I often discuss the use of salvage radiation after surgery has failed and the PSA begins to rise. Although often mentioned, but seldom used, men who fail radiation as a primary treatment can also benefit from salvage surgery. When I first was deciding what to use as my primary treatment modality I was led to believe that salvage surgery could not be preformed post radiation because “the prostate is just mucked up”.
In reality a salvage radical prostatectomy can be considered for men with locally recurrent prostate cancer after external beam radiotherapy has failed. Between 2001 and 2004, Leonardo C, Simone G, Papalia R, Franco G, Guaglianone S, Gallucci M. from the Department of Urology, University of Rome, Rome, Italy, treated 32 men who had undergone radiotherapy with curative intent for prostate cancer. Subsequently they were treated with salvage surgery for clinically localized prostate cancer once their PSA scores again began to rise.
They assessed the morbidity associated with this procedure and the outcome of these men. Initial pre-radiation median prostate-specific antigen was 13 ng/ml. Pre-radiation disease was clinical stage T1b in five cases, T2a in 10, T2b in 10 and T3a in seven. Mean operative time was 122 minutes, intraoperative blood loss was 550 ml and hospital stay and catheterization time were 5 and 12 days, respectively. There was biochemical failure in eight patients after salvage radical prostatectomy and 24 patients are biochemical non evidence of disease (bNED). In recurrent prostate local disease with prostate-specific antigen <10 ng/ml and life expectancy greater than 10 years, salvage radical prostatectomy is a reasonable treatment option if radiation has failed. 1: Int J Urol. 2009 Jun;16(6):584-6. Epub 2009 Apr 22. PMID: 19453762 [fusion_builder_container hundred_percent="yes" overflow="visible"][fusion_builder_row][fusion_builder_column type="1_1" background_position="left top" background_color="" border_size="" border_color="" border_style="solid" spacing="yes" background_image="" background_repeat="no-repeat" padding="" margin_top="0px" margin_bottom="0px" class="" id="" animation_type="" animation_speed="0.3" animation_direction="left" hide_on_mobile="no" center_content="no" min_height="none"][PubMed - in process] Joel T Nowak MA, MSW [/fusion_builder_column][/fusion_builder_row][/fusion_builder_container]
The objective of this study was to examine the feasibility
of draining the bladder with a percutaneous suprapubic
tube (PST) after robotic-assisted laparoscopic radical
prostatectomy (RALP) and to examine whether such a
technique would result in decreased postoperative discomfort.
In this study, we describe the technique of PST
placement and detail complications resulting from the
procedure. Specifically, urologic teaching has long held that
urethral anastomoses should always be bridged with a
urethral catheter; otherwise, mucosal cross-healing and
stricture formation may occur.
I read it in an artical from Dr Menon on his website http://www.drmanimenon.com.Please check the artical”Impact of Percutaneous Suprapubic Tube Drainage on Patient
Discomfort after Radical Prostatectomy”
I don’t understand most of what you’ve said. My husband’s tumor is wedged into the bladder, close to the rectum. He is currently on hormone therapy – 4 months duration – before the decision (obvious?) to do salvage prostatechtomy. This cancer was radiated 6 years ago; and PSA doubled, slowly over the past 2 years. His Gleason rating is highest (+ 5 +5)- but they are arguing about credibility of that finding….at Mayo. Gleason scales are based on a prostate that’s not been radiated???
Your mention of bladder involvement as well as my overwhelming need to understand and support what’s going on……..affirms whatever response you may make. Thank you.