Salvage prostatectomy surgeons

If you have had a salvage prostatectomy and were please with your results and the expertise of your surgeon, please pass along their information. I already know how difficult this surgery is for the average surgeon, which is why I am only looking for the exceptional doctor who has done many salvage surgeries. So, don't waste giving information for doctors who have onlyt done regular prostatectomies, or just a few salvage, they won't due.
Thank you

From what I understand this is a rare type of surgery. My surgeon has done a few but probably not more than a handful. Not sure you'll find someone with volume in this field and not sure you would be the right candidate as I understand many things have to fall perfectly in line for it to even be attempted.

I'm in the Los Angeles area, but that would stop me from traveling.

davidg, Yes it is very tricky surgery, that's why you need the best who has done the most. You were lucky that they found yours early and the Samadhi robot cut is out. Good luck.
I may be an ideal candidate, when I get some more diagnostic information, I will then know if I should move on this.

If the doc at Vanderbilt has done many of this specific surgery, please forward the information when you remember it.

what are you calling many in this case? again, they are rare surgeries that are rarely done. I doubt you will find any surgeon whose done more than a handful in their entire career. my own uro/surgeon, very experienced in general, only participated in one salvage surgery. he remarked that it was very brutal and the results were terrible for the patient. he said he would be involved in another attempt.

do you have failed radiation currently? are there any other options other than salvage radiation available to you?

david in sc

Dr. James Eastham at Memorial Sloan Kettering in NYC. My husband did surgery as a primary treatment so this recommendation is not from personal experience. I know that Dr. Eastham does this operation, and is known for doing it. He has a reputation as being a great surgeon.

Purgatory, Yes, I have failed radiation, so the salvage will be my only possible treatment other than hormone blockade. I don't doubt that the surgery was brutal especially since they hadn't done many before. It takes great skill.

davidg, I will search Jan des Bouvrie and see where it was done.

bluebird123 and Frackme, This name has come up several times, so I guess I will pursue it and see where it goes.

NYCA,

Dr. Eastham does both open and robotic surgery for primary treatment. I don't know if he does both in cases of salvage surgery. I'm sure you can call his office and find out. He is a very approachable guy and a straight shooter.

Nyca

Welcome. Salvage surgery is very difficult and rarely successful. As you mentioned further testing may be required to determine if the cancer is still local. The c11 PET scan has proven valuable in this regard. Other more common salvage treatments for failed radiation are cryosurgery, Duke Bahn in Ventura. Also look at HDR brachytherapy, Jeff Dermains at UCLA or LDR brachytherapy, Dattoli Cancer Center in Sarasota.
Best of luck, you should at least contact the above Drs for their opinions on your situation as they all have a lot of experience in treating failed radiation cases. Also if you are in LA Dr Mark Scholz would be a good guy to run your case by for a second opinion.
Good luck,
JT

I just remember my surgeon telling me this when discussing the subject of salvage surgery. Due to the "blurring" so to speak of the surrounding tissues from the radiation, there is extreme risk to having severe rectal wall damage. Ending up with a colostomy is a real danger with this type of surgery, as well as permanent incontinence and permanent ED issues.

I am facing a similar problem, but with my bladder. I just visited an upper level surgeon at MUSC in Charleston, SC. Dr. Thomas Keane. I suffered great damage to my body from a blotched salvage radiation job after a failed prostate surgery. My bladder and bladder neck was fried. I ended up having to have my bladder by-passed with a Urostomy surgery (similar to a colostomy, but for urinary reasons). My bladder should have been removed at the time, but wasn't. Now 2 plus years later, the disconnected bladder is acting up, going bad, etc, and possibly may be cancerous. The operation to possibly remove it is highly complex, and very risky, and it could make things worse than they are. Was told point blank, that death was a possibility in this surgery, or I too could end up with a colostomy.

It's possible with his level of skill, Dr. Keane may do the type of surgery you suggest. Mine bladder operation is still early in the planning stages and no decision has been made. The surgeon is still not sure he's willing to do it, even though he is the most skilled surgeon in SC to undertake it.

david

Hi davidg,

True, surgery is not recommended after failed radiation. Purgatory referred to the "blurring" of the tissue around the prostate from the radiation treatments. From what I have read, this refers to scar tissue that is created as a by-product of the radiation.

Not sure about HT, but I'm sure others can answer that.

nyca, have you thought about setting up a consultation with the Mayo Clinic urology dept? Or perhaps Johns Hopkins, etc? Mayo & Hopkins have probably done the most of just about every type of PC treatment (or salvage treatment) there is.

Might be worth a trip there to see what they have to say. Having been a patient there for years (including for PC), I'm naturally partial to Mayo in Rochester, MN. My own surgeon there is excellent & I would highly recommend him. I have no details about salvage surgery there, but I'd sure have to think they would be right on top of it.

Good luck to you!
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-firm erections now happening 14 months post-op & slowly getting a bit stronger.

When radiation fails, it is usually because the cancer was systemic before the treatment. Thus salvage surgery is also unlikely to be curative. As was stated, ADT is then the next line of treatment.

JohnT gave great information particularly regarding HDR brachytherapy. Demanes website is www.cetmc.com and has information about salvage therapy.

The best point made was that it will be best to determine where the cancer is before making salvage attempts. If it away from the area that either surgery or radiation would reach, then why go through the risk and side effects of the treatment? Time for more specific investigation.

When I was considering treatment options and scenarios, I discussed radiation followed (if necessary) by salvage surgery with my Ux. He explained the challenges of that path, and noted that he does do some (don't know how many).

In a search, I found him as a co-author on an article ... "Salvage laparoscopic surgery in advanced prostate cancer: is it possible or beneficial?" ... (I did not read the article).

So ... two suggestions ... consider looking into this Ux (Dr. Jean V Joseph, head of Urology at the University of Rochester (NY)) ... and as a means of finding others Drs, consider doing a search on the literature related to salvage surgery ... it might give you some leads.

Good Luck,
UG

Dr. Louis Pisters at MD Anderson Cancer Center in Houston does this surgery.

http://faculty.mdanderson.org/Louis_Pisters/Default.asp