difficult PC surgery ahead

I have just been dx'ed with PC, Gleason 4+3. I am 62.
I am 5 years out of surgery for colo-rectal cancer. My resection at that time was right at the location where prostate meets rectum wall. I had a stoma for 6 months and then re attachment surgery and that seems to work OK.
Now Dr says there is danger of rectum injury during prostate removal and risk of temp and maybe even permanent colostomy bag.
Apparently this is quite a rare juxtaposition of 2 surgeries and my Uro has never done one and has passed me on to a colleague.

Anyone else have a similar situation and found satifactory solution? I am new on the forum and sorry if I missed this in an existing thread.

BTW I can't have radiation-already had my max for the area with treatment for the colo-rectal tumour.

Eastman

Does surgery even have to be done, there are less invasive treatments for Pca, though admittedly do not know how the other treatment would affect the results of previous surgeries. With the limited information you provide, you appear to be eligible for all. The limited information, however, is a major caveat.

Welcome Eastman,

When having RP it is always critical to have a highly skilled and experienced surgeon but it sounds like this would be even more true in your case.

My surgery was complicated due to prior mesh hernia repair (the usual tissue planes all "glued together") and my surgeon told me most docs would likely have aborted the procedure but he was able to complete it successfully by his memory of the anatomy from having done 2500+ open RPs.

Prior radiation has a similar scaring effect and most surgeons will not do post-radiation salvage surgery but there a handful of surgeons (e.g. James Eastham @ Memorial Sloan-Kettering) who specialize in it. I would strongly recommend seeking out such a surgeon, even if it means traveling. Traveling for RP is common and really quite feasible.

Perhaps your case may be somewhat less complicated than typical salvage surgery following an failed radiation therapy for prostate cancer with the scaring mostly limited to the posterior region.

Good luck!

Not sure where you are, Eastman, but the docs at MD Anderson in Houston, TX are expert at difficult surgeries. I recently had a difficult salvage RP there, with good results.

I think Tudpock gave some good advice. Before committing to the surgery you may want to consult with a Radiation oncologist about may low dose brachytherapy or CyberKnife both of which keeps most of the radiation localized in the prostate. The risk of a permanent stoma would make me want to get second and third opinions. The other thing to consider with out  knowing more of your biopsy diagnoses other than the Gleason grade is if the PC has escaped the prostate your next option would normally have to be some form of salvage RT. Have you had and scans done on the prostate to see the extent of the PC?

Either way welcome to our forum and good luck for the future.

Terry

Thank you all for the response. A lot of information to consider here.
Additional info on my case is PSA 7, T2, 4 of 8 biopsy cores taken were cancerous, all on right side, left side negative-digital exam not possible because of scarring from previous surgery so it is unknown if cancer has reached prostate surface. Medium aggression suggested-RP surgery suggested take place within 6 months, gross hematuria before dx.
Meds-Flomax only.
I am investigating to see if I qualify for DaVinci robotic in Toronto.
I am self-employed and short recovery time is paramount.
Thanks again for your informative responses.