prostate turns to ‘mush’, and it is difficult to see what is a cancerous prostate and what is healthy tissue surrounding it.

The results of the trial are here:

https://www.auajournals.org/doi/10.1097/JU.0000000000001939

User
Posted 30 Jun 2021 at 15:56

Professor Whocannotbenamedhere does quite a number of salvage RS-RALP after both HIFU and RT.

Based on something he's found and something else I communicated back to him following this years Pelvic Radiation Disease Association conference, it's looking like salvage RT following hypofractionated RT (e.g. 20 sessions) is significantly more difficult than following standard RT (around 37 sessions).

It is also looking like PRD is more of an issue after hypofractionated RT too. Radiotherapy departments are moving to hypofractionation quickly because it helps with the country wide shortage of theraputic radiographers, and fewer sessions is preferred by patients.

RT doesn't turn the prostate to mush - quite the opposite - it makes it harder and unable to compress due to fibrosis to the smooth muscle. It's more difficult to remove because the fibrosis also ends up joining it on to neighbouring organs, where it wouldn't ordinarily be conjoined.

User
Posted 30 Jun 2021 at 16:56
our urologist described the removal of an irradiated prostate as like trying to scoop out jelly - not a tangible lump and bits fall off the spoon.
"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

User
Posted 30 Jun 2021 at 20:01
Professor Whocannotbenamedhere said he dreads the day, if it were to come, when radiologists just do one blast of their super-squirter ray-gun, rather than fractionated doses over a month or so.

I didn’t say an irradiated prostate looked like ‘mush’ a urological surgeon did!

Professor Whocannotbenamedhere occasionally puts colour photos on-line of a cancerous prostate he’s just removed on the end of a skewer, and I must say most look very tasty and ideal for the barbecue!

Cheers, John.

 
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