When discussing definitive prostate radiation, how do you respond to patients who mention that they heard that surgery is more difficult after radiation treatment?

I love this question! I hear it quite often, and it provides an opportunity to discuss the differences between radiation and prostatectomy, and the potential benefits and risks of both.

I start by stating that it is absolutely true that radiation causes scar tissue that can make surgery months to y...

I think the motivation for a urologist to raise this issue is to sway the patient towards surgery. The patients are led to believe that if surgery fails, they have options later—a second chance. I usually start out by acknowledging the fact that surgery IS more difficult after radiation but it is no...

This question is one of the most frequently asked ones—claims from urologists or medical oncologists conveyed to patients who are trying to decide between a surgical or non-surgical approach to manage their clinically localized disease. Indeed, salvage surgery after definitive radiation therapy is a...

I tell them that surgery after radiation is more difficult, but that the issue is what psychologists would call a "squirrel" or a distraction. I refer them to review articles on post radiotherapy salvage of localized recurrence in the prostate (an unlikely occurrence to begin with) and post prostate...

While salvage prostatectomy is indeed more challenging after EBRT, it is only indicated when there is local only failure. In the RTOG 0126 trial, the 8-year cumulative incidence of local progression was 3% in the 79.2-Gy arm. So, I emphasize that this is an uncommon situation, and the decision for d...

I often take a different approach. I suggest that there are surgical series on post radiation patients (Pontes et al., Woods et al., and several others), in which complication rates post operative are similar, and in some cases better, than those series reporting on up front surgical intervention.

I...

I agree with all of the above. Local recurrence in the prostate alone occurs, but is uncommon. In addition, I tell them that patients rarely die from local disease in the prostate. They die from distant disease which is equal with both forms of treatment. Furthermore, in addition to other local ther...

I would largely agree with the question in this regard.

This matter, operability post pelvic/prostate radiotherapy, was more of a problem for conversation when we used low energy pelvic treatments via cobalt and 4MV photon delivery machines, for examples. Tons of scarring, including intestinal and b...