Radiation as treatment IF cancer comes back - how effective?

Recently diagnosed. Stats below.

Have posted several times now.

Still weighing surgery vs brachy.

One data point seems to elude me.

Specifically, if I have surgery and cancer returns.... how effective is radiation as a secondary treatment upon return of cancer?

And how does that compare to re-radiating after brachytherapy?

And I understand it's different if it returns in the prostate area or returns metastasized elsewhere?

Try as I might I can't get any surgeons or radiation guys to shed any light on this.

To me this is a pretty central question if the possibility of radiation as a secondary treatment is being held out as the primary reason for surgery.

FB: How did they determine that you had a 60% chance of escaped cancer?

And what made you decide to go the non surgery route?

Aachen =  my urologist used the partin tables to determine that i had a better than average chance that my disease had escaped the capsule and he therefore did not want to operate knowing that i would most likely require salvage radiation.  He said with salvage radiation there's a greater risk of side effects like incontinence and erectile dysfunction as well as bowel issues.

he said he wanted to keep my prostate as a target.  we began with hormone therapy to stop and shrink the cancer and then the seeds were placed in my prostate.  a few weeks later i underwent 5.5 weeks of IGRT.  i then received my last shot of lupron. 

with this three-pronged attack we were able to deliver twice as much radiation to the prostate and also hit the lymph nodes and prostate bed.

so far so good.

ed

 

My surgery "failed" in 9 months time, then I underwent radiation, it too failed in less than 9 months. So both my curative hopes went out the window. There is a certain amount of sheer guess once your surgery fails, because in most cases, they don't really know if your cancer is in the prostate bed or not. Odds of success are typically 30-40% on the high side. For me, it was only given a 20% chance of it working.

david

It all depends on where the cancer is.   If it truly is within the capsule then surgery alone may work.   If it is within the area of the prostate, then surgery won't work but radiation probably will.   That is why many have to have radiation after surgery.   If it is in other parts of the body, then neither will be curative and hormone therapy becomes necessary.

You have to put your particulars into the nomograms and determine the risk factors.  I am surprised your doctors have not done that.   My uro, rad onc and med onc all started with a frank description of the biopsy and then went right to the nomograms to show the probabilities of capsular escape.   I had a high probability and so surgery was ruled out as not being curative.

 Thus I used High Dose Rate brachytherapy, IMRT external beam radiation, and adjuvant Hormone Therapy (ADT3).   My urologist-surgeon would not operate because he was sure the marginns would be positive and I would also need radiation.   He said it would subject me to too much risk and side effects when radiation would be as effective as surgery with less risk and side effects. 

Hi,

Our situations are somewhat different, but there ARE some similarities. My PC was a Gleason 3+3 and, like yours, was confined to the prostate. With a 3+4, yours is somewhat more aggressive than mine, but a 3+4 is much better than having a 4+3. You should be looking at a cure.

Here is what I was told at Mayo Clinic when I went there after being diagnosed back at home. I saw a radiation oncologist who told me that radiation OR surgery could both cure me. He explained that, in my case, either surgery or radiation would be 90% likely to cure me.

He further explained that, if there was a recurrence after surgery, salvage radiation would be the next step. He told me that, in such cases, the salvage radiation completes the cure in 7 out of 10 patients. So, I asked him if this essentially means I had a 97% chance of cure -- and he said YES.

I also had a BPH stricken prostate (4x normal size) that was causing terrific urination problems, so the Mayo radiation oncologist said my best course of action would be to go with DaVinci surgery. The BPH really offered no other logical choice for my case -- surgery was the way to go.

I had already planned to have the surgery anyway (as opposed to radiation) because I have a family history of PC and always promised myself that I would just get rid of the whole thing if/when I was diagnosed.

In your case, you seem to have a good choice between radiation and surgery. Be aware that external beam radiation, if it fails, makes a later surgery impossible because of the scar tissue around the prostate from the radiation. Be sure to ask a radiation oncologist about this.

While I would recommend you go with surgery, you probably should school yourself on all your options, including radiation, whether it is external beam, brachy, proton, etc.

Talk to a highly experienced radiation oncologist and also to a highly experienced urologist/surgeon -- get the pros and cons of all the forms of treatment. Then you can decide for yourself what you feel most comfortable with & confident in.

Good luck!
Chuck

Resident of Highland, Indiana just outside of Chicago, IL.
July 2011 local PSA lab reading 6.41 (from 4.1 in 2009). Mayo Clinic PSA Sept. 2011 was 5.7.
Local urologist DRE revealed significant BPH, but no lumps.
PCa Dx Aug. 2011 at age of 61.
Biopsy revealed adenocarcinoma in 3 of 20 cores (one 5%, two 20%). T2C.
Gleason score 3+3=6.
CT of abdomen, bone scan both negative.
DaVinci prostatectomy 11/1/11 at Mayo Clinic (Rochester, MN), nerve sparing, age 62.
My surgeon was Dr. Matthew Tollefson, who I highly recommend.
Final pathology shows tumor confined to prostate.
5 lymph nodes, seminal vesicles, extraprostatic soft tissue all negative.
1.0 x 0.6 x 0.6 cm mass involving right posterior inferior,
right posterior apex & left mid posterior prostate.
Right posterior apex margin involved by tumor over a 0.2 cm length, doctor says this is insignificant.
Prostate 98.3 grams, tumor 2 grams. Prostate size 5.0 x 4.7 x 4.5 cm.
Catheter out in 7 days. No incontinence, occasional minor dripping.
Post-op exams 2/13/12, 9/10/12, PSA <0.1.
Semi-erections now happening 14 months post-op & slowly getting a bit stronger.

Re: the Partin tables ... remember, they are just statistics. You need to weigh those probabilities against the possible outcomes. I.e., if you have a 40% chance of a cure, is that worth doing? Even if those percentages are low, you have to remember that someone has to be amongst that low percentage!

When I visited the RO for a second opinion, he recommended surgery for me. But also said I was likely to see him at some point in the future. I'm pleased to say that I have not, and remain hopeful that I will not!

I know I was lucky ... I can't remember and haven't gone back to look, but I think the probability of a cure for me was less than 20%. I felt the gamble worth it for the possibility of a cure and (important to me) the ability to get a full pathology on the little bugger.

I had surgery for a 3+3. I was 49 and they said that this was the best chance of a cure.
Post surgery the problem was they they upgraded me to 3+4, and I also had Seminal Vesicle Invasion.
They said they would not suggest any further treatment without first seeing my first post-op PSA test.
That was 0.1, not a zero club, but they still said wait till the next PSA test.
That next was up to 0.4, and at that point they said that surgery has failed and they were making appointments for me to see RT docs within a few minutes.
The good news was that my first PSA test after surgery was "Less than 0.1" so they were pretty certain that there had been a bit of nasty tissue in the prostate bed very close to what had been removed at surgery.
The lab now has a new machine and my latest PSA test was even better at "Less than 0.01"
We are all different, but I am very happy to have had surgery and then SRT.