Salvage Surgery

Salvage Surgery
Hi mcdcc! The great problem with salvage surgery is that the surgical planes have been badly distorted by the radiation. In addition, the bladder neck has been irradiated making it much more difficult to take the prostate out and sew back the urethra from the penis back to the bladder "stump." Finally, the prostate is next to the anterior rectal wall. They are held together by Denonviller's fascia. The surgeon must free the prostate from this fascia. The seeds, placed to give generous margins around the prostate, in order to bring lethal doses to any cancer that might lay in the prostatic capsule or beyond, gives a good dose to the rectal wall. Hence the fascia is badly distorted also. Only the very best surgeons can perform a prostatectomy in this environment. As for the best surgeon(s) in Seattle there is no doubt in my mind that they are Lange and Ellis at the UW (and the recent addition of Dr. Dalkin). If you call back to Memorial Sloan-Kettering and ask Dr. Scardino to give you a personal recommendation it will be for Lange or Ellis!!! I have met Ellis and he is very good indeed. Finally, it might be best to also consider in this context cryoablation, along with androgen deprivation. That way to bypass such a large surgery frought with complications. As I mentioned earlier, although I have never seen a PSA increase such as yours, you do fit the pattern for the dreaded post-radiation 'bounce' (i.e., timing, urinary symptomolgy). Frankly, I would go and see Dr. Wallner. He has perhaps more experience with this phenomenon than anyone else. He will give you the best advice that you can get. Although you are having such high PSA readings, there are documented cases in Wallner's et. al. book where the man underwent a bounce of 16 ng/ml. And he was ok!!! I am hoping that you are just the most spectacular example of this phenomenon. Please let us all know what you find out.
Cheers
Bill