Radiation and RP?

Hi Scottymo,

The answer to your question is "yes". If you have RP you can have a follow up with hormone or radiation or both. You can also have hormone concurrent with RP. Common belief is that if you have radiation first you cannot have salvage surgery. I have seen some evidence that you can do salvage surgery it is just that the side effects are not good and come with a high probability of occurence. Cryo is also available and getting better as salvage but you still have the SE's.

You do not give your age but your PSA score on 10/21 repeat does not look that high. Or is the date on the 5.9 a typo?

Good luck and I hope the news from your biopsy is good. By the way the biopsy is not that bad of a procedure so don't let your mind work you up over it.

Take care,

Don

Scotty,

This just came in from John Hopkins about RP. My husband had Radiation treatments and a seed implant and the same kind of physician experience is required for these procedures also. So, whichever one men choose as their treatment option, make certain that the physicians performing it have the experience required. Read Below:

According to a recent study, the risk of a prostate cancer recurrence after radical prostatectomy appears to depend in large part on how many procedures the surgeon has performed. The take-home message: experience counts.

Radical prostatectomy was developed at Johns Hopkins at the beginning of the 20th century. The operation was not popular at first because of the high rate of erectile dysfunction and urinary incontinence associated with the prostate surgery procedure.

But in the early 1980s, Johns Hopkins urologist Patrick Walsh, M.D., developed a new approach to the prostate surgery operation. He devised a "road map" that allows surgeons to remove the prostate with less risk of damaging the nerves that are essential for erections and urinary control. This "nerve-sparing" prostate technique has reduced the risk of severe incontinence to 1-3% and the risk of mild incontinence to around 10%.

The risk of erectile dysfunction varies according to a man's age and the surgeon's skill. One group of researchers reported that nerve-sparing prostate surgery achieved successful recovery of erections in 68% of patients. Dr. Walsh has performed the prostate procedure on more than 2,000 men with early prostate cancer, preserving erectile function in 90% of men in their 40s, 75% of those in their 50s, and 60% of those in their 60s.

The importance of surgeon's experience as it relates to prostate cancer outcome is underscored by the results of a study reported in the Journal of the National Cancer Institute (volume 99, page 1171).

Researchers analyzed the outcomes of 7,765 radical prostatectomies performed by 72 surgeons between January 1987 and December 2003 at four major academic medical centers. "Biochemical" recurrence was defined as a postsurgery PSA level greater than 0.4 ng/mL followed by a subsequent higher PSA level. The analysis took into account patient and tumor characteristics, such as pre-operative PSA level and Gleason grade. The men's PSA levels were measured every three to four months in the first year after surgery, twice in the second year, and annually during the following years.

The researchers found that surgical outcomes improved along with the number of radical prostatectomies a surgeon had performed, leveling off only after about 250 surgeries. The five-year probability of experiencing a recurrence of prostate cancer was 18% for surgeons who had performed only 10 operations compared with 11% for surgeons who had performed at least 250 surgeries.

Bottom line on prostate cancer surgery: The results suggest that you can improve your odds of a successful outcome from radical prostatectomy by taking time to find a surgeon with extensive experience.

Wiggyann

The best answer I can think of...no two men are identical...so the more experience a surgeon has...the better understanding he will have to those differences between men. A less experienced surgeon will have a learning curve in which he will be come comfortable with over time and the number of surgeries. I certainly would not want a surgeon just out of training to operate on me and by the same token I would not want an older surgeon that doesn't have a steady hand...regardless of how much experience he has.

Selmer, 

I agree with what you say  (first of all , hurray my number PSA went down!)

your numbers would not yet inidicate a Biopsy;

As you can see my PSA lowered after 2 week treatment of; even lower than the 1.38; so dicovering the baseline and velocity may be difficult.  I would think the lowest number ever (assuming no lab issues); would be your baseline; then every 3 months anotehr pSA test; and if it jumps; maybe another after a 2 week trratment as I had;  this way a true (as best as we can) PSA velocity can be determined.  As far as I can tell; if every man had a Biopsy they would find a ton of cancer; and depending on teh Biospy one would know whether they needed treatment only some of the time;  for alot of these cancers; they would not know whether it was aggressive or not;  The Biopsy does help in that area; so I could understand doing it for everyone who had some PSA rise; however; I am not sure if I would want to Biopsy a non life threat cancer; as I read that it may disturb it; although I doubt it; I dont think it has been proved one way or the other.  So alot to dicsuss; but it is clear that PCA can be aggressive and early detection is a key for those cases.