Li Liu, MD
Last Modified: November 1, 2001
Dear OncoLink "Ask the Experts,"
I have a question concerning radiation (external beam or seeds). If a man gets radiation for prostate cancer, can he have surgery after if the cancer comes back? If not, why?
Li Liu, MD, Editorial Assistant for OncoLink, responds:
Thank you for your interest and question.
A radical prostatectomy may be attempted if technically feasible in selected patients with prostate cancer who fail radiation therapy. However, surgical complications may be substantial. Rogers and colleagues from Baylor College of Medicine reported on 40 patients who underwent salvage radical prostatectomy 14 to 44 months after irradiation (Journal of Urology 1995 Jan;153(1):104-10). The operation was technically challenging, with 6 rectal injuries (15%), 2 requiring temporary colostomy. Serious technical complications were more common (31%) among the 29 patients who underwent pelvic lymph node dissection at the time of initial radiotherapy than among the 11 treated with external irradiation alone (9%). Similar surgical complication rates have been reported by other investigators (Journal of Urology 1995 Sep; 154(3): 1103-9). In patients who fail after radiation, another alternative is hormonal therapy. This may also be used as salvage therapy, either alone or in combination with surgery (Cancer 1993 Feb 1; 71(3 Suppl): 976-80).
Finally, the Abramson Cancer Center of the University of Pennsylvania is studying the use of photodynamic therapy (PDT) for treating patients with locally recurrent prostate cancer after radiotherapy (UPCC 1899). PDT may provide a new and potent weapon in the fight against prostate cancer.