Surgery

This content has been reviewed and approved by

Daniel P. Petrylak, MD
Associate Professor of Medicine
Director, Genitourinary Oncology Program
Columbia University Medical Center

Can patients undergo a radical prostatectomy after local failure? 

Question: I was recently told that my PSA has gone up from 0.5 to 0.75 to 0.95 measured every 4 months. The rise started about 4 years after external beam radiation therapy (EBRT). My doctor said that I would be a possible candidate for a radical prostatectomy. What do you think?

Answer: Patients who can undergo such a procedure have to be in generally good health and not have a high likelihood of systemic disease (those patients generally have a doubling time of greater than 3 months and recur within the first year after radiation). Patients who are more likely to have recurrence only in the prostate gland would be candidates for a radical prostatectomy; however, there is a high incidence of impotence and incontinence when undergoing this procedure. Those with high Gleason score tumors also do not do well.

What are the risks of salvage radical prostatectomy?

Question: I am an otherwise healthy 52-year-old man who had external beam radiation therapy for a Gleason 3 + 3 = 6, T1c prostate cancer 4 years ago when my PSA was 7.7. It decreased to 0.4, 1 year later, but began slowly rising in the fourth year to 1.7, 11 months later. Work-up showed no cancer anywhere else and a prostate biopsy showed recurrent cancer. Am I a candidate to undergo a radical prostatectomy now?

Answer: There is about a 30 percent chance of incontinence and impotence (if not already present) from the procedure, as well as strictures causing problems with urination. Only surgeons who have a lot of experience doing this procedure should attempt it.

What is the role of cryosurgery after local failure? 

Question: External beam radiation therapy (EBRT) failed to help me 3 years after treatment. Can patients who have had radioactive seed implantation, external beam radiation therapy, or a combination of both undergo cryosurgery if radiation fails?

Answer: Patients whose doubling times are greater than 3 months and whose cancer recurs in more than 1 to 2 years after radiation failure are candidates for cryosurgery if there is no evidence of systemic disease. It is important that there be documentation of persistent prostate cancer in the biopsy specimen before salvage.

What is the risk of hip fracture in men undergoing bilateral orchiectomy?

Question: I had both testicles removed 5 years ago when I was told that I had a large prostate cancer that was extracapsular at the age of 75. My support group says that I'm at high risk for a fracture if I fall down. Is this true?

Answer: It is about double that of the population of men who have not had their testicles removed. This begins within 6 months and lasts for more than 15 years. This also applies to men who are on long-term hormonal deprivation therapy. You should be taking 1,000 milligrams of calcium, 400 to 800 international units of vitamin D, and possibly Zometa® (zoledronic acid) if you have osteoporosis or metastatic cancer in your bones.