Traditionally, one of the key factors when deciding between prostatectomy and radiation for initial treatment was the issue of what options remain down the road if the PSA begins to rise. In the past, radiation therapy resulted in great damage to the genital area, making curative surgical resection of the remaining prostate and/or tumor tissue too difficult. Many men therefore opted for surgery simply because it gave them the opportunity to be treated afterward with radiation therapy, should their cancer return.

With the advent of 3-D conformal radiotherapy, IMRT, SBRT, and brachytherapy, local tissue damage is often kept at a minimum. However, sometimes there may be residual cancer in the prostate.  In this situation, surgeons at some of the larger cancer centers have been seeing improved results with “salvage” prostatectomy. Much of the data suggest that men who had tumors that were considered potentially curable before radiation might do well with post-radiation surgery. But if the tumor had characteristics that suggest a higher likelihood of early disease recurrence, such as a higher Gleason score or spread to the lymph nodes or seminal vesicles, the surgery will probably offer little or no benefit.

Nevertheless, even under the best of circumstances, post-radiation surgery is a very difficult operation to perform and can result in significant urinary and erectile dysfunction, so few surgeons across the country perform it regularly and successfully. If you talk with your doctors about this treatment approach, be sure to carefully weigh all of the different factors that can play a role in determining whether this approach is right for you.

Terms to know from this article:

PSA

prostate-specific antigen (PSA): A substance produced by the prostate that may be found in an increased amount in the blood of men who have prostate cancer, benign prostatic hyperplasia, or infection or inflammation of the prostate.

Tumor

A mass of excess tissue that results from abnormal cell division. Tumors perform no useful body function. They may be benign (not cancerous) or malignant (cancerous).

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