Need opinions about questions for dr

Steve1961

Everybody knows my story failed radiation treatment. It’s not biochemical failure .. the radiation treatment didn’t work because I apparently Cribi form is radiation resistant so now one final meeting tomorrow and then I’m making a decision between Cryo or salvage surgery.. the doctor UCLA will have some serious questions to answer i would I like everybody to see this and give some thoughts thanks

Our surgeons at UCLA have extensive experience performing these surgeries and most often performed with robotic assistance. This procedure is called salvage prostatectomy and is most frequently performed by Dr.Robert Reiter

This is uclas add .. Dr. Reiter seems to be an expert. He’s done about 3000 surgeries but he also does biopsies and he also does hifu . As well as other things Hmmm I asked a question via message through the Internet about how many surgeries has dr reiter done and is intern responded that the surgury is very rare. It not performed a lot. He can ask the doctor how many he has done in the intern said that he has done a couple of them himself….hmmm everywhere I read tells me this needs to be done expert surgeon only ..so last time a met with dr reiter i asked how many he has done he says they don’t really keep track but around 20 so I’m wondering if it’s fair tomorrow to ask him how he started doing this and why he started doing this because not that many surgeons that do it in the country and if he will be doing it and not one of his interns I think this is a fair question..thoughts .. because I don’t want to just be somebody’s experiment again..thanks ..20 to me doesnt mean extensive .. thanks for listening

Clevelandguy

Hi,

In my humble non medical opinion, a surgeon thats done only around 20 surgeries is still in the learning mode. I would find a much more experienced surgeon who has done hundreds or thousands of prostate salvage procedures.

Dave 3+4

Old Salt

Salvage prostate surgery after radiation is pretty rare. I doubt there are any surgeons/urologists (in the USA) that have done more than a few.

PS: I did a quicky search of published studies and came up with the following :

Conclusions

Salvage radical prostatectomy remains an effective but underutilized therapeutic option for men with localized prostate cancer recurrence after radiotherapy. While it offers long-term oncologic and survival benefits, salvage RP after RT is a technically difficult procedure due to obliterated tissue planes and fibrotic reaction. Although functional outcomes have improved over time, post-radiation salvage RP still poses an elevated risk of erectile dysfunction and urinary incontinence. Given these risks, patient selection is paramount in determining when to offer salvage RP, a recommendation that has found its way into international society guidelines. Patients who are likely to benefit most from salvage RP include those with long life expectancy who have lower preoperative PSA, a lower Gleason score, and lower post-prostatectomy staging and who do not have nodal involvement. As the detection of radio-recurrent disease continues to improve with novel imaging techniques, decision making surrounding salvage therapy will continue to become more individualized, and oncologic outcomes will similarly become more promising.

This is copied from a 2023 paper by Drobner et al:

Cancers | Free Full-Text | The Role of Salvage Radical Prostatectomy in Patients with Radiation-Resistant Prostate Cancer (mdpi.com)

Steve1961

https://csn.cancer.org/discussion/comment/1712818#Comment_1712818

Sorry 3000 regular arpund 20 salvage

centralPA

I don't think you will find anyone who does a lot salvage prostatectomies following failed radiation. If he's done a ton of standard ones and some salvage, that is probably as good as you’re going to get. He knows the territory.

csjchas

Is cribriform in fact resistant to radiation? I have seen studies saying androgen therapy is not effective for cribriform. It really is frustrating seeing so many different opinions on crib pattern. I have seen some youtube videos where the doctor just says he's not going to get into cribriform. Several others state that the study of crib pattern is relatively new and that more study is needed. I realize this site has several posts dedicated to this subject but they are frankly not that helpful.

My uro/surgeon told me a year ago when I was diagnosed that because it was cribriform that it had a 72% chance of bcr... which translates to a five year survival of 20%.

My biopsy was 4+4 but my pathology was 4+3... who the hell knows.

Steve1961

H

https://csn.cancer.org/discussion/comment/1712981#Comment_1712981

So biopsy results now are stating whether cribiform pattern is seen or not …no longer need decifer teating for that .now i 3+4 cribiform..i had radiation treatment..ok so now i have 4+4 ..small tumor right next to the fudicial marker that was targeted and targeted good .. two doctors are telling me that studies are showing that cribi form can be radiation resistant .. so what’s that telling you? I also brought this up about the 72% and study 200 men 70% of them had biochemical failure and my doctor said that’s absolutely not true. Now if he said I had 14 out of 17 positive positive course and it was in three places in your PSA was 12 then maybe …

Steve1961

https://csn.cancer.org/discussion/comment/1712981#Comment_1712981

Hmmm how does a 70 % chance turn in only a 20% chance 5 year survival rate .. that’s just micro, scopic failure, and then you treat it and manage it. I had Cribiform six years ago and I just now coming back a little bit. That is a ridiculous statement and your doctor is not very compassionate at the very most he should give you hope and not even tell you those things that are not true .