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Biochemical Recurrence and Salvage Prostatectomy

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User
Posted 22 Feb 2018 at 17:52

I have recently been diagnosed with biochemical recurrence of my PCa. I had 3 years of hormone treatment (2009-2012) as well as IMRT in 2009. My PSA has risen from undetectable to 2.4 ng/ml at the last measurement in January of this year hence the diagnosis. A recent PET/CT scan showed the cancer is still confined to my prostate and seminal vesicles.

The options I have been presented with are either standard care of further hormone treatment when my PSA approaches double figures or my PSA doubling time is less than 6 months or salvage prostatectomy.

Salvage prostatectomy as explained to me is still an experimental procedure and has the potential higher risk of side effects including urinary incontinence, bleeding and fistula formation. I have a meeting with the surgeon in two months time to find out more and if I would qualify as a suitable candidate. In the meantime I would like to know if there is any experience or knowledge of the procedure in the community.

Tom

User
Posted 23 Feb 2018 at 09:29

Morning Tom

Hmmm. Salvage prostatectomy eh. I would be interested in the answers to that too as I thought it wasn't possible (although as you say it's experimental)

Hopefully, you'll get helpful answers

We can't control the winds - but we can adjust our sails
User
Posted 23 Feb 2018 at 10:18

Some months back I had a referral due to rise in PSA after RT/HT. The options were discussed on what if by the same uro consultant when first diagnosed in 2004 - HIFU not advised, salvage surgery ( nothing was mentioned about experimental) was possible. The uro has a good reputation but I made the point I would decline that. So it was left as IHT for the time being. In the end my PSA took another dip so no action needed at this point.

Ray

User
Posted 23 Feb 2018 at 16:58

Andrew, you are correct that the surgeon screens potential patients as to their suitability for the operation.

I will find out more later but I have already been told that factors like general health, bladder and bowel functionality are taken into consideration. In addition there would be a template biopsy before being selected as suitable for the operation

My first thoughts are that I will stick with standard care but am trying to keep an open mind at present.

Tom

"I'm not afraid of dying, I just don't want to be there when it happens" - Woody Allen

User
Posted 23 Feb 2018 at 17:31

Another option? Member davekirkham initially had RT/HT then later salvage HDR brachy. Might be worth reading his profile.

Ray

User
Posted 07 Mar 2018 at 22:47

Sorry to be late to your chain.  Nearly same story.  I elected for Robotic radical salvation prostatectomy a year ago.  It is not for the faint of heart, but until SPARTAN study, not a lot of options. Suggest something like Mem Sloan Kettering website for good overview.  Will leave incontinent for sure, but varying degrees.   Artificial sphincter a nuisance but works very well.  PSA arising again.  None of us are going to live to be 140 - it is all about extending life as long as quality of life sustainable.

User
Posted 09 Mar 2018 at 13:46

Hi Gary

The artificial sphincter is new to me. Can you say a bit more about it.

Tom

User
Posted 09 Mar 2018 at 23:17

With a Transperineal template showing only one core out of fifty, I was considered suitable for HIFU and subsequent MRI seemed to show this was successful. However, my PSA has since risen and is likely due to a suspect iliac node which HIFU could not reach. The possibility of treating this with more RT may be possible (I await a PSMA scan to help determine this). I am reluctant to fall back on just HT. I am glad I didn't opt for radical surgery - I was told there would be a near 100% chance of incontinence and it would not have dealt with the suspected cancer in the iliac node. I was not offered brachytherapy but doubt this would have reached the suspect ilian node.

Barry
User
Posted 16 Apr 2020 at 18:40

Hi Tom, 

A long time since this post but I am now probably destined for salvage surgery following the return of my PCa, 6 years after treatment by HT, HDR brachytherapy and external beam RT. Your post came up in my search and I wondered if you underwent salvage surgery.  If so what was your treatment and outcome?

Regards 

Rob 

User
Posted 18 Apr 2020 at 15:14

Hi Rob

I haven't had any further treatment yet as my PSA has not reached a trigger point. Just now my PSA is just over 4ng/ml and creeping up slowly. When it goes over 5 I will be re-staged after another PET/CT scan.

However, I have more or less decided not to have the operation. I am nearly 80 and apart from the PCa I am healthy and active and have a good life-style. The potential of being doubly incontinent is not appealing so I am almost certain do go down the standard treatment path of hormone therapy.

Tom

User
Posted 18 Apr 2020 at 18:40

Hi Tom, 

Thank you so much for sharing your story with me.  Although my PSA is much lower at 2.5, the scans are very much pointing my oncologist towards pressing on with surgery soon. I too feel very well now but I don't want this thing spreading further. 

I wish you the smoothest possible journey on your chosen path. 

Best wishes, 

Rob

 
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